What is estrogen?
Estrogen is the basic female hormone produced by the body. Synthetic estrogen or semisynthetic, which is made from the urine of pregnant mares, can be used to replace natural estrogen that diminishes when a woman reaches midlife. It is also commonly used in birth control pills that inhibit ovulation.
Last month the Food and Drug Administration required a warning for all prescriptions containing estrogen. What does this mean?
For the first time women taking estrogen pills for menstrual distress and menopausal problems must be told in plain language what the risks of these drugs are. Drug companies for years have sent lengthy, detailed reports to doctors advising of possible side effects. Now similar warnings, listing over 40 side effects, will be included in every estrogen prescription.
Is a warning against cancer included?
Yes. The FDA has finally conceded that estrogen drugs may cause cancer. The most serious risk is cancer of the lining of the uterus—and the risk is four and a half to 14 times greater than for a woman who has never taken estrogens. The risk increases if estrogens are used often and over a long period of time. Two other artificial hormones, androgen and progestin, carry different risks, but excluding the progestin used in the Pill, they are prescribed less frequently than estrogen.
Why is estrogen treatment dangerous?
Unlike many drugs that have a narrow function, hormones affect every cell in the body. Estrogen is often used on perfectly healthy women on a long-term basis, not for illness but to "stay young." Menopause isn't a disease. The longer a woman takes such hormones, the more each cell in her body is poisoned. I don't think that's too strong a word.
What will this new labeling mean?
Probably a lot of women will stop taking drugs that contain estrogen. Many will change doctors or be furious at those who reassured them over the years that estrogen hormones weren't dangerous. It ought to give any woman taking these drugs second and third thoughts: at least she'll have the information to decide for herself whether or not to risk her health.
What are the major side effects of estrogen?
Among the 40-odd listed are fatal blood clotting, gallbladder disease, heart attacks, elevated blood pressure, liver disorders, migraine headaches and severe mental depression. Menopausal estrogens have been recognized as factors in speeding up already existing hormone-dependent cancers such as some skin and liver cancers, and there are reports tentatively linking estrogens with breast and ovarian cancer. Every woman who takes these pills is walking around in an altered biochemical state.
Are there differences among estrogen products?
Yes, but it isn't clear yet what they are. All estrogens, synthetic or semisynthetic, have more or less the same effects. The FDA has now acknowledged that the risk established for any one product should be assumed for others. For example, the new "mini-Pill," which contains little or no estrogen, may prove to have fewer side effects, but the main ingredient of most birth control pills continues to be estrogen.
Of the products using estrogen, which is the most dangerous?
It is the first orally effective synthetic hormone ever made, called diethylstilbestrol, or DES. This was a popular medication given to thousands of women to prevent miscarriage in the '40s and '50s. Today the daughters of several million women exposed to DES face a higher risk of vaginal and cervical cancer, and some have died of it. There is still no national program to locate daughters for checkups, despite the fact that it has been linked to cancer in animals since the '30s.
Is DES still being prescribed to pre vent miscarriage?
Yes, occasionally. The main reason I wrote this book was to spread the warning to the new generation. It is urgent for any DES daughter to know that she was exposed and to begin checkups immediately.
If you think you may be a DES daughter, what should you do?
First, try to obtain your mother's medical records to find out what medication she received. Avoid any further exposure to estrogen, present in both the conventional birth control pill and the "morning-after" pill. Find a specialist to examine you for any abnormalities of the vagina or cervix. The daughter of any mother who took estrogen before the 18th week of pregnancy may have been affected by DES.
What do we know about the DES used as the morning-after pill?
It is being prescribed irresponsibly at some clinics and university health services as a postcoital contraceptive, despite the leading manufacturer's warning that it should not be used as such. Furthermore, there is no solid evidence that it works. What is particularly horrifying—and what most young women don't realize—is that if the morning-after pill doesn't work and she really is pregnant, she probably should abort. DES may already have caused abnormalities in the forming genital tissue of the unborn child.
Has reliance on the conventional birth control pill had other effects?
Yes, it is dangerous in more subtle ways as well. Even though the estrogen level in the Pill has been decreased, the emphasis on it as a contraceptive has downgraded much safer methods of birth control. We have raised a generation of young people who consider their only alternatives to be sterilization, pregnancy or the Pill. That simply isn't true.
What are the alternatives?
Young women don't know that the diaphragm, if fitted properly and used consistently, is virtually as effective as the Pill, and infinitely safer. So is the condom, properly used with a contraceptive foam as a backup. The cervical cap may be the ideal contraceptive, but it isn't manufactured in the U.S. There's little money in it for either doctors or drug companies.
A recent British study concludes that users of the Pill have a 40 percent higher death rate from circulatory diseases, including heart attacks, than nonusers. Do you feel vindicated?
I feel sad. I would prefer to be wrong. All our worst fears are coming true. I think the Pill may turn out to be the major medical disaster of the century. It may contribute to death in ways we are just learning about. For example, suicide is twice as high among Pill users.
Why are women willing to risk estrogen therapy?
It has been proved to be an aid for hot flashes associated with menopause—although we think now it may only postpone them—and for the vaginal discomforts of advancing age. It is often described as an elixir for being "feminine forever" or the "cure" for what is really a very natural process. What infuriates me is that women have been taught to be terrified of menopause, when the postmenstrual time can be one of the healthiest and most creative times of a woman's life.
What do you advocate instead?
A program of diet, exercise, vitamins and possibly some herbs that can reduce about 80 percent of menopausal and menstrual problems safely. Ginseng root and vitamin E, for example, are effective for hot flashes.
How can women help themselves?
By learning to trust what their bodies tell them. They should listen to their bodies' signals and cravings; talk to their women relatives; insist on being full partners with their gynecologists in their own health care and demand satisfactory answers. If not, they can change doctors, since there are plenty of informed ones around. Women must learn to take responsibility for their own health, instead of relying on a cure-all pill for eternal youth or a carefree sex life. There are safer options and alternatives for almost every purpose hormones are used for.
Barbara Seaman, 42, is a medical writer and editor, former advanced science writing fellow at Columbia University and a founder of the women's health movement. In two previous books, The Doctor's Case against the Pill (1969) and Free and Female (1972), she warned against the potential dangers of artificial hormones. Last month, in collaboration with her psychiatrist husband, Gideon Seaman, 48, head of psychopharmacology at New York's Creedmoor Psychiatric Center, she published the results of their 20-year study, Women and the Crisis in Sex Hormones (Rawson Associates, Inc., $12.95). In it she argues that women are risking their lives with estrogens and other hormones commonly prescribed for birth control, menstrual distress and menopause. With Sally Moore of PEOPLE, Barbara Seaman recently discussed those risks and offered some alternatives.