Blog of the Society for Menstrual Cycle Research

Estrogen is the New Ritalin. NOT.

May 10th, 2010 by Elizabeth Kissling

Guest Post by Barbara Sommer, University of California-Davis

Ritalin bottle with tabletsWhy is it that assertions about hormones and behavior lead us to readily suspend our capacity for critical thought? It seems like folks will accept just about any assertion with regard to the power of estrogen and the fluctuation of the menstrual cycle.

My observations over several decades (I am nearly forty years post-doctorate) have been reassuring. I have not seen women crushed in the working and professional worlds by the demands of their physiology. In fact it looks like women might be moving towards running the world, at least in those areas where they have access to education. Nevertheless, it rankles when a journal of some credibility makes assertions based on scanty evidence.

It is difficult to evaluate the quality of the research underlying the claims of the article “Is Estrogen The New Ritalin?” in the current issue of Scientific American: Mind. The title is cute. A writer for the New Yorker recently claimed that “White is the New Black.” Do we believe it? The article was provocative, and did not pretend to be a scientific piece of work. In contrast, the estrogen piece, by appearing under the prestigious banner of the Scientific American, carries an imprint of scientific credibility. The first paragraph claims the menstrual cycle might affect the brain as much as caffeine, methamphetamines, and Ritalin. Nowhere in the study is there any indication that estrogen levels or even menstrual fluctuation effects were actually compared with the above substances. The author also claims that this study is “the first to show that cognition is tied to estrogen levels in people” – perhaps the first because no one else has done a good job of it, but certainly not for a failing to try. There are many published studies claiming that estrogen affects cognitive function.

The central problem with this report is that the scientific community has not vetted the research. There is nothing to suggest that it was subject to review. It has not been published – at least nowhere that could be found by this writer with access to a university library. I don’t expect a popular version of scientific research to include information about whether there were adequate controls for subject selection, for practice effects on the task performance, or that the claim of population dopamine levels was accurate, and whatever measure was used to estimate estrogen levels was reliable. But someone needs to have looked at those aspects of the research. Without that, we end up with questionable conclusions at best, and junk science at worst.

Post to Twitter Post to Plurk Post to Yahoo Buzz Post to Delicious Post to Digg Post to Facebook Post to MySpace Post to Reddit Post to StumbleUpon

Tags: , , , , ,
Posted in anatomy, magazines, Menstruation, New Research, Pharmaceutical | Comments Off

Neurology and steroid hormones – where is progesterone in this discussion?

April 23rd, 2010 by Chris Hitchcock

Recently the New York Times published a long article entitled the Estrogen Dilemma. It’s an article rich with many issues, and previous blogs have critiqued its uncritical acceptance of the timing hypothesis, and its failure to distinguish between the transient symptoms of perimenopause, early menopause, and the rest of your long, healthy, post-menopausal life.

But it is quite remarkable to me that, when speculating about potential hormonal treatment for poor memory and issues of staying on task, the only steroid hormone that seemed to be on anyone’s radar was estrogen. The writer had a lot of space (7600 words) and gave the scientist a lot of freedom to speculate, so I’m guessing that the absence of progesterone in the article is a true representation of her conceptual blind-spot. Progesterone was mentioned a few times, in the context of protection from uterine cancer, and in the context of using MPA (a synthetic relative) as a possible scapegoat in interpreting the WHI randomized hormone therapy trial data. But never did I see any suggestion that progesterone might be anything other than a necessary evil.

In fact, there are some intriguing new research areas that look at progesterone as therapy in neurological domains.

So, in a free-wheeling article about how scientists are exploring possibilities, it’s interesting that the possibilities seem to be limited by a cultural bias towards estrogen.

Post to Twitter Post to Plurk Post to Yahoo Buzz Post to Delicious Post to Digg Post to Facebook Post to MySpace Post to Reddit Post to StumbleUpon

Tags: , , , ,
Posted in Menopause, Menstruation, New Research, Newspapers | Comments Off

The Great Perimenopause Cover-Up

April 19th, 2010 by Elizabeth Kissling

Guest Post by Jerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research

I just read “The Estrogen Dilemma” in Sunday’s New York Times Magazine,  and I feel like weeping—in sorrow and deep sadness. This article by Cynthia Gorney is about energetic, intelligent women who feel they must take estrogen in order to survive perimenopause yet have deep worries about its risks. I know personally the anguishing changes that erupt during perimenopause. “The Estrogen Dilemma” also evoked my frustration and even rage. It is wrong that symptomatic women in the midst of the long and stormy midlife transition have to face a conundrum—to take estrogen or not. It arises from a Nixonian-style cover-up of three proven and important-for-women truths: 1)    Perimenopause causes higher and not lower estrogen levels. (By perimenopause I mean the transition from fertile menstrual cycles to menopause, or the life phase beginning one year beyond the final menstrual flow.) 2)    Progesterone, estrogen’s essential partner hormone, in contrast to estrogen, truly is lower in perimenopause. 3)    Women survive perimenopause and “graduate” into a less symptomatic menopause.

Are estrogen levels low in perimenopause? No. Taking all perimenopausal women together (a meta-analysis of published levels comparing within-center young with perimenopausal women) estrogen levels are 26 percent higher (1). For symptomatic perimenopausal women like Cynthia Gormley and myself, estrogen swings to Everest-like peaks and may intermittently be a 1000-fold greater. Perimenopause, for some of us, is estrogen’s storm season (2).

Despite that, ever since estrogen was first discovered in 1926, anything ailing women has been deemed “estrogen deficiency.” And often inappropriately so treated. Thus, estrogen levels must be dropping and low in perimenopause when women become symptomatic—it makes sense because we know that perimenopausal women are running out of their store of ovarian follicles that, after all, make estrogen. That perimenopause-dropping-estrogen idea fits with the fact that perimenopausal women begin to have night sweats. But it doesn’t fit with the reality that night sweats begin while women are still having regular menstrual cycles (3) and thus still have adequate estrogen levels (but the misunderstanding of what causes hot flushes is yet another story).

The evidence that perimenopausal estrogen levels are higher than in the sexiest 20-something is strong and consistent (1;4-9). Why are media articles, consensus documents and authorized definitions still talking about dropping estrogen levels? A cover-up. The first clear evidence for higher estrogen was published from a Melbourne epidemiology study in 1995 (10). The back-story here is telling—the authors measured estrogen levels that were variable but at least a quarter of them were much higher than expected. However, their interpretation was that estrogen levels were dropping. That’s because levels in the 45-55 year old women with regular cycles (whom they wrongly called premenopausal) were higher than in those who’d been without flow for three to 12 months (10). That illustrates the power of what I call “the estrogen myth.” I, who at the time was suffering with puzzling sore breasts, heavy but regular flow and mood swings, was ecstatic to see data that explained my experiences. However, I was horrified at the erroneous interpretation—my colleagues and I wrote an impassioned letter to the editor demanding that the authors “let the data speak” (11).

Now to the second cover-up—lower perimenopausal progesterone. If this were a world where women’s health was guided by science rather than by power-over-women, we would all know that perimenopause, besides being a time of higher estrogen, is a life phase in which progesterone is too low. You ask, “Why are lower progesterone levels important? I thought it causes PMS and breast cancer.” This ignoring or blaming of progesterone is the second major cover-up, and not just for 15 years, but since estrogen’s discovery in the 1920s. Framing women’s reproduction only in terms of estrogen creates the postulate that “Estrogen’s what makes a girl, a girl.” The estrogen myth further asserts that estrogen is the female hormone, much as testosterone is the only important male hormone.  Continue reading...

Tags: , , , , , ,
Posted in Menopause, New Research, Newspapers, Pharmaceutical | 2 Comments »

Time and Time Again

April 18th, 2010 by Elizabeth Kissling

Guest Post by Paula S. Derry, Ph.D.

Déjà vu

An article in today’s New York Times Magazine recounts the author’s experience with a debilitating depression that began during her perimenopause, the transitional time leading up to menopause.   For her, prescription estrogen was a life-saver that alleviated her symptoms.  The article places her experience in the context of research on the Timing Hypothesis, an idea that arose after the Women’s Health Initiative, or WHI, research project.  WHI clinical trials documented that hormone supplements after menopause did not, as had previously been assumed, lower a woman’s risk of heart disease.  Heart disease risk was not lower, and, in fact, when a number of chronic illnesses were considered together, the medication did more harm than good overall.  The Timing Hypothesis is the idea that the WHI was fundamentally flawed, because hormones must be started right around the time of menopause to have a health-promoting effect and the subjects in WHI were on average over 60; if started when a woman is older, when chronic illnesses have already started, the hormones are actually harmful rather than helpful.  The Sunday New York Times article presents this idea uncritically, without quoting any of the many experts who do not find it plausible or convincing, and, in addition, presents a lurid, unscientific  description of perimenopausal hormonal dynamics with words like “ricocheting hormones” and an “upheaval” that causes a “hellacious strain” on the brain. The author suggests that WHI was  a poorly planned study that asked the wrong questions with the wrong methodology.  The Timing Hypothesis, if true, might lead to a cure for Alzheimers and have other important health repercussions.


Time for a reality check.

Let’s go back in time to before the WHI research. Beginning in the 1980s, professionals asserted that hormone therapies were safe and effective to prevent chronic illnesses, especially heart disease, in postmenopausal women.   This idea was aggressively promoted, and it was not limited to women around the time of menopause.  Clinical trials are required to prove that a new medication is safe and effective before the Food and Drug Administration will approve that medication. However, once approved and available on the market, it is okay for doctors to use their judgment and prescribe the drug for whatever use they believe is reasonable.  Many of the claims for estrogen were for this kind of off-label use because there was no clinical trial proof that estrogens reduced heart disease, made women “feel better,” or improved their lives in many other ways being claimed.  However, other kinds of evidence made it seem plausible. There were “biologically plausible” mechanisms–this means that because of things we know about the body–like the fact that there are estrogen receptors in the brain–it is plausible, we can hypothesize a way that  estrogen would have a certain health effect.  There were the personal experiences of women. There was the idea that menopause was intrinsically unhealthy and that women were not meant to “outlive their ovaries.” Using estrogens was compared by some to using vitamin supplements or to a diabetic using insulin. There was a strong conviction among certain enthusiastic scientists and practitioners, some of them highly respected individuals, that it was all so. Professional groups of various sorts frequently issue opinions about medications; here, many groups offered the opinion that all women be offered hormone treatment.  Physicians were encouraged to prescribe hormones for disease prevention because it was so certain that it would help their patients, rather than waiting for the slow process of clinical trials to take place. Wyeth, a pharmaceutical company,  asked the FDA to approve estrogen for heart disease prevention even without clinical trials.  Continue reading...

Tags: , , , , , , , , ,
Posted in Menopause, New Research, Newspapers, Pharmaceutical | 1 Comment »

Menstruation, Menopause, and HIV

March 1st, 2010 by Elizabeth Kissling

Menopausal women seeking relief from hot flash in front of electric fan.

POZ magazine and poz.com claim to be the leading publication and website in the U.S. about HIV/AIDS. The March 2010 issue has a great article by Suzanne Bopp about menstruation, menopause, and HIV. As with medical and cultural knowledge about HIV itself, understanding of how HIV affects menstruation continues to evolve. Irregular menstruation is a common complaint of women with HIV, but

“[Today] we have a better grasp of factors associated with abnormal menstrual cycles: substance abuse, AIDS, wasting disease—it relates more to overall nutritional status,” says Kristine Patterson, MD, clinical assistant professor at the University of North Carolina School of Medicine in Chapel Hill. “If the body doesn’t have enough fat, production of estrogen and progesterone shuts down,” Patterson says. This can happen anytime a woman loses too much weight, and it is exacerbated by advanced HIV disease, which causes the body to burn calories more rapidly.

. . . .

Researchers do know, however, that female hormones affect the virus—and that sex hormones generally have an impact on immunity. “We know that where a premenopausal woman is in her menstrual cycle affects her infectiousness,” Patterson says. “Estrogen plays a role—not only in HIV and the interplay of HIV and meds, but also in [the likelihood of] women transmitting and acquiring HIV.” Estrogen’s role may explain why women progress to AIDS at lower viral loads than men.

Highly recommended. Read the whole thing.


Post to Twitter Post to Plurk Post to Yahoo Buzz Post to Delicious Post to Digg Post to Facebook Post to MySpace Post to Reddit Post to StumbleUpon

Tags: , , , , , ,
Posted in Health Care, Menopause, Menstruation, New Research, Sex | Comments Off

Selling Shoes for Running while Cycling

February 16th, 2010 by Elizabeth Kissling

Asics gender-specific running shoeAsics footwear has developed a new running shoe that accommodates changes in women’s arches across the menstrual cycle.  According to the Daily Mail, new research shows that changes in levels of estrogen affect flexibility and the height of the foot’s arch. When estrogen is high, and a woman is at her most fertile, the arch drops. Later in the month, when she is menstruating, levels of the hormone are low and the arch is raised.

So the athletic shoe manufacturer has created a new model of running shoe with with three layers of cushioning below the arch.  Closest to the foot is a layer of foam, followed by an air-filled gap and a plastic block. When the woman’s arch is low, the foam is compressed into the gap and when her arch is high the foam fills out. This supposedly assures adequate support throughout the menstrual cycle.

Neither the Daily Mail article nor Asics clarify what causes men’s arches to fluctuate; a quick search-and-surf through Asics website shows the Space Trusstic System® is available in both women’s and men’s models of shoes.


[via Glad Rags]

Post to Twitter Post to Plurk Post to Yahoo Buzz Post to Delicious Post to Digg Post to Facebook Post to MySpace Post to Reddit Post to StumbleUpon

Tags: , , ,
Posted in Advertising, anatomy, Menstruation, Objects | Comments Off

Early menarche, late menopause and breast cancer – what’s the whole story?

December 10th, 2009 by Laura Wershler
Mammograms showing healthy (left) and (right) cancerous breast. Courtesy of the National Cancer Institute.

Mammograms showing healthy (left) and (right) cancerous breast. Courtesy of the National Cancer Institute.

Can having too many menstrual cycles give you breast cancer?  That’s what one might conclude from two unrelated articles that appeared in national newspapers this week.

First was Nicholas D. Kristof’s Op-Ed in the New York Times. Kristof had recently attended a symposium exploring whether certain common chemicals are linked to breast cancer and other ailments. The role of estrogen – both the real thing our bodies produce and the pseudo-estrogens – in breast cancer was his major example.

The real thing:

One theory starts with the well-known fact that women with more lifetime menstrual cycles are at greater risk for breast cancer, because they’re exposed to more estrogen. For example, a woman who began menstruating before 12 has a 30 percent greater risk of breast cancer than one who began at 15 or later.

The pseudo-estrogens:

One class of chemicals that creates concern — although the evidence is not definitive — is endocrine disruptors, which are often similar to estrogen and may fool the body into setting off hormonal changes. This used to be a fringe theory, but it is now being treated with great seriousness by the Endocrine Society the professional association of hormone specialists in the United States. …These endocrine disruptors are found in everything from certain plastics to various cosmetics.

(Do you ever wonder, like I do, why the birth control pill is not considered an ‘endocrine disruptor’ when that is exactly what it is?)

The second mention of the connection between too many periods and breast cancer came in dietician Leslie Beck’s Food For Thought column in Canada’s Globe and Mail. She was reporting on a new study showing that women with breast cancer need not shun soy:

By acting like weak forms of the body’s own estrogen, some experts have worried that soy isoflavones could possibly promote cancer growth.  That’s because certain risk factors for breast cancer, such as beginning your menstrual period before age 12 or starting menopause after 55, are related to the length of time breast cells are exposed to the body’s own circulating estrogen. It’s thought that estrogen can promote the growth of breast cancer cells.

It’s reasonable to think that the both the writers and readers of these articles (and the many more that have surely mentioned this connection) might assume from this information that too many menstrual cycles means too much estrogen, therefore too many menstrual cycles must be a bad thing.  What they don’t know is that not all menstrual cycles are created equal. It’s not necessarily about quantity, it’s about quality.

Common belief is that all menstrual cycles are ovulatory. (Unless, of course, you are using a hormonal birth control method that suppress ovulation like the pill, patch or ring.) In other words, the assumption is that if get your period you must have ovulated. This assumption is challenged by UBC endocrinolgist Jerilynn Prior, MD, and Scientific Director of the Centre for Menstual Cycle and Ovulation Research (CeMCOR). In her article Is Ovulation (and are normal Progesterone levels) Important for the Health of Women?, Dr. Prior has this to say about the connection between ovulation, menstruation and breast cancer:  Continue reading...

Tags: , , , , , ,
Posted in Birth Control, Health Care, Media, Menarche, Menopause, Menstruation, Newspapers, ovulation | Comments Off

Hot Flushes Relief Needn’t Enter the Bio-Identicals Fray

November 5th, 2009 by Elizabeth Kissling

Guest Post by Jerilynn Prior, Centre for Menstrual Cycle and Ovulation Research

pharmacy_clipAs a clinician scientist with expertise in hormones and women’s health, I sit in Canada and look at the hype and dis-sing going on about “bio-identicals” in the USA and shake my head. If we don’t want estrogen that is not FDA approved to be used to treat hot flushes, the simple answer is to regulate appropriately. The perpetual debate about bio-identical hormones has now hit USA Today with a headline: “Bioidenticals: Estrogen without FDA approval for menopause?”

In Canada, all hormonal preparations require a prescription. Full stop.  And the pharmacists who compound estriol or progesterone do so with my prescription for a specific dose and clear purpose. Those compounding pharmacists are also regulated the same way as pharmacists who dispense FDA/Health Canada approved medications. End of story.

What bothers me is that I believe there is an intrinsic advantage to  hormones that are molecularly the same as our bodies produce. They are certainly better, a priori than those that are natural for horses or are “similar-but-different.” When oral micronized progesterone (molecularly identical, Prometrium®) is prescribed with estradiol (there are multiple FDA-approved brands of molecularly identical estrogen), there is no increased breast cancer risk.[1] On the other hand, medroxyprogesterone (a similar synthetic derivative of progesterone) with estradiol increases the risk for breast cancer by 79%.[1] That’s called a nasty surprise.

When a hormone treatment is the same as a native hormone we know exactly how it will act, be metabolized, and be excreted. We can learn, if we don’t know, how it interacts with other important factors like age, weight, kidney function, and in relationship to heart disease or breast cancer. So the fact that Wyeth “suggested” that the FDA take compounding and bio-identical hormones to task for false advertising, was simply an effort to regain market share in a legal drug war. They were reeling from the negative results of the Women’s Health Initiative. That’s why they also planned, wrote and published monthly Premarin-positive or estrogen-positive editorials and reviews in house at Wyeth and had them ghost authored by prominent scientists. A turf war.

As a physician, I believe the best treatment for severe vaginal dryness causing repeated bladder infections in older menopausal women is vaginal estriol in a dose of 0.5 mg twice a week.[2] However, there is no FDA/Health Canada approved estriol product. It’s just not available. So, I can prescribe that estriol—the weakest of the three estrogens our bodies make—and a local compounding pharmacist will make it for my patient. And that is a dose and kind of estrogen hormone that doesn’t cause a risk for endometrial (uterine lining) overgrowth or cancer as Premarin cream can (especially if delivered with that ridiculous vaginal applicator and in the doses that are commonly recommended).

What makes me feel both sad and angry is that this bio-identical “tempest in a teapot” (as my grandmother would say) is ignoring the distress of women with severe hot flushes. They are the reason for the popularity of compounded hormones, of the “experts” like Suzanne Somers and those who publicize and back her exuberant and likely imprudent self-medication. I have been cheering since Dr. Leonetti showed that 20 mg twice a day of progesterone cream significantly improved hot flushes.[3] If compounded hormones are evidence-based, as estriol and progesterone cream are for the conditions mentioned, who would fault women for wanting them? Especially when there is sufficient reason to doubt the hormone promises of Big Pharma?  Continue reading...

Tags: , , , ,
Posted in Menopause, New Research, Pharmaceutical | 1 Comment »

Newer Entries »
Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.