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Estrogen is the key hormone responsible for the transition from childhood to womanhood. It causes the breasts to develop and produces our characteristic feminine shape. It also causes the lining of the womb (uterus) to thicken each month in anticipation of receiving a fertilized egg.
Symptoms associated with menopause such as hot flashes, night sweats, etc can all start well before your periods stop. As you get nearer to menopause, ovulation (when an egg is released) becomes less likely each month because estrogen levels are beginning to decline. However, as they will still have a period most women won't know they have not ovulated.
At actual menopause, when you have your last period, you have literally run out of eggs. You start off with a certain amount of eggs from birth but over the years they are used up and die off.
Contrary to popular opinion, the menopausal ovary is not a dead or dying organ. It continues to produce estrogen, although in smaller quantities, for at least 12 years after the start of menopause. (The start is considered to be the moment when hormone production begins to decline.) In addition, the adrenal glands (which sit on top of the kidneys) produce estrogen, which is used alongside the ovaries' diminishing supply. Body fat is also a manufacturing plant for estrogen. Fat produces estrogen all our liveswhich is why low- or no-fat diets, so often recommended for dieters, can be a big mistake for women.
As women, we need estrogentoprotect our bones and heart. Nature is always trying to maintain a balance because there are problems if estrogen levels are either too low or too high. If we don't have enough our bones and heart are not protected, and if we have too much we risk breast cancer.
Because body fat is a manufacturing plant for estrogen, if you are overweight your estrogen levels will be higher than normal. It is fine to become slightly heavier at menopause since this extra estrogen from the fat cells balances the estrogen decline from the ovaries. However, being very overweight brings with it excess estrogen levels, which can mean increased risks of breast and uterine cancer. Both breast and uterine cancer are estrogen-sensitive, meaning that estrogen can stimulate cancer cells and can actually grow in the presence of this hormone. Estrogen's role in the body is as a `builder', helping to build the lining of the uterus in the first half of the menstrual cycle. If this `building' mechanism goes out of control, then increased cell growth could lead to an estrogen-dependent tumor and sometimes cancer.
Other conditions that are affected by high estrogen levels include endometriosis (when the lining of the uterus grows in places other than just the uterus), fibroids (benign tumors in the uterus), heavy and/or long periods and fibrocystic breast disease (lumpy and tender breasts). Eating healthy foods, such as the recipes in this book, will help to control your weight naturally without having to diet, which doesn't work anyway.
`GOOD' AND `BAD' ESTROGENS
There are `good' and `bad' estrogens, in terms of whether they are carcinogenic or not. Estrogen is not one hormone but several grouped together, including estradiol, estrone and estriol. All three estrogens have the same beneficial effects on our skin and vagina and protect the heart and bones. The estrogens vary in strength: estradiol is 80 times more potent than estriol and estrone is 12 times stronger than estriol. It is the liver's job to convert estradiol (the more carcinogenic estrogen) first into estrone (less carcinogenic) and then into estriol (which is non-carcinogenic), so it is especially important that your liver is working efficiently as you get older.
Each estrogen is active at different stages of our reproductive lives. Estradiol is very active during our adolescent years, but as menopause approaches production of it declines. Around this time the adrenal glands and estrogen-producing fat cells are producing estrone instead.
THE ESTROGEN IN HRT
If you decide to take HRT, you are adding back estrogen in its most carcinogenic form (estradiol) precisely at the time when your body is naturally reducing its supply of estradiol. You are therefore asking a lot of your liver to convert this more carcinogenic estrogen into harmless estriol and to excrete it from your system.
Estrogen therapy has existed since the 1930s when it was given in the form of an injection. By 1938 estrogen implants were introduced, which were more convenient. However, it soon became clear that supplying estrogen alone could increase the risk of cancer of the uterus and breasts. When research studies demonstrated that this increased risk could be up to seven times higher than normal for uterine cancer, there was panic. As mentioned above, estrogen builds up the lining of the uterus ready to receive a fertilized egg, so logically, if estrogen is added on its own without the uterine lining being shed each month, there is a real chance of overproduction of the cells lining the uterus and of possible mutation. So in the early 1980s scientists added progestogen (the synthetic version of progesterone) to the hormone therapy in order to protect the uterine lining from overstimulation and subsequent cancer. And so ERT (`Estrogen Replacement Therapy') became HRT, as it no longer contained estrogen only.
There still remains the risk of uterine cancer even with combined HRT (estrogen and progestogen) but it is less than with pure estrogen therapy. The risks of developing breast cancer from taking HRT are now well known and were confirmed in a study in The Lancet in 1997. Researchers looked at the results from 51 studies around the world (the most extensive research on breast cancer and HRT ever) and found that after 11 years on HRT there was a 35 percent chance of developing breast cancer.
Due to the links made between HRT and cancer, research is under way into the possibility of creating a much more targeted drug that would stimulate certain estrogen receptors but avoid any detrimental effect on the breasts and uterus. The drug would function as an estrogen promoter in organs where estrogen is needed and beneficial (eg the heart and bones) while acting as an `anti-estrogen' in organs where unnecessary estrogen can be dangerous (eg the breast and uterus) . This new generation of HRT is called SERMS (Selective Estrogen Receptor Modulators). The relatively new drug raloxifene is one of these, but its full potential is still being examined. Possible side effects include increased clots and even an increase in hot flashes! So it is unfortunately useless in the treatment of hot flashes or hot sweats; instead it is aimed at those women who want protection for their bones without running the risk of breast cancer. As yet, therefore, we must continue waiting for the ultimate designer drug for menopause.
LIVING IN A `SEA OF HORMONES'
We are also exposed to estrogens from the environment. There are estrogen-like chemicals from pesticides or plastics called xenoestrogens ('foreign estrogens') which have been linked to changes in wildlife. Just how potent these xenoestrogens are was discovered by a group of scientists who found that alligators which had hatched in Lake Apopka, Florida had abnormally small penises and altered hormonal levels. They linked the findings with the fact that in 1980 there had been a massive spill of kelthane, a pesticide, into the lake. The xenoestrogens from the pesticide were feminizing the alligators.
Xenoestrogens enter the body through food and drink but can also enter our skin from toiletries such as skin creams. These xenoestrogens are stored in body fat, with overweight people tending to have a higher concentration because xenoestrogens are lipophilicfat-loving. Xenoestrogens can affect men and women differently. Women with higher concentrations of certain organo-chlorine pesticides in their bodies run a greater risk of developing breast cancer than women with lower levels. Girls in the West are now entering puberty earlier than they did in past generations, which may be partly due to the influence of xenoestrogens. At the turn of the century the average age was 15; nowadays some girls as young as eight are growing breasts and pubic hair.
As for men, there are concerns that xenoestrogens are responsible for the decrease in sperm counts by 50 percent in the West over the last ten years. There has also been a rise in testicular and prostate cancer, and even breast cancer. More young boys are now born with undescended testes and other reproductive problems.
How can you reduce levels of xenoestrogens?
The food industry has become reliant on pesticides; some fruit and vegetables are sprayed as many as ten times before they reach the supermarket shelves.
To reduce your own intake of xenoestrogens, where possible, try to buy organic produce. With concern over BSE and genetically modified food (see page 41) there is increasing public demand for organic foods, which is bringing prices down. Organic foods are generally free of genetically modified ingredients, antibiotics and growth hormones and should contain higher amounts of vitamins and mineralsparticularly vital micronutrients like zinc as they are grown on more nutrient-rich soil.
You may know of a local farmer who grows vegetables, or there may be local companies which could deliver a box of organic produce to your home every week. Otherwise most supermarkets have an excellent range of organic produce. If you are on a tight budget, try at least to buy organic grains such as brown rice, oats etc or organic whole-wheat bread. This is because the smaller the food, such as rice or wheat, the more pesticides it can absorb as compared with a carrot for example.
If your vegetables and fruit are not organic, wash them thoroughly. You can buy a wash (like Veggi Wash) from health food shops which claims to be able to remove farm chemicals, waxes and surface grime. Washing cannot alter the amount of pesticides inherently absorbed into the vegetables but it can at least take away surface residues.
It is not only pesticides but also plastics that can mimic estrogen, so you should try to reduce your exposure to plastics. One scientist in the USA was studying breast cancer cells and stored them in plastic test tubes. Then one day these cancer cells started to divide and multiply of their own accord, just as if estrogen were present. On analysis of the tubes it was found that they contained nonylphenol, which is one of the family of alkylphenols which are used in paints, toiletries, agricultural chemicals and detergents. As soon as they changed the tubes, the effect stopped.
Try to avoid as much as possible food and drinks in plastic containers or wrapped in plastic, especially fatty foods, because the xenoestrogens are lipophilic. Remove food from plastic packaging as soon as possible. Do not heat food in plastic, particularly in a microwave oven. Store your food in the fridge in a glass dish covered with a glass lid or saucer rather than plastic wrap.
WHERE CAN YOU GET BENEFICIAL
Naturally, all of us want the beneficial effects of estrogen soft skin, strong bones, a healthy heart, etcwithout running the risk of developing cancer from taking steroid hormones (which is, after all, what HRT is). Even better, we would like to receive the cancer-protection effects of estrogen. Marvellously, it is possible to do this, just by eating!
Sounds too simple to be true? Well, it really is simple. The `good' estrogens that we require are phytoestrogens, or plant hormones, and they naturally occur in certain foods. By maintaining a healthy diet of phytoestrogen-rich foods, we can mirror what women in traditional cultures such as India and Japan have been doing for centuries and, like them, enjoy strong bones, healthy hearts and minimal menopausal symptoms. The next section explains how this is possible.