Hormone Replacement, Contraceptive Medications, and Other Hormonal Therapies

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Current approaches with contraception and hormone replacement after menopausal deficiency utilize low doses of a group of synthetic hormones called progestins, with assurances that these synthetic hormones do not have the relatively severe risks associated that the previous class of synthetic hormone therapies were proven to have. Progestins are the most frequently used form of synthetic progesterone-like chemicals, now in the form of Levonorgestrel and its mirror image Norgestrel, used in the OrthoEvra contraceptive patch, the DepoProvera injection, the Mirena IUD, the OrthoEvra vaginal ring, and most contraceptive and post-menopausal therapeutic drugs. Norplant was an early form of easy use progestin contraceptive that was discontinued due to numerous lawsuits claiming severe side effects of pain, weight gain, depression/anxiety disorder, etc. In 2011, a study by the University of Washington, published in the prestigious Lancet Infectious Diseases medical journal, found that use of the injected progestin contraceptive in Africa had increased the rate of incidence of acquiring an HIV infection by nearly two-fold, and the rate of passing the HIV to a partner by nearly 40 percent. This large study indicated that injected progestin contraception, such as Depo-Provera, had a significantly negative effect on the immune system, a consequence rarely discussed with patients. Even in the industry trials of Levonorgestrel, common adverse side effects included irregular menstrual bleeding, increased or decreased menstrual bleeding, headaches, and nausea, and the International Federation of Gynecology and Obstetrics stated that the primary mechanism of action of Levonorgestrel is the inhibition of ovulation and hyperplasia of the cervix, often leading to anovulation that is not easily reversed when stopping the unopposed progestin. In clinical trials an oral intake of 1.5 mg caused adverse effects in more than 10 percent of patients chosen of delay of menstruation, heavy menstruation, abnormal uterine bleeding, fatigue, dizziness and lower abdominal pain. Levonorgestrel was created and is used as a "morning after pill" contraceptive, and is now FDA approved as a Plan B One-Step medicine sold without a prescription to women of all ages. While progestins are an effective birth control method, risk versus benefit and adverse effects are rarely discussed realistically, and options for subsets of patients, and consideraton of patient needs and desires, are often ignored or discouraged in a one-size-fits-all approach.

Acknowledging common adverse health effects and consequences of long-term use of synthetic steroid hormones should be part of the prescription, and discussion of realistic treatment protocols to counter or decrease these adverse effects, euphemistically still called "side effects" needs to be part of a patient-centered approach going forward. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) present a large array of treatment protocols that fit into an holistic scheme, and are increasingly proven in sceintific studies and human clinical trials to work well to correct the adverse effects of these synthetic hormone medicines. Preventive treatment is most effective, but treatment of the symptoms themselves is most common.

On July 9, 2002, the National Institute of Health announced that it had halted a major study of synthetic progestin estrogen combination drugs because concerns of high risks concerning invasive breast cancer, blood clots and cardiovascular disease precluded safety of the taking of these drugs in study! The NIH also found that a one year use of synthetic progestin estrogen combination increased an otherwise healthy woman's risk of heart attack by 29 percent, incidence of blood clots doubled, strokes increased by 42 percent, and breast cancer incidence increased by 29 percent.

On May 30, 2003, further reports published in the Journal of the American Medical Association showed added risks of developing neurodegenerative conditions such as dementia, with a 105 percent increase in risk, as well as a 33 percent increase in hip fracture incidence, 37 percent increase in colon cancer incidence, and 111 percent increase in the risk of blood clots. A large multicenter study of the newer types of progestin plus estradiol was initiated by the FDA and this report was released in 2011, showing a 55-74 percent relative increase in the incidence of both arterial and veinous thromboses and embolisms with the use of the newer forms of oral contraceptive tablet, injection, and vaginal ring (see the study results in more detail below). The Canadian Health Services issued a review of scientific studies in 2011 that associated a 1.5-3.0 increased chance of blood clot or embolism from the drospirenone-containing oral contraceptives. The U.S. CDC (Centers for Disease Control and Prevention) lists a 5 year use of contraceptive synthetic hormones as one of the most significant risks for acquiring cervical cancer, most of which is associated with a viral infection. This is now a long list of concerns.

Also in 2011, a selective study of the broad Women's Health Initiative study sponsored by the National Institutes of Health, was published in the Journal of the American Medical Association, asserting that data from this large study indicated that for a select group of patients, those that had undergone hysterectomy (surgical removal of the uterus), hormone replacement therapy using unopposed estrogen had resulted in decreased cardiovascular and cancer risks. Most of the women in the WHI study had been taking a combination of synthetic estrogen with progestins. A specific group had been given unopposed estrogen. Follow-up study by the WHI found that those women who had been taking unopposed estrogen after a hysterectomy had a 23 percent lower incidence of breast cancer, instead of the markedly higher incidence of breast cancer in the group taking a combination of progestins and estrogens. The point that was not emphasized in the JAMA article, though, was that these women had been prescribed estrone, a natural bioidentical type of estrogen derived from the urine of pregnant horses (e.g. Premarin). The continuing failure to distinguish bioidentical steroid hormones from synthetic hormone mimics or receptor agonists lies at the heart of the problem.

Estrone is one of three known types of human estrogen, and differs in effect from estradiol, or estriol. Estrone primarily provides a precursor bioavailability to local production of estradiol. Estradiol sulphate, and other synthetic estradiols commonly used in hormone therapies did not produce a decrease in breast cancer risk in this group of post-hysterectomy patients. While a number of studies over the years have demonstrated that estrone presents less risk in hormone replacement than synthetic estradiol, there still persists an economic need to promote the more profitable prescription of synthetic estradiols, and combinations of synthetic estradiols and progestins, and now synthetic estradiol with testosterone and progestins. News articles and journal headlines concerning this study inaccurately give the impression that the study results imply that perhaps a combination of progestins and synthetic estradiol may not increase risk of cardiovascular disease and cancer. Why we persist in this large effort to complicate the issue and confuse women, rather than simply move on to better and safer hormonal therapies when possible, is the question that a lot of female patients, and a growing number of medical doctors, are now asking.

This WHI study also revealed that this subset of women, namely those that received a hysterectomy in their 50s and were placed on estrone (not synthetic estradiol) therapy, had no increased incidence or risk of cardiovascular disease, hip fracture, colon cancer, or premature death. The study did reveal, though, that women placed on unopposed estrogen therapy, or continued with unopposed estrogens later in life did have a markedly higher incidence risk in these categories. Experts at the Women's Health Initiative (WHI), such as Dr. JoAnn Manson, of the Brigham and Womens Hospital in Boston, stated that these findings did not mean that more women should be placed on unopposed estrogen earlier in life, but that instead, these findings should be used to explore why breast cancer risks were decreased with the use of estrone (not synthetic estradiol) at this age. The medical extrapolations associated with this new evidence did not reflect the details of this study, but like so many examples of evidence-based practice today, merely changed clinical guidelines based on a short summary of the WHI study.

The response to this assessment in gynecology was a push for the use of 'unopposed estradiol' in the form of etonogestrel plus ethinyl estradiol in the NuvaRing and subdermal implant as the preferred contraceptive for premenopausal women. These now popularly prescribed hormonal contraceptives are not actually unopposed estradiol, though, but a combination of the third generation of progestins plus synthethic estradiol. An obvious assumption would be that the synthetic estradiol and progestins exerted significant risks of cancers, cardiovascular disease, and osteoporosis, for all women, while the use of natural estrogens did not, but the medical field obstinately failed to distinguish the details of this scientific evidence. Of course, there is no current practice of the use of bioidentical hormone therapies for contraception. Once again, the wording of the study summaries, not distinguishing between synthetic estrogens and natural estrogens, results in a failure to grasp the consequences and risks. This array of confusing and often seemingly contradictory evidence and advice has served to put off women to gaining a real understanding of this subject of significant risk and harm from synthetic hormone replacement and contraception. Some understanding of the steroid hormones in our bodies is necessary to fully grasp the fundamental facts concerning healthy hormonal balance and the ramifications of altering this balance. Without a basic understanding, an intelligent proactive participation in decisions regarding hormonal therapies, either contraceptive, post-hysterectomy, or post-menopausal, is difficult for the patient.

The development of a combination esterified synthetic estradiol with synthetic testosterone ester (undecanoate) presents new challenges as well for the postmenopausal woman. While such new medicines represent little change from past medications in hormonal replacement, they are frequently touted as new developments that are safer and more "natural". A 2012 study at the Karolinksa Institute, in Stockholm, Sweden, evaluated this new approach and concluded: "The addition of testosterone undecanoate improved specific aspects of sexual function (enjoyment, activity and libido) more than treatment with estrogen alone. Improvements in well-being and self-esteem were similar for both treatments. If testosterone undecanoate 40 mg daily should be used for clinical treatment, regular monitoring of androgen serum levels is needed (as excess, or supraphysiological levels of testosterone were seen in a signficant percentage of the women in the study after 24 weeks)". (PMID: 12626215). Thus, the use of esterified (adding a carbonyl group to interact with lipids better) synthetic estradiol in combination with esterified testosterone may be an improvement from prior hormone replacement, but not a significant one, with the same health warnings as discussed above for synthetic estradiol and progestins, as progestins are still prescribed with this new hormonal combination. How significant the return of sexual function is with the use of synthetic testosterone is yet to be determined. The widespread promotion and use of synthetic or semi-synthetic testosterone for men in aging has produced a very significant percentage of men trying these treatments for "Low T" reporting adverse hormonal and neurohormonal effects that are somewhat alarming.

The increasing evidence of adverse health effects from synthetic hormone therapies in menopausal hormone replacement as well as hormonal contraceptives has become alarming in the last decade or two. There is very little effort on the part of standard medicine to give up this strategy, though, and instead we see a very stubborn insistence on its widespread use. The amount of such prescription has become so large that alarm has occurred even in the effects of these pharmaceuticals in wastewater and the environment, with numerous studies now documenting endocrine disruption in wildlife, such as fish, and fears that low levels of such synthetic hormones are accumulating and contributing to human hormonal imbalances, especially in children. A 2011 article by Harvard Medical School, entitled Drugs in the Water, reveals that studies in 2000 show that up to 50 percent of medications are discarded into wastewater in the United States, and that up to 50 percent that is taken is not broken down, and is excreted in urine. Our water treatment plants do not have the capability to clear pharmaceuticals from the treated water, and for many synthesized drugs, they do not break down easily in the environment, accumulating to perhaps harmful levels with some drugs. The Harvard article noted that numerous studies have found that fish downstream of wastewater treatment show a much higher incidence of feminized male fish, fish with both male and female characteristics, and other evidence of effects of synthetic estrogen drugs. The report also noted evidence of accumulation of antidepressant drugs in brain tissues of these fish, affecting neurohormonal health. The implications for the human population are worrisome. While, as with all types of medicine, there is a subset of patients that need these synthetic hormonal therapies, and the benefits for these patients may outweigh the health risks, for most patients, other therapies could and should be utilized to avoid the adverse outcomes. Complementary Medicine does provide an array of therapies that can be incorporated into care, or integrated, yet these have been vilified by standard medicine with little evidence of potential harm. Also, standard medicine has developed some alternatives to these synthetic hormonal therapies, yet this is not widely known. With the extreme insistence on supporting present pharmaceutical profits over development of better and safer medicines, it is the public, and the patient population, that is finally achieving some progress in this regard.

Cardiovascular risks in the modern contraceptives, and the realistic picture of overall health risks, common and uncommon side effects

In 2011, the U.S. FDA updated its risk of cardiovascular adverse effects for the new generation of supposedly safer oral, transdermal and localized contraceptives twice, notifying healthcare professionals that the final report of an FDA-funded study of contraceptives containing the progestin Drospirenone (Yaz, Yasmin et al), as well as the other marketed new generation of "safer" contraceptives, revealed a 75 percent increase in risks of blood clots (thromboses and embolisms that lead to heart attack and stroke).

The principle investigators on the study included prominent MD researchers from the University of Washington (Dr. Fred Connell) and Vanderbilt University (Dr. William O. Cooper), as well as lead researchers and pharmaceutical analysts from Kaiser Permanente. These investigators stated that there has been a long and considerable concern about the risks of cardiovascular consequences in both arterial and veinous health from combined estradiol and progestins in large part due to the prothrombotic effects of synthetic estradiols, but insufficient data from a lack of scientific study of the long-term effects of the drospirenone plus ethinyl estradiol tablet (DRSP - e.g. Yasmin or Yaz), norelgestromin plus ethinyl estradiol transdermal patch (NGMN - e.g. Ortho Evra), and the etonogestrel plus estradiol vaginal ring (ETON - e.g. NuvaRing). This study included 835,826 women with 898,251 person-years of use of these contraceptives, and can be considered highly accurate and predictive of risk. Significantly higher risk of veinous thromboses and embolisms (VTE) were associated with these newer contraceptives than the prior low-estradiol oral contraceptives, with relative risks of 1.55 to 1.74. Relative risk is the risk of an event or disease occurrence due to exposure, and is a ration of probability of the event or disease occurring versus a non-exposed group. The increased risk of incidence of veinous thromboses and embolisms is thus 55-74 percent increased with this type of contraceptive use. The drospirenone plus ethinyl estradiol tablet was associated with significantly higher risk of both arterial thromboses and embolism, and veinous thromboses and embolism, and was associated with this higher risk with less than 3 months of use, whereas the other contraceptives studied were associated with the increased risks after one year of use. With the use of this tablet, the risk for veinous thromboses and embolism was significant in the 10-34 year age group. These are the definitive findings of a very conservative, multicentered, long-term, and very large scientific study.

This large multicentered study found that, contrary to marketing, the NuvaRing, or vaginal ring with the combined chemicals, had a very significantly higher risk of veinous thromboses and embolisms compared to the standard contraceptives used in prior years. New reports of this study have only emphasized the contraceptive hormone tablets, Yaz or Yasmin, diverting attention from the more popularly prescribed NuvaRing. The NuvaRing website itself lists blood clots, strokes, heart attacks, hypertension, heart disease, cancers of the breast, uterus and ovaries, gallbladder disease, liver tumors, triglyceride elevations, and pancreatitis as significant risks, and side effects commonly reported of increased incidence of vaginal infections (e.g. yeast infections), and weight gain, with less commonly reported side effects of headache, irregular menstrual bleeding, changes in the menstrual cycle, temporary infertility after stopping the contraceptive use, swelling and edema, darkening of the skin, weight changes, depression, nervousness, dizziness and hair loss. While depression and anxiety (nervousness) are de-emphasized in this warning by the company, most women that have used contraceptive hormones are fully aware of the often immediate disturbing emotional lability, anxiety and depression that occurs with these drugs. A large percentage of women discontinue use due to the severity of these psychological side effects, and many prescribing doctors change the prescriptions to variations on the hormonal contraceptive chemicals until these psychological side effects are decreased.

The February 7, 2011 Product Mongraph of NuvaRing from the manufacturer Merck Canada Inc., stated that: "Patients with a history of emotional disturbances, especially the depressive type, may be more prone to have a recurrence of depression while using combination hormonal contraceptives (including Nuvaring). In cases of serious recurrence, a trial of an alternate method of contraception should be made which may help to clarify the possible relationship. Women with a premenstrual syndrome (PMS) may have a varied response to combination hormonal contraceptives, ranging from symptomatic improvement to worsening of the condition."

The researchers of this FDA sponsored definitive study of modern popularly prescribed hormonal contraceptives concluded: "The main findings of this study are that all use of the drospirenone plus ethinyl estradiol pill (Yaz or Yasmin) and each of the continuous exposure preparations, the norelgestromin plus ethinyl estradiol transdermal patch (Ortho Evra) and the etonogestrel plus estradiol vaginal ring (NuvaRing), are associated with an increased risk of veinous thromboses and embolisms relative to the standard low-dose oral contraceptive pills." The authors also stated: "The Medicaid site population was considerably younger than the KP sites and had higher rates of comorbidities (not shown)." This particular study addresses just one of the list of risks for these synthetic hormonal contraceptives, and does not imply that the other risks are unimportant or insignificant. Veinous thromboembolisms present a very underdiagnosed medical condition that leads to a variety of health problems, including a pulmonary embolism which may result in death, a heart attack, leg pain or swelling, chest pain, heart palpitations, anxiety, shortness of breath, and osteonecrosis. Standard medical websites addressing veinous thromboembolism do not emphasize hormonal contraceptives as a risk factor for veinous thromboembolisms. The standard risk factors include obesity, varicose veins, inflammatory bowel disease, surgery, trauma, immobility, cancer, prior stroke, and aging. Patients with these risk factors should be more concerned with the use of synthetic hormonal therapies. These numerous health risks and adverse consequences of long-term use of these newer synthetic hormone contraceptives are often downplayed by the prescribing gynecologist, and even the alarming result of anovulation, or the cessation of the menstrual cycle, which alarms a great percentage of the young women using these contraceptives, is downplayed. Many gynecologists tell their patients that the cessation of ovulation will help prevent cancer, especially ovarian cancer. A 2013 study at the David Geffen School of Medicine, University of California at Los Angeles, noted that prolonged exposure to the unopposed estrogens during anovulation significantly increases the risk of cancer of the uterus and ovary, especially when polycystic ovarian syndrome occurs. These experts noted that the widely held belief that oral contraceptives offered protection from ovarian cancer via anovulatory processes were mistaken, and any benefit in this regard could be attributed to suppression of gonadotropin secretion at the hypothalamus/pituitary complex (see study link cited below).

The vaginal ring (OrthoEvra) may also be associated with a higher risk of cervical cancer, given that the use of the combination progestin and synthetic estradiol is associated with an increased risk of viral infections such as HIV in large studies, and that the vaginal ring also has a risk of irritation of the vaginal membrane, vaginitis, and increased incidence of yeast infections, all of which increase the risk of the human papilloma virus (HPV) types that are associated with most cervical cancers to infect and spread.

Added to this is the finding by the manufacturer that the vaginal ring is associated with a higher risk of uterine cancer. Since Merck is the manufacturer of both the popular OrthoEvra vaginal ring contraceptive and the most popularly prescribed HPV vaccine, Gardasil, there is an obvious reason why Merck is investing so heavily into lobbying to mandate the HPV vaccines in prepuberty, which may alleviate future concerns about the OrthoEvra vaginal ring and the increased risk of cervical cancer. But the question of the HPV vaccine has not addressed the effectivenss, or the risk-versus-benefit, of this vaccine. In 2009, Dr. Diane Harper, a lead researcher for Merck who helped design the phase 2 and 3 trials of Gardasil, questioned the efficacy of this vaccine (see the link to the CBS investigative report below). Dr. Harper stated that data showed that the vaccine lasted a mere 5 years, with no data to support its effectiveness after this time period. Dr. Harper stated: "If we vaccinate 11 year olds and the protection doesn't last...we've put them at harm from side effects, small but real, for no benefit. The benefit to the public health is nothing, there is no reduction in cervical cancers, they are just postponed, unless the protection lasts for 15 years, and over 70 percent of all sexually active females of all ages are vaccinated (to significantly stop the spread of the HPV strains that cause cancer)." Dr. Harper also stated that the risks of serious adverse events after taking the HPV vaccine is comparable to the rate of serious cases of cervical cancer in the population, and that she believes that these risks with the vaccine are underreported, as they are based statistically on the denominator of doses distributed from Merck's warehouse, not the number of doses taken by the patients. Dr. Harper also stated that she believes that the aggressive marketing by Merck may be giving women a false sense of security, undermining sensible measures that can be taken by women to decrease the risk of HPV and of cervical and uterine cancers (see the article entitle Cancer on this website).

The association between Irritable Bowel Syndrome and drospirenone (Yasmin or Yaz)

In 2012, LT United States Public Health Service in Silver Spring, Maryland (Bird ST et al) reported that a study of 939,281 cases of women of an average age of 29 with no prior history of IBS showed a positive association between drospirenone and a subsequent diagnosis of IBS that was not observed with other oral contraceptives (Curr Drug Saf 2012 Feb:7(1):8-15). These researchers, at the University of British Columbia, and other universities, found that drospirenone-containing oral contraceptives, such as Yasmin and Yaz, exerted antimineralcorticoid activity, or suppression of this aspect of the adrenal hormonal production. This antimineralcorticoid activity has been linked to an increased risk of gastrointestinal bleeding and irritation of the gastrointestinal tract. The U.S. Department of Health and Human Services FDA, Center for Drug Evaluation and Research, in Silver Spring, Maryland, also found in 2011 that physicians were not following recommended potassium monitoring and prescribing guidelines with these contraceptives, concurrently prescribing such medications as spironolactone despite bold warnings on the contraceptive labels for risk of hyperkalemia, or excess circulating potassium (PMID: 22208934). Spirinolactone, marketed as Aldactone, is a synthetic steroid hormone antimineralcorticoid and antiandrogen drug that is prescribed as a hypertension medication, or for reducing androgen activity associated with polycystic ovarian syndrome. The lack of serious consideration of adverse effects of these synthetic hormone medications is alarming.

Choices and consequences with contraception

A September 17, 2012 article in the New York Times, entitled Switching Contraceptives Effectively reported that the United States has one of the highest rates of unintended pregnancies in the developed world at nearly 50 percent. One reason for this continued poor control of choice in pregnancy is dissatisfaction with hormonal contraceptives, which are now almost always recommended by gynecologists and primary care physicians, and the high rate of discontinuation or switching of contraceptive methods due to adverse effects.

A study by the Battelle Centers for Public Health Research and Evaluation cited in this article found that over 60 percent of unmarried women, and 40 percent of married women, had switched birth control over a 2 year period. The rate of pregnancy with this switching was very high, with most women unaware that there may be a transition period where the new contraceptive hormones do not work. Gynecologists recommend overlapping these methods to insure protection, or being careful to utilize a barrier method during the transition, but apparently in real life few gynecologists emphasize the importance. De-emphasizing the adverse effects of hormonal birth control protocols is justified in the profession by the emphasis on the need for the birth control. Many women were unaware of the variety of birth control choices available to avoid pregnancy during the transition from one hormonal birth control to another, and showed a poor understanding of these non-hormonal methods, as well as fertility-awareness-based cyclic abstinence from coitus. Understanding when the ovulation occurs and the "window of opportunity" to actually get pregnant allows greater control of the fertility process. This patient knowledge has not been supported due to fears that women would abandon their hormonal birth control for other methods of contraception. The lack of information and intelligent action, though, has resulted in the United States having among the highest rates of unintended pregnancy in the world, without improvement in this regard for well over a decade. The emphasis on denying abortion is seen every day in the United States, yet the practice of denying pregnancy is not.

Rather than being the answer to the problem of control of pregnancy planning, synthetic hormonal contraceptives may be the problem. When women are not aware of the physiology of fertility and the menstrual cycle, when they are unaware of the choices, and when hormonal methods that come with unacceptable side effects, adverse long-term effects, and increased health risks are touted as their only alternative, then synthetic hormone contraceptives become a bigger problem for effective proactive control of pregnancy. The study cited above states that 10 percent of women stopped their contraception altogether, and cited an array of reasons. These included adverse side effects, worry about hormonal health, a change in health insurance or doctor, a move to a different location, difficulty paying for the contraceptive, difficulty contacting the prescribing doctor easily, and not being familiar with all the options. Often, an unmarried woman will stop having regular sexual intercourse and these concerns prompt a change in habits. If the woman does not understand all of the facts about contraception and fertility, these choices often result in unintended pregnancy. An attitude of keeping female patients in the dark concerning choices in contraception, and descouraging real understanding, is obviously tied to these reasons for discontinuation of birth control and unwanted pregnancy. Increased knowledge and support of a more proactive approach will help women to control this important aspect of their life, while lack of real physiological understanding, of method choices, and efforts to curb financial coverage of contraception, will work to maintain this problem of unwanted pregnancy. Certainly, the health problems associated with synthetic hormones are not helping.

A large and comprehensive study of birth control methods by experts at the Brigham and Women's Hospital in Boston, Massachusetts, U.S.A. in 2008 showed that the rate of stopping a birth control method within one year was 32% of oral contraceptive users, 32% of combined patch and ring users, up to 70% of Depo-Provera® (Pfizer Inc., New York, NY) injection users, 10% to 13% of progesterone implant users, and about 20% of intrauterine device with progestin users. The rate of choice of vasectomy and tubal ligation was a little over 9 percent of the male popluation, and about 36 percent of women. The choice of tubal ligation, still referred to as sterilization, unfortunately, a poor choice of wording, is greater than the choice of oral contraceptive synthetic hormone use. To see this study, just click here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492586/ . Studies have also shown that the success of hysteroscopic ligation compared to laparscopic procedure is lower, with similar minial risk of pregnancy, but a 10-fold higher risk of undergoing reoperation. To see such a study, just click here: http://www.bmj.com/content/351/bmj.h5162 . Obviously, patient education is sorely needed to make these choices in reproductive health and planning.

The most common option to achieve safe and effective birth control is the copper-releasing IUD (intrauterine device), commonly called the Copper-T. Copper ion molecules released in minute amounts interfere with both the penetration of the ova, or egg, into the uterine lining, as well as the motility and viablitiy of sperm. Combined, these effects were shown to result in a zero penetration rate of the ova in the uterine lining. This effect occurs only after a concentration of copper ions occurs, not in the immediate days after implantation, though. (PMID: 8876046). A large 2016 population study in the U.S.A. by experts at the Johns Hopkins Bloomberg School of Public Health and the National Institute of Demographic Studies in France showed that IUD use increased from 1.8 percent to 9.5 percent between 2002 and 2010, and was a choice for many women who had a child and wished to wait some time to have a second child, as well as women who were dissatisfied with the use of synthetic hormone contraception. Such a trend was deemed the main reason for declining rates of unintended pregnancy. (PMD: 27251204). The choice of the copper-releasing IUD without synthetic progestins needs to be fairly discussed. Evidence suggests that increased use of the IUD since 2010 has resulted in greater decreases in unwanted pregancy and reduced abortion rates. In 2015, the results of a Colorado program to reduce teenage unwanted pregnancies by providing free IUDs and implants resulted in a dramatic drop in both unwanted teen pregnancies and abortions, much more than any other program in history, with a 40 percent decrease in teen births as well. This trial was funded by the wife of Warren Buffett, though, and while the program would result in a net decrease in government healthcare costs, the dramatic opposition by the Republican Party to any form of effective family planning and contraception choice threatened to stop the program going forward in Colorado or in the rest of the United States. There were no increases in negative consequences, such as a rise in sexually transmitted disease, or a rise in the percentage of sexually active teens. Such a program provides real life education to teens concerning healthy choices in their sexual and reproductive life as well. Hopefully, the copper-releasing IUD is considered, as the use of synthetic hormones at an early stage of hormonal maturing can have negative long-term effects.

Integration of herbal medicines as an adjunct to integrate into contraceptive methods, especially with use of barrier method contraceptives, is being investigated. In 2011, researchers from West Virginia University School of Medicine, Reproductive Immunology and Molecular Biology Laboratories (Naz RK - PMID: 21337449), found that administration of the herbal chemical Curcumin, from various Chines medicinal herbs, such as Curcuma longa and zedoaria, intravaginally, significantly reduced fertility and sperm motility and function. Since prior studies have identified intravaginal curcumin cream as an effective treatment for HPV and cervical dysplasia and cancer, the potential for a curcumin cream as adjunct to barrier methods of contraception may provide not only contraceptive protection, but protection against infection and HPV-associated cervical dysplasia. In 2010, the College of Staten Island developed a curcumin cream that eliminated HPV cancer cells in laboratory studies in vitro, and produced no tissue irritation. The cream was called Vacurin. These studies also found that the anti-fertility effects were easily reversible, producing virtually no adverse effects. Greater choice in contraceptive strategies, along with better education of the young woman concerning fertility physiology, would allow individuals to weigh the benefits and risks of all contraceptive methods and make the intelligent choices. Obviously, the current advice and management of contraception in the United States is not working well, with high rates of unintended pregnancies, and medical advice proposing that synthetic hormone contraceptives are the only real choice, despite the increasing evidence of health risks, as well as the proposals that HPV vaccine should be mandated for all women in the early teens.

Now, the subject of herbal birth control has been studied for a few decades in China, albeit underfunded, and a few scientists have looked into the purported use of herbal medicines to achieve birth control in the past. The Chinese herb Gossypol, or Mian hua gen, derived from the seed, stem or root of the cotton plant Gossypium, which is rarely used for any medicinal purpose, is a potent suppressor of spermatogenesis, which is quickly reversible when not taking the herb. The Chinese have been utilizing Gossypol acetic acid, or Gossypol formic acid, in pill form, to achieve male birth control. Unfortunately, for a percentage of patients the sperm count is depressed for nearly a year after discontinuing the medicine, and hence the public is wary. The Chinese have produced a second contraceptive pill from the same root called Celatrol, reportedly with less risk of long-term sperm count suppression. In India, extensive research on a handful of herbs that were used traditionally for contraception has been ongoing as well, and the National Institutes of Health (NIH) and the World Health Organization (WHO) has been collaborating with the Central Drug Research Institute, in Lucknow, India, to confirm the efficacy of some form or standardized herbal chemicals for contraception without side effects. Unfortunately, this research and potential of a more benign form of birth control almost is never publicized.

Another form of male birth control that has been heavily researched and is currently in clinical trials, is called Vasalgel, which is an injectable gel that stays in the male vas deferens (sperm tube) and breaks up sperm. This form of contraception is reversible and extremely safe, easy to install in a quick outpatient setting, and does not come with the negative aspects of vasectomy, such as the need to surgically cut the vas deferens and then the stopping of the flow of sperm into the system, which has produced no adverse health effects, but is still led most men to avoid vasectomy. While the work to develop birth control without the adverse health effects of synthetic hormones, the promotion of standard female birth control methods that are almost as effective as hormonal birth control if used effectively and in combination, the promotion of safe and effective male birth control other than the unwieldy condom, and the development of safe and effective herbal birth control, are adamantly discouraged by standard medicine, the promotion of synthetic hormonal birth control, despite the problems and adverse health effects, is adamantly insisted upon, despite the evidence that the results are not very good overall, with the high rated of unintended pregnancies in the United States, and consequently, a rate of abortion that no one, not even Pro-Choice advocates, want.

The vasectomy, or reversible obstruction of the spermatic cord in men, have shown in long-term studies a success rate of greater than 99 percent in preventing pregnancy, with no increased hormonal imbalances noted, such as atherosclerosis, immune dysfunction, or prostate pathology. The rates of immediate complications from the procedure are between 1-6 percent, and are usually mild and manageable. A lack of studies published since 2000 and lack of discussion of the vasectomy has limited its use. Studies of the reversal success rates of vasectomy have shown that 90-100 percent can expect a return of spermatic function within one year, and over 80 percent achieve successful fertilization, although this depends on a number of factors, including the length of time the vasectomy has been in place (less than 5 years insures great success), the procedure technique used, and individual issues with sperm viability and other heatlh issues. To see such study, just click here: http://www.healthcentre.org.uk/vasectomy/vasectomy-vasovasostomy-effectiveness.html . Currently, up to 17 percent of young men in the UK choose this birth control method, and reversals are common as the couple reaches the stage of family planning.

For women past the age of desired reproduction, tubal ligation is a common choice, and the efficacy of tubal ligation in a large study conducted by the Harvard Medical School and the esteemed Brigham and Women's Hospital in Boston, Massachusetts, U.S.A. in 2008 showed that the failure rate was about 18.5 per 1000 cases over 10 years. Of course, continued attention to the ovulatory cycle and window of opportunity, or the few days in the older female of reproductive age where fertilizaton is possible, could reduce this risk to zero. Reversal of the tubal ligation shows a return of pregnancy rate on average of 45 percent, but if the procedure was performed properly, and the remaining length of the fallopan tube is greater than 5 centimeters, then the rate of success in pregnancy is 70 percent, about the rate of women over 35 years of age that did not have the procedure. Calling this procedure "sterilization" perhaps has contributed to the inattention to preserving the length and viability of the fallopian tube in the procedure. The cost of reversal of tubal ligation is not mandated, and not covered on many individual policies, which should be discussed when choosing an insurance plan, but out-of-pocket costs are now less than $3000.00.

Understanding natural and synthetic steroid hormones

Progestins are considered a class of steroid hormones in the body that includes progesterone, which is the most biologically active progestin in human metabolism. Natural progesterone is synthesized in the body from the precursor pregnenelone, which also is the precursor to DHEA (dehydroepiandosterone), which is the precursor to both estrone and testosterone. Estradiol, the most biologically active of the estrogens, many be synthesized in the body from testosterone or estrone. There are many pathways of steroid hormone production in the body, though, both systemic, glandular, and local, and a complex system of feedback regulation keeps the circulating and local levels optimum for effective metabolic regulation. Estrogen receptors may be stimulated by a variety of chemicals, especially estradiol, estrone and estriol, with estradiol exerting the most effect. In local tissues, such as the breast tissue, estrogen receptors may be stimulated by estradiol created from local testosterone or estrone. Circulating estradiol may not be as important as the production of localized estradiol in these tissues concerning cancer stimulation. Imbalances of precursor hormones, or the rate of conversion of hormones in breast tissues via aromitization, may be more important to the question of breast cancer risk than the level of circulating estradiol. Synthetic estradiol as a hormone replacement thus may have negative consequences on breast cancer risk, whereas maintenance of a hormonal balance and natural ability to regulate steroid hormones will have a positive protective effect.

Estriol is the most abundant of known forms of estrogen in the human body, and is especially abundant during pregnancy, as it is converted from DHEAS in the placenta. The human placenta produces much pregnenelone and progesterone from circulating cholesterol. The adrenal tissues of the fetus convert pregenelone to DHEA, which becomes DHEAS, and the DHEAS is converted in the liver of the fetus to a form that converts to estriol. Estriol is also produced in the adult ovary. Estriol was first isolated in 1930, from study of human pregnancy urine metabolites and placenta, and was found to convert to estrone in the human body. Subsequently, a plant source of bioidentical estriol was found to be derived from the Pussy Willow. Dr. John R. Lee, a pioneering M.D. researched such data to create bioidentical hormone therapies that were safe and effective, and widely used today as topical creams. Estriol has been periodically researched as a form of estrogen that exerts estrogen-like effects, stimulates increased production of estrone, and offers a protective effect against estradiol dominance and its cancer risks. The use of bioidentical hormone therapies has been fiercely fought since these studies in the 1930s revealed the potentially safe and effective use of such therapies, and medical industry journals have been loathe to publish any studies concerning estriol or bioidentical hormonal therapies.

In studies of women who are not pregnant, the blood production rate of estriol was measured and found to be significantly higher in the luteal phase of the menstrual cycle (second half of the cycle). The metabolic clearance rates were the same for estriol in circulation during the follicular and luteal phases of the cycle (see study cited below in information resources). There is little data on estriol values in non-pregnant women before 1999, mainly because estriol was considered a weak estrogen compared to estrone and estradiol. In 1999, a small study was finally conducted to determine the estriol production in the non-pregnant female at the Tahoma Clinic in Kent, Washington, and these researchers found that estriol was the most abundant estrogen of the three known estrogens, estriol, estrone, and estradiol, in the non-pregnant woman, and much less fluctuating than these other estrogen forms (Altern Med Rev. 1999 Aug(4):266-70). A subsequent study by Morris R. in 1981 (cited below) showed that estriol values in a non-pregnant woman, measured by radioimmunoassay of the urine, measured as 80% of total estrogens. Despite these studies, many standard experts still insist to patients that estriol is probably not abundant in the non-pregnant woman based on the early study of estriol in pregnancy. Each attempt by researchers to suggest that estriol is a viable and safe hormonal therapy over the decades has been dismissed as standard medicine has pushed the widespread use of the patented synthetic estradiol chemicals. Estrone itself was ridiculed for years until popular demand created the need for this safer estrogen therapy in the form of Premarin.

In the 21st century, most women are now realizing that it is vital that each individual woman takes a proactive approach to understand their hormonal physiology and make correct decisions concerning risks of hormonal therapies and ways to maintain the healthiest hormonal balance. Standard medicine has not provided a reassuring approach to women's health, and the results of these standard approaches over the last half century and more are alarming.

Relying on the pharmaceutical industry to provide guidelines in women's health has been devastating, as revealed by the large Women's Health Initiative study of 1999. Not only the alarming prescription history of synthetic hormones despite the evidence and clinical incidence of serious long term side effects and health risks, but the alarming rates of surgical removal of the uterus, ovaries and breasts in the U.S. compared to Canada, Europe and other developed nations has finally created much concern in the female population in the United States. The uterine and ovarian tissues continue to produce steroid hormones after menopause, and removal of these organs creates a need for either increased production of steroid hormones in other tissues, or the use of synthetic hormone replacement therapy. In other words, medical guidelines that support increased rates of hysterectomies produce increased prescription of synthetic hormone replacement therapy. The difference in recent years between the hysterectomy rates in the U.S. and Canada are striking. Between 2000 and 2010, the rate of hysterectomy in Canada decreased to 338 per 100,000, while the rate of hysterectomy increased in the U.S. population to the point where 1/3 of women could expect to have a hysterectomy by the age of 60. In the United Kingdom, 1/5 of women were likely to have a hysterectomy by this age. In Canada, approximately 23,000 hysterectomies were performed per year in recent years, whereas in the U.S., 617,000 hysterectomies were performed in 2004, with the rate of hysterectomy increasing yearly. The rate of hysterectomies is approximately 3 times higher in the U.S. than Canada.

In 2002, The U.S. Centers for Disease Control (CDC) stated that hysterectomy was the second most frequently performed surgical procedure in the United States, after cesarean section, for women of reproductive age, with approximately 20 million U.S. women having had a hysterectomy. By 2010, this number had increased to the point where approximately one third of women of post-menopausal status have had a hysterectomy. Some studies have indicated that we are approaching a point where approximately 60% of women at age 65 will undergo a hysterectomy.

The majority of hysterectomies were performed among women earlier than the age of 44, and the highest rate of hysterectomies occurred in the 40-44 age group (11.7%, with 16.8% in the black population). Hormonal imbalance, which is the main driver of uterine fibroids, endometriosis, and uterine prolapse, was the main cause for these hysterectomies. The post-menopausal group had the second highest rate of hysterectomies, and again, hormonal imbalance was the main driver of the cancers, hyperplasias, and prolapses that were cited as the reason for choosing a hysterectomy. In addition, a majority of patients undergoing hysterectomy had a bilateral surgical removal of the ovaries. To understand endometriosis, uterine fibroid, and ovarian cyst pathology better, you may go to the article on this website addressing these concerns. Better hormonal balance, health maintenance, and preventive medicine with the integration of Complementary Medicine could reduce the incidence of hormonal symptoms, unnecessary surgical removal of sexual reproductive organs, and the high rates of cardiovascular disease, cancers, osteoporosis, and neurodegenerative disorders in the aging female population.

Besides the alarming lack of professional guidance concerning the actual long term risks of synthetic hormone replacement and contraceptive hormonal therapies, we are now finding out that standard medicine has promoted much misinformation to guide choices in women's health. Women are routinely told that the ovaries and uterus cease to function after the reproductive years, and thus there is no reason to avoid surgical removal of these organs, especially as hysterectomy and ovarian removal, and even removal to the breasts, could reduce the risk of cancers. This is not true. As early as 1965, studies showed that postmenopausal ovaries frequently maintained a steroid hormone production capability for several decades (Novak et al, Am J Obs Gyn 93:669 1965). There is a marked change in the type of hormonal production in these tissues following menopause or hysterectomy, but nevertheless, they do still contribute to hormonal production and balance. Aging ovaries actively produce androstenedione, a precursor to estrone. By urging many women in the United States to have unnecessary removal of the ovaries, uterus, and even breast tissues, and now to unnecessarily urge many younger women to utilize progestin therapy in IUDs, inserts, or orally, that stop ovulation and menstruation, standard medicine has reduced the capacity for millions of women to maintain a normal healthy hormonal homeostasis. Sides have clearly been drawn in this area of women's health, and standard medicine has decided that synthetic hormone therapies are the crux of their business, and that the subject of natural hormone therapies and homeostasis is a threat to their business. Still, a growing body of medical doctors, inspired by Dr. John R. Lee, and subsequent MDs, are now promoting natural estrogen therapies and Complementary Medicine in the arena of gynecology. An even greater number of women are taking control of their reproductive and hormonal health and seeking to proactively understand and participate in achieving better hormonal health with Complementary Medicine.

A better patient understanding of natural, or bioidentical, hormone therapies, phytohormones, and hormone-modulating herbal and nutrient molecules is needed

Today, the subject of natural estrogens is a complicated subject. Women are realizing that the term estrogen does not apply to just one chemical. Besides the three most abundant estrogens in our bodies, estriol, estrone and estradiol, a number of chemicals in foods and even industrial chemicals are now called estrogens or estrogenic. Phytoestrogens, or chemicals in plants and foods that are similar to human estrogens, exert some mild estrogen-like effects in the body, but do not directly stimulate human estrogen receptors like human estrogens. Estriol derived from the Pussy Willow appears to be the exception to this rule, but estriol does not exert a strong estrogen stimulation at most estrogen receptors, and appears to work mainly by creating a more abundant bioavailability for estrone and thus estradiol, as the body needs these more potent hormonal chemicals. Laboratory analysis shows that in the estradiol deficient female, a small dose of topical estriol cream will stimulate increased production of estradiol. Since estradiol may be produced in local tissues from testosterone, though, overall hormonal balance, and adrenal health, are also very important to estradiol physiology and estrogen receptor effects.

Isoflavones, such as those found in the soy bean, exert estrogen effects that stimulate increased estrogen-mediated metabolic effects. Thus, in some women, these plant phytoestrogens, or isoflavones, are able to modulate estrogen effects and calm some symptoms of estrogen imbalance, such as menopausal or post-menopausal hot flush. Phytoestrogens are also found to be potent estrogenic chemicals, able to stimulate increased estrogen production. Environmental, or industrial xenotoxic estrogens, are increasingly abundant in our world, and are shown to have a potential for blocking estrogen receptor activity, thus causing negative effects. Phytoestrogens, on the other hand, have been shown to have little or no antiestrogeic activity. The metabolism and physiology of estrogen feedback and production, and estrogen receptor activities, is complex and fluid, though, and the research of various estrogen-like nutrients, and estrogen-stimulating hormones, such as enterolactone, has produced a complex set of research findings. Human clinical trials have demonstrated that various isoflavones and coumarins, and lignan stimulation of enterolactone, have produced a variety of positive effects on estrogen receptor modulation, though, and do have a significant role in modulating symptoms of steroid hormone imbalance and deficiency, and in decreasing risks for estrogen receptor positive cancers. Studies in 2003 demonstrated that various phytoestrogens bind to different estrogen receptor types with different affinities and that the potential to increase the rate of estrogen receptor binding to a estrogen response element also varies between phytoestrogens.

Hormones act on the body's tissues by stimulating a wide variety of metabolic actions. Hormones themselves do not affect these cellular actions, but are a type of molecule that attracts to receptors that stimulate the activities. Steroid hormones are very similar to one another, and consequently may easily convert to other steroid hormone forms in the body as needed. This feedback system of hormonal balance is called the endocrine system. The term endocrine literally means to secrete within, and comes from the roots endo- meaning absorbing within, and -krino, to separate. When the hormones are synthetically altered, forms are found that may stimulate certain processes or receptors, but will not stimulate all of the metabolic effects of the natural hormone, and will not be able to convert to other forms of steroid hormones as needed. Symptom relief and contraception are achieved, but the inhibition of the sum total of healthy hormonal effects and regulation are eventually a major health concern.

Synthetic progestins are a group of altered progesterone hormones that still act upon progesterone receptors, but do not stimulate all of the hormonal effects that natural progesterone does. The first progestin synthesized was a derivative of pregnenelone, not progesterone. Many scientists now are of the opinion that the synthetic progestins we use in therapy are not actually progesterones, but more related to androgens. These progestins, such as Levonorgestrel, has a binding affinity at the progesterone receptors over 3 times that of natural progesterone, largely blocking progesterone effects, but also has an affinity to bind at androgen receptors of 58 percent of that of testosterone, 17 percent of that of aldosterone, and 7.5 percent that of cortisol at the glucocorticoid receptor, resulting in broad effects systemically, even in the brain. The effect on the esrogen receptor is less than 0.02 percent, but this synthetic progestin is still often referred to as an estrogen by prescribing Medical Doctors, especially in the post-menopausal use in hormone replacement therapy.

With the use of synthetic progestins the menstrual cycle may be disrupted and the woman may not only prevent pregnancy, but often will have the menstrual cycle itself discontinued, with anovulation common. While elimination of the monthly bleeding cycle may be convenient as far as the lack of need to use menstrual products, the menstruating woman obtains most of her normal progesterone and estrogens from the normal menstrual cycle, and continued disruption will have long term consequences of hormonal deficiency that will not completely be addressed with the continued use of the synthetic or combination drugs. The long term use of even low dose synthetic steroid hormones increases risks of common health problems because they result in less production of natural hormones in the endocrine feedback system. The risks of hormonal imbalance affecting a variety of systems, especially inflammatory regulation and tissue repair and maintenance, increase over time. If one chooses to take synthetic hormones, which is a relatively safe therapy for a percentage of women, it is advisable to address these issues of potential risk and side effects by seeking care from an knowledgeable Complementary Medicine physician, both as a preventative medicine, or to treat the side effects and risks as they develop.

Another response to the risks and side effects of standard hormonal therapies in medical practice has been the reintroduction of topical synthetic hormones. In 2002 estrogen creams were reintroduced to the standard practice in response to the public alarm over current hormonal replacement therapies, as well as to respond to the growing interest in topical creams that utilized herbal bioidentical hormones. There was unfortunately an alarm sounded in the industry over reports of these synthetic hormones affecting children, causing such symptoms as breast enlargement and early puberty. In 2007, the use of topical synthetic hormones was again reintroduced, this time as a spray utilizing low dosage synthetic estradiol on the inside of the forearm. Unfortunately, once again, on July 29, 2010, the FDA had to issue a safety warning that the use of the topical synthetic estradiol spray, Evamist, appeared to adversely affect children and pets that came into contact with the skin of the patient using the drug, causing breast enlargement and nipple swelling in small children, both male and female, and swelling of the vaginal tissues in small children (see the link to the FDA warning below). The report indicated that these adverse effects were consistent with premature puberty in females and male gynecomastia, which are conditions that are seen with increasing frequency in the U.S. population today. There has also been concern raised over the slow breakdown of these drugs outside of the body and their introduction into the water supply by bathing as well as urinary excretion and dumping of unused pills into waste. There are few measures taken by common water treatment plants to address these chemicals in the public water system, and areas of the country that depend upon water from the underground aquifers are most affected.

Synthetic hormones are primarily used because the pharmaceutical industry is able to patent them and thus control profits. Natural, or bioidentical hormones, are simple chemicals that are found in identical forms in both plants and animals. Synthetic hormones create numerous eventual side effects by a variety of metabolic routes, not only stimulating unwanted actions within the body, but also creating a cascade of events by not stimulating metabolic actions while creating a feedback mechanism that prevents normal production of the analogous hormones, as well as eventual deficiencies of similar steroid hormones that depend on the balanced endocrine feedback system to control levels. These other steroid hormones include insulin, as well as the estrogen, androgens, pituitary hormones etc., and hormonal imbalances may affect a wide variety of hormones, including thyroid hormones, parathyroid hormones, adiponectin, ghrelin, Vitamin D3 hormone, and others.

Research in recent years (cited below in information resources) has discovered that women with metabolic syndrome (diabetes type 2), and insulin resistance, should perhaps avoid the use of estrogen replacement with synthetic progestins. This is because the progestins are found to interfere with the cellular hormone adiponectin, and may significantly decrease the release of adiponectin into circulation, thus both upsetting normal balance of inflammatory mediators, and decreasing the body's protection against buildup of atherosclerotic plaque. Progestins have been found to promote atherosclerotic plaque and instability of this plaque, leading to increased risk of thromboemboli, the main cause of strokes. Synthetic estradiol, and relative estradiol dominance, have also been associated directly with metabolic syndrome and insulin resistance, especially with women that experience increased midsection fat (android obesity). Since the problem of metabolic syndrome (see related article on this website) is becoming increasingly prevalent, these cautions and warnings affect a large number of patients that may want to utilize synthetic hormonal birth control or menopausal medicine.

The choices that women now have include the simple solution with synthetic hormone replacement, which comes with an eventual complicated set of potential risks and an array of health problems in your future, or a more complicated attention to the maintenance of healthy physiological function and processes with an holistic health regimen now, and a healthy life and function in the future.

For premenopausal women, an array of non-hormonal contraceptives are available, and knowledge of the fertility physiology will help to utilize these most effectively. IUDs (intrauterine devices), condoms, fertility-awareness-based cyclic abstinence, diaphragms, spermicides, and contraceptive sponges are typically available at health clinics, but effectiveness rates equal to hormonal contraceptives (91-96 percent) often depend on intelligent use, and sometimes a combination of methods. Surgical sterilization, either vasectomy or tubal ligation, are also popular with advancing age. Both the choice of when to start a family and the maintenance of optimum hormonal health is possible, but patient understanding and a proactive approach is necessary. The holistic regimen utilizes professional guidance from a Complementary Medicine physician that integrates with your M.D. gynecologist and utilizes an array of treatment options that includes bioidentical hormones, herbal formulas, acupuncture and nutrient medicine, as well as the expert knowledge to help you understand fully your own health and healthy physiology. The proactive approach is more complicated than taking a single pill, but the rewards are great. Many women are frustrated by the array of information and lack of success when attempting this process without professional guidance. Poor quality products and information provided to sell these products rather than to simplify your understanding are the main stumbling blocks. Professional products and guidance assures greater success.

The following is a list of prior and current common forms of hormonal replacements and contraceptive chemicals that were studied for over fifty years and resulted in stern warnings concerning long term use:

  • Estradiol benzoate: estradiol benzoate is given in 3 drug forms: estradiol alone, and combined with testosterone or progestin (progesterone) synthetic medications. The FDA warns that estrogens increase the risk of endometrial cancer, heart attack, stroke, breast cancer, pulmonary emboli and deep vein thrombosis. The studies confirming this risk dealt with synthetic estrogens.
  • Estradiol ethinyl and mestranol: these common birth control synthetic estrogens are nearly identical and cause the same side effects as estradiol benzoate. Currently, side effects and risks are theoretically reduced to acceptable levels by prescribing extra low dosage, and esterifying the synthetic estradiol, but the long-term benefits are yet to be measured. Birth control regimens often use monophasic regimens for ease of use, where the type of pill dosage is not varied over the cycle. Bi- and triphasic pill combinations seek to more closely mimic natural cycles with varied dosage of hormones, but the prescribed hormones are still always at higher levels than normal menstrual cycle natural hormones. The phased pill regimens sometimes use dummy pills for up to seven days in the regimen to give the woman a break from the synthetic hormone dosage. Phasing regimens probably result in less severe inhibition of natural hormone production. Anovulation, sometimes persistent, is a growing concern for women taking the newer estrogen medications combined with progestins, yet is downplayed in gynecology, often touted as perhaps beneficial to quit ovulating and menstruating. Most women realize that artificial inhibition of ovulation and menstruation is not healthier, and that our bodies have evolved homeostatic patterns that are very important to overall health maintenance.
  • Progestins in birth control; nine forms: levonorgestrel, norgestrel, ethynodionol diacetate, norethindrone acetate, northendrone, norgestimate, desogestrel, gestodene and drospirenone: The prescribing doctor will often have to try more than one type of progestin to reduce immediate side effects. The patient often is poorly informed concerning the greater risk of the long term side effects that are more important, and assumes that decrease in immediate side effects prevents the long term consequences. Patients are also told that low dosage will prevent long term consequences, which is a subject facing strong debate among researchers. Extra-low dosage comes with less effective birth control statistics, but health care providers consider these acceptable. Localized delivery of a low dose of progestins via the IUD is now often prescribed as a contraceptive. The progestins in this device do exert the same systemic effects on the endocrine system as topical and oral progestins. This is evident by the fact that for a high percentage of women using this IUD with progestins, ovulation and the menstrual period itself is stopped. Cessation of menstruation, or anovulation, will occur due to excess prolactin (hyperprolactinemia), and the subsequent effect to suppress FSH (follicle stimulating hormone). Estradiol alone is shown to not affect prolactin levels, but a combination of estradiol and progestin may induce hyperprolactinemia (JCEM 1985; Robt F Williams et al of the Jones Institute of Reproductive Medicine).
  • Ethinyl estradiol sulfate combined with drospirenone, commonly called Yasmin or Yaz: In 2011, the first of a series of stronger FDA warnings were issued for these newer forms of contraceptive hormones, which have been marketed as safer than previous contraceptives, and often prescribed to decrease acne. The 2011 FDA warning was in response to large long-term studies showing significantly, and alarming, increased risk of blood clots compared to older contraceptive hormones. Of course, blood clots are the cause of most strokes and heart attacks, but also cause peripheral vascular disease and organ disease, and further FDA warnings were issued linking these newer contraceptives to gallbladder and kidney disease. Two Danish studies showed a doubling of blood clot risk with these newer contraceptives, and a six-fold increase in risk over women using non-hormonal contraceptives, while British studies showed a tripling of risk of blood clots over older contraceptive hormones. Bayer, the drug manufacturer, continues to deny increased risk. Canadian health authorities have conducted a review of scientific studies and concluded that there is a 1.5 to 3 times increased risk of blood clots over older contraceptive hormones, and has released the company monogram showing that these newer contraceptives may contribute to anxiety and depression disorders, and should be discontinued if this is a serious problem. In addition, a number of studies have shown that induced anovulation is common with these contraceptives, especially with non-cyclic forms, and that for about 20 percent of these patients, ovulation and menstrual cycle did not resume more than a year after discontinuing the contraceptive.
  • A high dose injected progestin contraceptive, such as Depo-Provera, or depot medroxyprogesterone acetate, is now the most popular hormonal contraceptive in the world, since it needs only one injection every 3 months. In 2011, a large study following nearly 4000 African women and their sexual partners found that use of this high-dose progestin nearly doubled the rate of acquiring an HIV infection in a country with a high rate of such infections. The study uniquely followed the sexual partners of the women, and found that when a woman was infected with HIV that those who used the high-dose injectable progestin passed this infection on at a rate nearly 40% higher than those not using the contraceptive. The WHO is following up on this University of Washington study to see if new international guidelines should be written. The implications are that a high dose progestin may not only affect the hypothalamus, GnRH, FSH, LH, and estradiol levels, but may significantly decrease the immune function in specific ways. We already were aware that use of this high dose progestin affected the cervial mucus and caused the endometrial membrane to become thin and atrophy, as well potentially causing bone loss. Some studies showed that the synthetic hormone affected the vaginal tissue as well, and there is speculation that progestin causes immunological changes in the tissues of the vagina and cervix. Measurements showed that increased numbers of HIV in genital fluids were found in women using the injected high dose progestin, as well, though, indicating that a more generalized affect on the immune system might be caused by the synthetic hormone. The researchers tracked the use of condoms and eliminated this as an explanation. The links between the endocrine and immune systems do appear stronger as more and more research uncovers the ways that immune cytokines and hormones interact at cell receptors.
  • Progestin derivatives in post-menopausal hormone replacement; seven forms: allylestenol, norethisterone, danazol, dydrogesterone, medroxiprogesterone acetate, cyproterone acetate, and tamoxifen: Progestins are now considered a more acceptable form of synthetic progesterone in post-menopausal regimens because low dosage purportedly protects the woman from the cancer causing tissue stimulation of the synthetic estrogens. A variety of combinations of progestins with synthetic estradiol and even synthetic testosterone are now offered. Studies have revealed that most of these progestins have little or no inhibitory effect on suppression of endometrial hyperplasia caused by the usual prescription of the least risky conjugated equine estrogen in these pills, though. In fact, combination of synthetic estradiol and progestin therapy has been associated with increased breast cancer risk in postmenopausal women (PMID: 20103679). While the large Women's Health Initiative study cited at the beginning of this article demonstrates that use of natural equine estrone signficantly reduced cancer risks, most postmenopausal women are prescribed a synthetic version of estrone instead, or esterified estradiol ethinyl sulfate, in combination with progestins. One strategy pushed to decrease the cancer risk with this protocol is use of the harsh drug tamoxifen. Today, there are many combination drugs that include tamoxifen, including cancer drugs, acne drugs, and combinations of synthetic estradiol and tamoxifen are now prescribed as well. Studies in 2010 at Wake Forest University School of Medicine showed that the combination of synthetic estradiol with tamoxifen did not reduce risks of endometrial cancer more than tamoxifen alone, though (PMID: 20103679). In the U.S. tamoxifen is prescribed for 5 years for postmenopausal women with hormone-receptor positive localized cancerous or precancerous lesions as a precaution. The usefulness of this long prescription of a progestin with tamoxifen has been highly questioned in Europe since 2003, due to studies noting long-term side effects and limited effects on the time of recurrence of precancerous or cancerous lesions. Standard protocol reduced the time of use to 18 months for most women in Europe, and many European medical doctors switched to a protocol using only aromatase inhibitors, which were shown to have fewer side effects and thus fewer withdrawals from treatment (The Lancet, Vol.365;Issue 9453, Jan2005). A number of studies now show that concurrent use of an antidepressant SSRI significantly decreases Tamoxifen efficacy as well, opening a broad arena of questions concerning hormonal therapy with progestins, tamoxifen, and concurrent prescription of these antidepressants, which is common. As far back as 1993, a study of 801 patients at the Institute Pharmacological Research Mario Negri, in Milan, Italy, found that the effects noted in reduction of metastatic breast cancer was no different with progestins or tamoxifen (PMID: 8233291). While this was spun as a positive finding for the use of either progestins or Tamoxifen to treat or prevent breast cancer metastasis, evidence since 1993 points to the fact that progestins increase breast cancer risk, which would logically nullify the assumed benefits of Tamoxifen, an estrogen receptor antagonist, yet this fact has been ignored. The end result of all of this study and combinations of drugs for hormone replacement therapy postmenopausally is a lot of confusion, naturally. This confusion seems to be a good selling point for postmenopausal hormone replacement therapy, especially as the safe use of bioidentical hormone therapies is discouraged, or worse yet, used improperly to achieve less than spectacular therapeutic results. Why the simple use of low-dose bioidentical hormone creams, varied in dosage as needed, combined with other phytohormonal therapies, such as lignans and DIM, herbs and other nutrients, as well as acupuncture stimulation, is not better utilized, despite the wealth of supporting evidence of effectiveness, is a big question.
    • Estradiol: there are 124 brand names for estradiol delivered by itself, including Vagifem, Encore, Estrace, Femestrol, Menorest, Ovocyclin, and Syndiol.
    • Estradiol combination drugs: there are 24 brand name mixtures containing estradiol benzoate, including Triphasil, Alesse, Tri-Cyclen Lo, and Brevicon. Often, the patient does not realize that they are taking estradiol benzoate. Yasmin, or Yaz, is a combination of estradiol ethinyl and drospirenone, a synthetic progestin, and is a widely prescribed oral contraceptive. Estradiol ethinyl is now the most prescribed form of synthetic estradiol or contraception, due to the slower breakdown in the liver, and increased reliability as a contraceptive. It was the first semisynthetic oral estrogen prescribed, but lost FDA approval in 2004 in the form of Estinyl.
    • Effects of estradiol benzoate: studies confirm that estradiol benzoate (EB) stimulates a dopaminergic mechanism in the brain. Dopamine is the main inhibitory neurotransmitter in the central nervous system, and is the target of many anti-depressants and anti-anxiety medications. EB is shown to inhibit prolactin release, and this mechanism is now linked to many psychological disorders, including depression and schizophrenia. This mechanism is normally blocked by increased noradrenergic activity, meaning that the adrenal gland usually will respond with increased function, unless there is adrenal insufficiency or endocrine deficiency. The endocrine system includes the pancreas (insulin mechanisms), thyroid, and hypothalamus. The hypothalamus is closely associated with the brain centers regulating mood and emotion.
    • Depending on the condition of the patient concerning adrenal insufficiency, hypothyroid states, or adult onset diabetes or metabolic disorder, or concerning the patient with chronic depression, anxiety, or the patient taking various medications for depression or anxiety, the effects of estradiol benzoate will vary. Since chronic narcotic pain medication use may also affect prolactin levels dramatically, this may increase the adverse effects of the EB use, and explain the percentage of women taking estradiol ethinyl plus drospirenone progestin that experience anovulation, or cessation of the menstruation (amenorrhea) due to excess prolactin and suppression of FSH.
    • Estrogen benzoate coupled with excess production of prolactin in breast tissue cells (endogenous prolactin): this combination has been studied to explain the increase in breast cancer incidence with chronic EB use.
    • Estrogen benzoate effects on the blood calcium levels: the endocrine system strives to tightly regulate blood calcium levels. Estrogen and parathyroid hormones are the main stimulators of this regulation along with hormonal Vitamin D3. Estrogen in the body consists of a family of chemicals, all interdependent and performing specific sets of tasks. Taking of synthetic estrogen benzoate will signal via a feedback system a decrease in production of estrogen family chemicals. Estrogen benzoate will not duplicate all of these chemical effects. The end result is a lack of sufficient regulation of many biological mechanisms in the body controlled by the estrogen family chemicals, including regulation of circulating calcium levels. It is very important to tightly regulate circulating calcium, since calcium is a very large molecule that is highly charged, and thus may easily lodge in the capillary beds of joints and in various tissues, especially when there is much muscular contraction or swelling that impinges the blood vessels. These calcium accumulations commonly lead to frozen shoulder, painfully inflamed tissues, muscle firing dysfunction, and decreased organ function.
    • Estradiol benzoate effects on the diuretic hormones and kidney function in relation to chronic hypertension and swelling: since EB affects the hypothalamus, which signals the release of antidiuretic hormone, this may contribute to hypertension and swelling. Estradiol benzoate is used as an intramuscular injection in an oily base to provide slow release for contraceptive purposes.
    • Estradiol benzoate effects on the thyroid function: thyroid function also is affected by the complex feedback mechanisms of the neuroendocrine system, with thyroid stimulating hormone regulating this function and this hormone regulated in the hypothalamus/pituitary gland complex that is directly affected by estradiol benzoate. Poor thyroid function may be the result of either direct thyroid dysfunction or problems with the hypothalamus/pituitary complex. Both the thyroid and its embedded parathyroid gland regulate circulating calcium levels, bone calcium deposition and absorption rate of calcium from the diet or supplement pills. In addition, the thyroid hormones regulate much of our metabolic rate, or overall energetic function in the body.
  • Estrone: the least prevalent of estrogenic hormones in the body, secreted by the ovaries mainly, acts as a stored precursor that converts to estradiol as needed; synthesized from androstenedione, a derivative of progesterone. Estrone sulfate is a long-lived estrogenic hormone.
  • Diethylstilbestrol (DES) and conjugated estrogens: conjugated estrogen typically is derived from a pregnant mare and the brand Premarin is given. It is predominantly composed of estrone. It has been used since 1942, and the FDA cites a Women's Health Study Initiative that shows that risks are similar to other synthetic estrogens, with increased risk of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosus in postmenopausal women using a combination of Premarin with medroxyprogesterone acetate during a 5 year period. DES was an early synthetic estrogen that was found to be a serious cause for birth defects when used to prevent miscarriage.
  • Estropipate: a salt of estrone sulfate, and thus a conjugated estrogen with the risks mentioned above.

Danish researchers in 2006 found that of 1925 men studied in military physicals, men conceived of women who had taken hormonal fertility treatments had 46% less sperm concentration in the testes, and slightly smaller testes (.9mm).

Certain estrogens have caused serious birth defects in humans, especially DES, with developmental problems in the reproductive & urinary tracts and cancers of the cervix and vagina developing at child bearing age.

CAUTIONS: risks must be weighed against the benefits

  • Growth of bones in children may be affected, as well as vaginal changes and vaginal bleeding in young girls.
  • Nursing mothers may easily pass the estrogens through the breast milk, causing problems in the infant.
  • Elderly people are especially sensitive to estrogen therapies and may easily develop side effects, especially stroke and heart problems, breast cancers and memory disorders.
  • Many medications may have negative interactions: acetaminophen (Tylenol), antibiotics, Tegretol, Antabuse, Depakote, Aldomet/methyldopa, Mellaril/phenothiazines/Compazine/Thorazine, anti-seizure medications/Dilantin, valproic acid.
  • Many medical problems may indicate a reason for caution or avoidance of hormone therapy: asthma, calcium imbalance, diabetes, high cholesterol or triglycerides, inflammatory disorders, thyroid deficiency, blood clotting, seizure disorders, heart problems, kidney problems, liver problems, migraines, autoimmune disorders, cancers, endometrioisis.

SIDE EFFECTS (listed on drugs.com):

  • Prolonged use increases risk of uterine cancers and breast cancers. Evidence published in the New England Journal of Medicine in 2009 confirms that cancer risk falls sharply when women stop synthetic hormone replacement. To see the latest findings, click here: http://news.bbc.co.uk/2/hi/health/7869679.stm
  • Increased blood clotting with HA, breast pain, vaginal bleeding, irregular menstrual bleeding, stomach pain.
  • Abdominal bloat, cramps, acid stomach, anxiety, backache, loosening of the skin, chest discomfort, decreased urinary flow, constipation, confusion, depression, loose stools, dry mouth, eye pain, heartburn, metallic taste, irregular heart beat or palpitations, muscle spasms, pain and/or numbness and tingling in the hands, feet, face, knees, groin, legs, calves, face, back or neck, pelvic pain, bladder pain, loss of appetite, nervousness, increase digestive gas, indigestion, stuffy nose, sudden sweating, insomnia, tiredness.

Depression in the use of hormonal replacement and oral contraceptives: This has been a major health problem linked to synthetic hormone use. Recent studies show that this is linked to induced metabolic deficiencies, especially Vitamin B6 pyroxidine, which leads to an increased excretion and deficiency of tryptophan (serotonin precursor) and methionine. Supplementation to correct these deficiencies has showed remarkable improvement. This link between the estradiol system and the serotonin system is also linked to chronic fatique syndrome and fibromyalgia, with hormonal synthetics creating problems in these complex systems.

Information Resources and Links to Scientific Studies

A number of FDA warnings were issued to the public in recent years concerning synthetic hormone drugs. These warnings reflect a conservative view on the risks and are naturally tempered by objections from the pharmaceutical manufacturers, who exert much influence on our government:

  1. A 2008 followup of the women in the 2002 Women's Health Initiative trial of synthetic progestiin estrogen hormone therapy, that was halted due to risk of breast cancer etc. for the women, shows that increased risk for breast cancer continues after halting the drugs, while benefits cease. This is from the National Cancer Institute: http://www.cancer.gov/ncicancerbulletin/NCI_Cancer_Bulletin_030408/page3
  2. The 2004 FDA warning concerning progestins and estrogen: http://www.fda.gov/cder/drug/infopage/estrogens_progestins/Q&A.htm
  3. The 2007 FDA warning concerning progestins and estrogen: http://www.fda.gov/cder/drug/infopage/estrogens_progestins/default.htm
  4. The 2011 review of cardiovascular risks associated with the newer drospirenone-containing oral contraceptives (Yasmin, Yaz et al) by Health Canada (a federal agency similar to the U.S. FDA) determined that without doubt these newer contraceptives are associated with a 1.5-3.0 times higher risk of blood clots than the older contraceptive hormones: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2011/2011_164-eng.php
  5. A 2011 report from Harvard Medical School noted that numerous studies have found evidence of accumulation of synthetic estrogen drugs in wastewater affecting wildlife, with increasing alarm that overprescription of many pharmaceuticals, which do not break down in water treatment, may be affecting the human population, especially children. While the present levels in drinking water of synthetic hormones and hormone-disrupting drugs are much smaller than naturally occurring estrogens and phytohormones, the fear is that while humans have adapted to natural hormones that synthetic hormones may present more difficult challenges to the human organism, especially in fetal and childhood developement: http://www.health.harvard.edu/newsletter_article/drugs-in-the-water
  6. A 2011 study at West Virginia University School of Medicine found that intravaginal curcumin cream effectively provided anti-fertility effects, completely blocked sperm motility and function, and protected against infection and HPV cancer: http://www.ncbi.nlm.nih.gov/pubmed/21337449
  7. A July 29, 2010 FDA warning on the potential for spray mist topical synthetic estradiol to cause adverse hormonal affects in children that come into physical contact with the patient, producing early puberty and abnormal breast growth, as well as other signs of hormonal imbalance, in both female and male children: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm220185.htm
  8. A report in 2010 in TIME magazine reveals that the incidence of girls reaching puberty between the age of 7 to 12 has doubled in recent years, compared to 1997. This high incidence is primarily in the Caucasian population, according to the Breast Cancer and the Environment Research Center, and reflects increased exposure to hormonal drugs and environmental chemicals, as well as the hormonal effects of metabolic sundrome in children: http:/www.time.com/time/health/article/0,8599,2009341,00.html
  9. Studies as far back as 1994 confirmed that progestins did not protect well against prescribed estrogen stimulation of endometrial tissue growth that is considered the mechanism of eventual cancer cause: http://www.ncbi.nlm.nih.gov/pubmed/7951564?dopt=Abstract
  10. A 2006 study at the Center for Clinical and Basic Research, Ballerup, Denmark, found that synthetic estradiol plus progestins present significant risks for patients with metabolic syndrome and insulin resistance: http://www.ncbi.nlm.nih.gov/pubmed/16766431
  11. Study findings regarding the rate of osteoporotic bone loss from DepoProvera, a progestin-only hormonal contraceptive injected every three months: http://www.nichd.nih.gov/news/releases/bone_loss.cfm
  12. FDA update warnings were issued in 2005 concerning the popular Ortho Evra contraceptive patch: http://www.fda.gov/bbs/topics/news/2005/NEW01262.html
  13. A 2016 comprehensive study on the use of the IUD in the U.S.A. between 2002 and 2012, by experts at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, U.S.A. showed that dramatically increased use of the IUD, which was so discouraged in 2002 due to the push to use the synthetic hormones extensively in contracption that the choice fell to less than 2 percent of women, was the main determinant of the great success in reducing unintended pregnancy and abortion rates, especially in teens, where the program to offer free IUDs and implants, funded completely by the wife of Waren Buffett, achieved a 40 reduction in teen births, pregancies and abortions, perhaps that most effective reduction in abortion seen in history. The use of the copper-releasing IUD does not involve synthetic hormones and is very effective and safe: http://www.ncbi.nlm.nih.gov/pubmed/27251204
  14. A 2008 comprehensive study of the use of tubal ligation, unfortunately still called "sterilization" in the U.S.A., by experts at the esteemed Brigham and Women's Hospital in Boston, Massachusetts, U.S.A. shows that this procedure, now usually performed as a minimally invasive laparoscopy, is the most chosen form of birth control, used by 37 percent of the female population, and is reversible at a high rate if performed properly, leaving more than 5 cm or fallopian tube: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492586/
  15. In 2009, the head researcher for the phase 2 and 3 clinical trials of the vaccine for human papilloma virus (HPV) spoke out with concerns about the efficacy of the vaccine strategy, effectiveness beyond 5 years, and the risk-versus-benefit of this strategy in the United States: http://www.cbsnews.com/stories/2009/08/19/cbsnews_investigates/main5253431.shtml
  16. An amazing amount of fraud in published studies of hormone replacement therapy in 2002 was uncovered by Charles Grassley and a senate committee, which uncovered direct manipulation of PremPro studies by Wyeth when HRT sales plummetted: http://www.startribune.com/business/37023559.html
  17. A study of estriol in the non-pregnant woman was conducted at the Boston University School of Medicine in 2010, showing that the estrogenic effects were probably mild in the non-pregnant pre-menopausal female, but could prove to make a significant contribution to the post-menopausal woman: http://jcem.endojournals.org/cgi/content/abstract/42/1/1
  18. A study of estriol in the non-pregnant woman was conducted in 1981 and published in the Annals of Clinical Biochemistry, showing that estriol, contrary to popular belief, comprised 80% of the total estrogens in the non-pregnant female: http://www.ncbi.nlm.nih.gov/pubmed/7283367
  19. A study of excess prolactin (hyperprolactinemia) coupled with deficient endogenous estrogen (which occurs with synthetic estradiol use) and the adverse effects on bone loss (osteoporosis and osteopenia) in premenopausal women, by the Massachusetts General Hospital, in 1988, showed that women with amenorrhea experienced significantly greater bone loss than women still having their menstrual period (eumenorrheic): http://www.ncbi.nlm.nih.gov/pubmed/3379129
  20. Guidelines for evaluation of amenorrhea (cessation of menstruation) by the University of Michigan Medical School, in 1996, suggest that serum prolactin and TSH should be assessed to determine ovarian suppression versus hypothalamic deficiency, and then estradiol and progesterone levels taken, followed by measurement of FSH and LH. A careful assessment and evaluation may guide the therapy to restore menstruation. While standard medicine only prescribes cyclic progestin to induce the menstrual cycle, Complementary Medicine offers and array of bioidentical hormones, herbs and nutrient medicines, as well as acupuncture, to restore hormonal balance, endocrine function, and normal menstrual cycle: http://www.ncbi.nlm.nih.gov/pubmed/8629565
  21. The exact cause of secondary amenorrhea induced by synthetic hormonal contraceptive is rarely explored, giving women little information on how to proceed with restoration once chronic anovulation has occurred. This 1990 study outlining a course of testing was performed in Mexico, and almost no published studies exist from the United States. Here, we see that a few tests, of serum prolactin, LH, FSH, with a GnRH challenge test, elucidated the source of the dysfunction, with a complete hormonal profile of estradiol, progesterone, cortisol, DHEAS, testosterone, TSH, fT3, fT4, further elucidating the assessment. Such tests are now available with active hormone metabolite panels at a reasonable cost. This integrated diagnosis and assessment could allow the patient to utilize Complementary Medicine to restore hormonal homeostasis: http://www.ncbi.nlm.nih.gov/pubmed/2127582
  22. A study of chronic estradiol exposure in laboratory animals at the Neuroendocrine Research Laboratory of Michigan State University in 2010 found that hyperprolactinemia, a cause of amenorrhea and anovulation, often occurs by affecting the hypothalamic function and dopaminergic system negatively, via oxidative stress. To effectively resolve this problem, restoration of hypothalamic function, stimulation of dopamine production, and resolution of oxidative stress need to be included in a comprehensive treatment protocol. Complementary Medicine may help achieve these treatment goals safely and effectively: http://ajpregu.physiology.org/content/300/3/R693.full
  23. A 2013 study at the David Geffen School of Medicine, the University of California at Los Angeles, California, found that women who failed to ovulate had a significantly higher risk of ovarian cancer, especially when polycystic ovarian syndrome occurred. These experts stated that use of a synthetic hormone oral contraceptive is thought protective against ovarian cancer, but that this should no longer be attributed to inducing anovulation, as has been widely professed by gynecologists, and may be due instead to suppression of gonadotropin secretion from the hypothalamus/pituitary: http://www.ncbi.nlm.nih.gov/pubmed/23624028
  24. A 1993 randomized and double-blinded clinical trial at the Institute of Pharmacological Research Mario Negri, in Milan, Italy, showed that Tamoxifen, and estrogen receptor antagonist widely used to prevent and treat breast cancer, showed no more efficacy than progestins in this regard, and with progestins now known to potentially increase the risk of breast cancer, this sheds some light on the failure of Tamoxifen that is largely ignored in standard medicine: http://www.ncbi.nlm.nih.gov/pubmed/8233291
  25. A 2013 review of scientific study of synthetic estrogen plus progestin and association with breast cancer risk, at the University of California at Los Angeles Medical Center, in California, U.S.A. concluded that this course of common hormonal therapy is associated with increased breast cancer risk: http://www.ncbi.nlm.nih.gov/pubmed/23543779
  26. This concise history of historical methods of contraception by the University of Illinois Chicago shows that a variety of herbal extracts and methods provided significant effects when well understood and used intelligently. Of course, lack of education and understanding of the physiology of conception has promoted a less thoughtful approach with just a single pill a day, but the lack of understanding of the adverse health effects and future risks involved is not ethical: http://www.uic.edu/classes/osci/osci590/13_2%20Birth%20Control%20in%20Antiquity.htm