April 2013 - Page 2 of 2 - Hormones Matter

Unnecessary Hysterectomy

by WS

Published on April 11, 2013

10906 views

I became a “sitting duck” for the hysterectomy industry after experiencing a day of unremitting abdominal pain. Having never experienced female problems before, this had me concerned. So off I went to my gynecologist, a man I’d respected for 20 years, the man who’d treated me for infertility and saved me from another c-section by doing VBAC (Vaginal Birth After C-section). So the stage was set.

An ultrasound showed a large, complex ovarian cyst. My gynecologist said that “everything must be removed” and scheduled surgery. Of course, I was in shock and didn’t even know what to ask. He referred me to an oncologist for consultation who said he couldn’t tell if it was cancer and then quickly disappeared giving me no chance to ask questions. I went back to my gynecologist with a list of questions asking why I needed other organs removed. Unbeknownst to me, I was lied to about my condition (as later discovered from my medical records).

Although my barely audible inner voice told me something wasn’t right, I dismissed it telling myself that I had a good, reputable doctor who wouldn’t needlessly remove organs. I also convinced myself that a surgery that’s so common can’t possibly be all that bad. And ovarian cancer is often deadly. I mistakenly listened to family and friends who urged me not to delay surgery.

Fast forward to the day of surgery: There were residents surrounding my bed in pre-op. I didn’t recall this ever being mentioned or on any of the “consent” forms. I didn’t even know it was (is) a teaching hospital because it’s not affiliated with any university.

The surgical recovery was easy for me. However, it became clear very quickly that I had become a different person. I felt like my HEART and SOUL were removed in that operating room. Despite being prescribed estrogen, everything fell apart. I quickly spiraled into a suicidal depression, couldn’t sleep more than two or three hours at a time, with a lengthy list of symptoms of hormonal deficiency and endocrine havoc. I also developed rather severe diarrhea. By 4 months post-op, I’d aged about 15 years from massive hair, skin collagen, and muscle mass loss. Yet a call to my gynecologist/surgeon resulted in being told “we’ve never heard of those problems before” followed by the phone being hung up. He’d now abandoned me as his patient.

I could barely function and was holding onto my job by the skin of my teeth. I became a recluse going to great lengths to avoid running into people. And when I did, I could see the shock on their faces. Thankfully, my husband took on the household and minimal child care duties (my children were older) but I missed out on years of my children’s lives. Once I finally found a doctor who would “dole out” more estrogen, I could at least do basic daily functions. But the taken-for-granted, joy-filled days from when I was intact seem to be gone forever. I don’t even have the strong feelings of love for my family any more. Seven years after that fateful day, I still mourn the many losses caused by the removal of the organs that were so essential to every aspect of my being, the ones that made me female in every sense of the word.

What I found in my medical records and through research was eye-opening. All my female organs were removed to help gynecology residents meet their surgical requirements. Sadly, Graduate Medical Education (GME) accreditation requirements emphasize hysterectomy to the exclusion of organ-sparing procedures. And the hospital’s GME website stated that hysterectomies are the “bread and butter” of gynecological training.

I wonder how much my gynecologist was paid to train these residents? My records from the oncologist show that he enabled my gynecologist. I also question what was submitted to my insurance company for them to authorize “hysterectomy” because there was absolutely NOTHING wrong with my uterus (or my other ovary). Based on all my research and the experiences of scores of other women, if one female organ is being removed, it’s acceptable to remove them all. Insurance authorization and hospital consent forms are designed to allow this. This doesn’t make sense. I wonder if prostatectomy consent forms allow removal of testicles?

The hormonal effects of ovary removal are far more understood and acknowledged. But the anatomical and skeletal effects, not so much. So my next article will talk about these changes.

Hormones Matter^TM is conducting research about hysterectomy. If you have had hysterectomy, please take a few minutes to complete this important survey. Then share the survey link with all of your friends. These data could save the life of another women. The Hysterectomy Survey.

To learn more about our research, click Take a Health Survey and sign up for our newsletter for updates on the latest research and new surveys.

Menopause, Migraines and My Empty Nest

by Nancy Bonk

Published on April 10, 2013

2360 views

While growing up three things I never thought about were migraines, menopause and having an ’empty nest.’ What I did think about were the clothes I wore to school, whether or not I had the “in” purse, how not to get my period in school and how my hair looked. When I had a migraine it was around my period and I was able to tend to it with over-the- counter medications. As I got older, my thoughts turned to my education and career goals. At some point I assumed I would get married, but only after I was set in my career. Nowhere in my ‘plan’ were children included – I just wasn’t going to have any. After high school I went to college to pursue a degree in music education. But as I’ve come to find out, life rarely goes according to any plans I’ve set.

In the middle of my sophomore in college as a music education major, I discovered I didn’t have the patience to teach music to a classroom full of squiggly little children. This confirmed my feelings that motherhood wasn’t for me. My new major in music business would be a great start in become a manager of an orchestra, or at least that was the plan. My college internship at ICM Artists (now Opus 3 Artists) in New York City was an amazing experience and my plan was set in action. But somewhere along the line I met Michael and my world turned upside down. We fell in love, graduated from college and got married. After my internship I came right home and got married – what was I thinking?

Anyways, as we settled into our lives and careers life was very good. Michael was a math teacher and I was in music administration. Suddenly after four years of marriage, my biological clock starting ticking and I wanted a baby. Soon after our beautiful daughter Sarah was born and motherhood became my new career path and passion – I was now a stay-at-home-mom. Five and a half years later, our wonderful son Samuel was came along and our nest was complete and together we raised our two gems. Motherhood and migraines seemed to be manageable during this time.

But once again, my life abruptly changed when I sustained a traumatic brain injury or TBI. You can read more about my history here. Somehow my family muddled through the chronic pain I battled and still do but no without the support of a husband. It was too much for him, so after nearly 25 years of marriage my role as a wife was over. Two things that remained constant in my life were migraines (which increased dramatically since I fell) and motherhood.

Motherhood is something I took (and still do) very seriously and went about in a “traditional” manner. My job was not to be best friends with my children, rather their mother who went about setting limits and boundaries with patience and love – most of the time. My children often heard “I’m not interested in what Bobby and the rest of your friends are doing, YOU aren’t allowed to do that.” Difficult decisions were made on a daily basis they didn’t like. For example, no PG-14 rated movies until they turned 14; no sleep over’s unless I’d already been to the house and knew the parents; shorter curfews compared to their friends, you get the picture – I was pretty strict. When my 18-year-old comes home at his assigned curfew I always get a good night kiss no matter what time it is. This way I can “see” and “smell” any signs if he has made any poor choices. So far, so good.

But the thing is Sam graduates from high school this June and is off to college in the fall. Even in chronic pain, motherhood has always been my primary function. I felt it’s important to raise children who would become respectful, independent, loyal, compassionate and loving adults, which they both are. When Sam leaves for college this fall, is my role of mother finished? I feel like I’ve been working on a ‘project’ for 23 years and its coming to an end. It feels like I’m about to make the final presentation for this project, and then, it’s over. Is this what an ’empty nest’ feels like? A glorious ‘project’ that is done? Within the last three years my role as a mother and a wife feel like they have been ripped from me. I’m thrilled that my children have made it through and turned out “OK” after surviving a crummy divorce and elated they are both starting new chapters in their lives. But this emptiness I am starting to feel is totally unexpected.

So here’s the thing – how do I fill my nest and figure out who am I now? Where to start -how does a disabled woman in chronic pain redefine themselves after being a stay-at-home-mom for 23 years? There are plenty of mothers who go back to school and find a new full time career or go back into the career they had before they became mother, but that’s not me. Battling chronic pain each day and taking it one day at a time may be the path to stay on for the moment. Because other than that, I really have no clue where to go from here.

Hormones, Hysterectomy and the Hippocampus

by Chandler Marrs, PhD

Published on April 5, 2013

6016 views

hormones, hysterectomy and the hippocampus

New research, conducted on rodents, suggests that pre-menopausal hysterectomy with ovariectomy induces changes in the hippocampus (memory center of brain) making it hypersensitive to ischemic stressors (reduced blood flow). In contrast, ischemic stressors did not cause hippocampal damage in non-ovariectomized female rats or even gonadectomized male rats

The hippocampus, located in the temporal lobe of the brain, is responsible for working memory formation, storage and retrieval. Researchers have long known that damage to cells in the hippocampus cause significant problems in short-term, long-term and working memory, ranging from mild cognitive decline to complete impairment. Certain cells in the hippocampus are particularly sensitive to the amyloid protein buildup associated with Alzheimer’s disease.

In the current study, removal of the ovaries and the associated long-term estradiol deprivation made the hippocampus hypersensitive to ischemic stressors and induced a myriad of events leading to significant hippocampal CA3 cell damage and cell death. The long term estradiol deprivation also led to increased amyloid production and associated neurodegeneration. As one might expect, damage and disruption to the hippocampus, the brain’s memory center, was associated with the animal’s ability to learn, remember and function.

What was particularly interesting, female animals who retained their ovaries and were exposed to the same ischemic stressor demonstrated neither the brain damage nor the decline in cognitive function. Similarly, male animals whose gonads were removed, suffered no notable brain damage or cognitive decline either. It was only the female animals whose ovaries were removed and whose systems were deprived of estradiol for a long period of time.

When estradiol was added back to the ovariectomized female animals shortly after the surgery, the female animals were able to weather the ischemic stressor and hippocampal damage was reduced significantly. However, when the estradiol was added back after an extended period of deprivation, it had no effect on the hippocampal damage or subsequent decline in memory.

Estradiol is important for cognitive function.

It is important to note, that animal researchers use 17B-estradiol, the same form of estradiol produced in the ovaries. In contrast, researchers who study human memory, often supplement with synthetic estrogens (Premarin, Prempro etc.), which is molecularly different than what is produced in our bodies. Indeed, the synthetic estrogen is actually about 20 different estrogenic compounds synthesized from pregnant horse urine. With synthetic hormone replacement therapy (HRT), recently renamed menopausal hormone therapy (MHT), the difference in molecular structure, as well as the long chain of metabolites that MHT produces, lead to an increase in the number of illnesses and may or may not be protective against the diminished estradiol induced hippocampal damage or the associated cognitive decline.

Oxytocin Impacts Our Response to Advertisements

by Denise McKee PhD

Published on April 3, 2013

2011 views

In a previous blog, I spoke about oxytocin and how it’s commonly referred to as loving or bonding hormone. Oxytocin also seems to be responsible for trust and empathy between human beings (as well as in other animals). That begs the question; can oxytocin persuade our decisions?

Most likely. In a recent study published at PLoS One by Lin et al, researchers discovered that oxytocin effects men’s choice in donating after viewing public service announcements (PSAs). Oxytocin increased the likelihood of donating to a PSA by 12% and increased donation amount by 56%.

Testing Method

Forty healthy males were infused intranasally with 40 IU of oxytocin or saline, then placed into separate cubbies to watch PSAs to reduce smoking, drinking, speeding and global warming. After, males were asked questions regarding the PSA in order to earn cash, $5 per correct answer for the chance to win up to $100. Obviously, the cash prize was an incentive to participate in the study.

After they earned their money, male participants were shown PSAs of well-known charities and were given the opportunity to donate their newly received earnings.

Results

The group given saline donated to 21% of the PSAs, compared to the group given oxytocin that donated to 33% of them. On average, the oxytocin group donated 56% more than the saline group. Male participants who received oxytocin were not affected by PSAs in the same manner. Instead, participants were only affected by PSAs that personally resonated with them.

Similar effects likely would be seen in women as well. These effects would very depending upon the stage of the menstrual cycle, which was one of the reasons why women were not used in the study. Since women release more oxytocin than men in response to a stimulus, it is possible that women would have a more intense empathetic response to the PSAs.

Implications

Be aware of your oxytocin levels when watching PSAs and commercial advertisements! Just kidding, well kind of. Being aware of how our bodies innately respond to the world around us allows us to make conscious decisions. Knowing that there are strategies to advertising which provokes emotions that make us want to buy a product could be useful while watching commercial-interrupted TV.

From making sure we are donating our money to the best causes to making sure we are picking the right partner (because if not oxytocin can bond you to a jerk), indeed, hormones do matter!

Of BPA and Endocrine Disruptors: New Research, Same Flaws

by Chandler Marrs, PhD

Published on April 3, 2013

3596 views

Bisphenol A or BPA is the ubiquitous estrogenic compound used to create plastics. It leaches into our food stuffs and because of its hormone-like qualities elicits a myriad of health issues in adults but especially in children and most especially when exposed in utero or during key developmental phases.

As we cover the expanding research base on BPA, it becomes increasingly clear that traditional methods of toxicology do not work for understanding endocrine disruptors – the man-made chemicals that alter our hormone pathways . A case in point, the latest research on BPA.

Exposure in Adults

A report published online in June of 2011 and presented at a prominent toxicology conference in February 2013, measured BPA exposure levels over a 24-hour period in adults fed a high BPA diet (lots of canned food and water from plastic bottles). The report showed that the concentration of BPA measured from blood was below the level of detection in most of the study participants, even though urine concentrations were extremely high and indicated exposure levels above the 95th percentile of the US population.

From urine tests, researchers were able to detect an average 84% – 97% of the dosed BPA and its metabolite, BPA glucuronide – indicating a high rate of clearance from the body. The ranges varied widely by time of day (morning tests showed significantly less clearance) and gender of participant (women did not process the hormone as well as men).

The researchers argue that their failure to detect BPA in blood, combined with the high concentration in the urine meant that risk was minimal. Their reasoning, even though BPA exposure was high, most of the BPA was cleared from the body rapidly and efficiently; no harm, no foul.

Medical and science marketers latched on to this and soon every major and minor media outlet was reporting that risks were minimal. Here are just a few headlines.

No Ill Effects Found in Human BPA Exposure, says the Wall Street Journal

Majestically Scientific Federal Study on BPA has Stunning Findings: So Why is the Media Ignoring it? – says Forbes

No toxic effects from controversial food packet, says expert – the Guardian

Ahh, where to begin?

Flaws in the Research

Conflicts of interest. Always look for industry sponsorship of for research, see my previous post on evaluating endocrine research for details. The relationship between the investigators in the present study and industry are muddled, but they do exist. For more information, click here.

Below the level of detection. When researchers report that their tests are unable to detect a visible pathology or measure a particular compound that any reasonable person would expect to be present, the test is likely at fault. Below the level of detection, means just that. It does not mean the compound was not present or that it was not exerting effects, only that the tests were not sensitive enough to measure the compound. This was case here and I suspect as testing methods improve, we’ll see higher detection levels in blood.

High clearance is not the same as never exposed. In this study, not all of the hormone was recovered in the urine, only an average of 84% – 97%. That sounds like a lot. With hormones, however, small amounts do great damage. Why? Because steroid hormones are stored in fat (and other tissues). They accumulate over time and metabolize into a myriad of different hormones (metabolites), some more potent than the parent compound. After the initial exposure and certainly after repeated exposures, our bodies become little (or big) hormone factories, storing and creating more and more hormones and hormone metabolites.

Metabolites matter. Hormones are shape shifters. Every time they meet an enzyme, the interaction between the enzyme and the hormone creates a new, similar, but differently shaped hormone. Hormones are never ‘one and done’ metabolizers. Even though a large percentage of the original hormone and its primary clearance metabolite were measured from urine in the present study, one cannot assume that there were not still other metabolites circulating within the body and wreaking havoc.

BPA has metabolites. This is critical and often ignored in toxicology research. BPA is a hormone like substance and as such, it metabolizes into many different forms. BPA has metabolites that are more potent than BPA itself. New research shows that BPA metabolizes into a compound called 4-methyl-2,4-bis(4-hydroxyphenl)pent-1-ene or MBP for short. MBP is 1000-fold stronger than BPA in its estrogenic effects. MBP binds strongly to both types of estrogen receptors (ERa and ERb) and may change the activity of the cell, displacing native or endogenous estradiol. So within that 3%-16% range of BPA not cleared, comes a compound 1000 times stronger than the BPA itself. As the research progresses, who knows how many other active and potent metabolites from BPA or MBP we’ll see. With hormones, nothing is simple or straightforward.

What this Means

Avoid medical marketing, it’s usually incorrect. Learn how to evaluate endocrine disruptor research. Once you get the hang of it, you’ll be able to dismiss faulty research at a glance. More importantly, learn about hormone systems and environmental hormone disrupting chemicals. Otherwise, our children will bear the brunt of our ignorance.

A good review article: Bisphenol A and the Great Divide: A Review of Controversies in the Field of Endocrine Disruption.

Gynecologists, What’s Your Problem With Our Ovaries?

by Robin Karr

Published on April 1, 2013

3314 views

The New York Times recently reported that only 37% of women receive proper treatment for ovarian cancer, mostly because gynecologists do not follow guidelines set out by ACOG (American Congress of Obstetricians and Gynecologists) and the NCCN (National Comprehensive Cancer Network). This information was taken from a study led by Dr. Robert E. Bristow, director of gynecologic oncology at the University of California, Irvine. Sadly, the study revealed that most women with ovarian cancer or a suspicion of ovarian cancer are simply not being directed to surgeons who specialize in treating cancer and specifically, gynecologic cancers.

According to Dr. Bristow, just making sure women get to the people who are trained to take care of them would improve the odds in the fight against ovarian cancer than any new chemotherapy drug or biological agent. Even ACOG agrees that women with pelvic masses indicating a high suspicion for ovarian cancer should be managed by physicians with the training and experience that offers the best chance for a successful outcome. Generally speaking, OBGYN’s lack this type of experience because ovarian cancer is so rare. Shockingly, more than 80% of the women in the study were treated by what the researchers call ‘low volume providers’ – surgeons with 10 or fewer cases a year and hospitals with 20 or fewer.

This story really hit a nerve with me for many reasons, but mainly because the guidelines are being ignored. Most women do not know that they need to be referred to a gynecologist specializing in oncology and it appears most docs are none to keen to tell them. These aren’t the only guidelines gynecologists ignore, by the way. When one considers that only 30% of OB/Gyn clinical practice guidelines have actual evidence behind them, it makes me wonder what the heck is going on with women’s healthcare today.

When I read that only 37% of women with ovarian cancer were receiving the proper care, I immediately thought of how I was subjected to improper clinical care. You can read my full history here.

Briefly, my healthy ovaries were removed during a routine hysterectomy, placing me at a much greater risk for heart disease. The removal of my ovaries and in fact the hysterectomy itself, was against clinical guidelines.

Women with ovarian cancer rarely receive proper treatment while women with no cancer often receive radical over-treatment.

Houston, we have a problem! When it comes to women’s ovaries, gynecologists too often just can’t get it right. Or maybe they just don’t want to… Of the 600,000 hysterectomies performed each year, 73% are estimated to involve ovary removal. Since 90% of all hysterectomies are considered to be medically unnecessary in the first place, this is a huge problem. Even more disturbing is the fact that less than 1% of women whose healthy ovaries are removed have a family history of ovarian cancer. One has to ask why gynecologists are routinely removing healthy ovaries from so many women – especially given the many serious health risks.

There are guidelines in place regarding the indication for hysterectomy and ovary removal. Yet, those guidelines are not followed. A whopping 76% of hysterectomies do not meet ACOG’s own criteria. The most common reasons hysterectomies don’t meet criteria and are considered to be inappropriate are lack of adequate diagnostic evaluation and failure to try alternative treatments before hysterectomy.

Gynecologists routinely rush women into surgery without trying other options first, including doing nothing other than ‘watch and wait’ in some cases. Clearly, women aren’t receiving proper care all the way around regarding ovarian cancer nor are they being properly informed about the alternatives to hysterectomy. Whether we’re talking about birth control, HRT, ovarian cancer or hysterectomy, it pays for women to become educated about their health and their healthcare options. It may save their life.

A Global Contamination: Persistent Organic Pollutants

by Lauren Chmiel

Published on April 1, 2013

2047 views

For personal reasons, I have been investigating environmental toxins and their effects on hormonal, neurological and reproductive health. The bioaccumulation of Persistent Organic Pollutants (POPs) within our bodies and the proliferation of POPs across the entire planet is frightening, but like most, I was not aware of the dangers. Despite the abundance of research linking POPs to many of the health epidemics we face here in the United States, such as Type II Diabetes and obesity, the public’s attention has not been directed to this man-made creation. Here is some of the research I found on persistent organic pollutants and what is being done to control our exposure to them.

What are Persistent Organic Pollutants?

Persistent Organic Pollutants, or POPs, are a number of organic (mostly man-made) compounds resistant to degradation by natural environmental processes. A number of POPs became widely utilized during the increase in industrial production post-World War II, a time when thousands of chemicals were introduced into commercial use. Many of these chemicals were proven effective in pest and disease control, crop production, manufacturing and industrial processes. Also in existence are a number of POPs which are “unintentionally produced chemicals” as the result of combustion (e.g., trash burning or municipal/medical waste incineration).

Why are Persistent Organic Pollutants So Bad?

Since they cannot be broken down via natural degradation in the environment, they are transported by wind and water. POPs are known for bioaccumulation in human and animal tissue and have become a part of the food chain, affecting all life on earth. Isolated communities, such as indigenous populations in the Arctic Circle, have a particularly high exposure risk to POPs. POPs have been linked to disruption of our endocrine, reproductive and immune systems, neurological problems, diabetes, obesity and cancer. According to The United Nations Industrial Development Organization (UNIDO), the international community has been calling for “urgent global actions to reduce and eliminate releases of these chemicals.” A number of POPs are compounds the reader may be familiar with, such as DDT, PCBs, and HCH.

“The Dirty Dozen” and the Stockholm Convention

Coordinated by the United Nations Environment Programme (UNEP), The Stockholm Convention serves as “a global legally-binding instrument for targeting persistent organic pollutants.” The purpose of the Convention is to direct us toward a future free of POPs and re-shape the global economy in order to eliminate reliance on such dangerous pollutants.

The Convention initially identified twelve POPs (“The Dirty Dozen”) considered to be the most detrimental to the well-being of humans, animals and the environment. This measure created a system that allows for a greater number of chemicals to be identified as “unacceptably hazardous.” In accordance with the Convention, governments are obliged to eliminate or reduce the introduction of POPs into the environment. Such is done by channeling resources into “cleaning up existing stockpiles and dumps of POPs that litter the world’s landscapes.” The Convention was ratified May 17, 2004, with 150 signatory countries. As of February 20, 2013, Afghanistan acceded to the Convention as its 179th party. According to Kyoto Energy, the Convention aims to prohibit the production of POPs, with the exception of equipment currently in use; they have set a deadline for the elimination of the remaining usage for 2025.

Destroying and Transforming POPs in the Environment

The UNIDO website suggests that POPs stockpiles “must be destroyed in a manner which does not further degrade the environment by generating or releasing POPs.” The Convention calls for community participation, safety of the community, full disclosure of information, monitoring and release of data.

Details regarding the destruction process on the UNIDO website are vague; they suggest that traditional methods use “landfilling, ground storage, deepwell injection and combustion by open burning, incineration or in cement kilns or metal furnaces.” UNIDO stresses that there are “serious limitations” to the “normal incineration process,” considering that incineration can lead to the creation of dioxins, PCBs and HCBs. The quantities of POPs are rather difficult to estimate; almost no inventory exists. Kyoto Energy estimates that one million tons of PCBs and 100,000 tons of obsolete pesticides exist within countries that are not member to the Organization for Economic Co-operation and Development (OECD).

Are We Burying POPs for Future Generations?

Many of these methods do not entirely eliminate the problem. Rather, we are, quite literally, burying them for future generations to deal with – if we don’t burn this stuff and release it into the atmosphere first.

The United Nations Environment Programme (UNEP) suggests that high temperature incinerators, incineration in cement kilns and chemical treatment are proven methods of destruction. There is no evidence of this being true, and most research indicates that POPs are created as a result of incineration.

A number of countries have continued to produce POPs such as DDT, with a staggering 3,314 tons (7,306,119 pounds) produced globally in 2009. On the bright side, this signifies a 43% reduction in DDT production from 2007. Considering the stability of POPs (i.e., resistant to degradation), it’s difficult to imagine any concerted effort can “undo” the damage that has already been dealt to the planet, especially since a number of POPs like DDT continue to be produced and exported in such exorbitant quantities.

It’s time to rethink our reliance on dangerous chemicals and the industries that use them. Though, many of these chemicals were developed before we understood their dangers, now that we know, it is difficult to support their continued use. With all of the advances in science, one would think we could design better, safer tools for industry, than the non-degradable, persistent organic pollutants we have now.

April 2013 - Page 2

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Testing Method

Results

Implications

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Exposure in Adults

Flaws in the Research

What this Means

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What are Persistent Organic Pollutants?

Why are Persistent Organic Pollutants So Bad?

“The Dirty Dozen” and the Stockholm Convention

Destroying and Transforming POPs in the Environment

Are We Burying POPs for Future Generations?

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