Copyright ©2002. Winnifred Cutler, Ph.D. and Athena Institute for Women's Wellness
Dr. Cutler analyzes the Negative Effects of Menstrual Suppression via Contraception and certain HRT regimens that obliterate the natural cyclic rhythm of a woman's reproductive and consequent general health.
When Dr. Susan Rako, a well-known author/physician asked for Dr. Cutler's reaction to hormone regimens that suppress menses, the similar problem both for hormonal replacement therapy and contraceptive regimens emerged.
Read Dr. Cutler's summary for Dr. Rako's book; No More Periods...
"Physicians who care for women as patients should understand the interplay between sex hormones and their well-being. The peer-reviewed literature, whether focused on metabolic bone diseases, cardiovascular health, atherosclerotic processes, immunology, sexual response cycles, or studies of cognition, continues to reveal complex associations among physiology, behavior, and sex hormones. Cyclic secretions of estrogen, progesterone, testosterone, androstenedione, and DHEA(S) play significant roles in maintaining the cascade of physiological events that promote healthy bone metabolism, sexual interest and response, and cardiovascular function, as well as adequate sleep and energy cycles.
Ovarian hormones influence diverse neuroendocrine pathways: Beta endorphins, melatonin, oxytocin, growth hormone, prostaglandins, and the adrenal androgens (including DHEA{S}) are all increasingly being identified as intimately dependent upon the cyclic secretions of ovarian hormones. Excessively high or low levels of the hormones are associated with many diseases.
Estrogen has been shown to play a structural role in the central nervous system, interacting with progesterone to help maintain both nerves and myelinization. And now it seems that the cyclic progesterone of a fertile menstrual cycle is responsible for triggering other hormone secretions such as oxytocin which, in turn, enhances sexual sensation of uterine and breast tissue by enhancing contractility. Fertile cycles promote the excretion of sex-attractant pheromones. Oral contraceptives which are monophasic suppress (flatten) the cyclic rise and fall of sex hormones and have negative effects on sexual interest (libido), in contrast to the triphasics, which yield better sexual response in women.
Bones represent another concern (click for more). The life history of a healthy woman’s bone shows the period of rapid pubescent growth of long bones to conclude when the end-plates close shortly after puberty. Thereafter, provided her calcium intake exceeds the obligatory daily calcium excretion (estimated at about 600 mgs per day), and her health habits are good, with regular monthly ovulatory menstrual cycles, her bones continue to accrete mineral by thickening instead of lengthening through her mid-thirties. The thicker the bone she is able to build, the less vulnerable to fracture she will be during her menopausal years.
The regulation of bone remodeling involves a continual cycling of bone resorption and bone formation and is under the control of hormones and other factors that include: mechanical stress, inorganic phosphate levels, and plasma calcium levels. The rate of bone formation diminishes at the same time of life that the fertile rhythm of the menstrual cycle moves into the aging pattern of the perimenopausal transition years, usually around age 40. Once the dynamic process of bone resorption and bone formation are no longer closely linked (termed “uncoupled bone remodeling”) bone loss occurs.
Experts suggest that bone remodeling is closely coupled to the ovarian cycle of the fertile years, and that a high (29%) rate of ovulatory disturbance, generally unappreciated by either the woman or her physician, occurs in 20-45 year old healthy women. The consequence of these hidden ovulatory disturbances is a dramatically declining spinal bone density in young women. Young women develop old women’s bones. Progesterone in cyclic opposition to estrogen is not yet universally appreciated for its essential role in bone metabolism. Hence it is an informed concern that menstrual suppression will have long term negative effects on bone remodeling.
Traditional medical practices have long focused on disease treatment, which necessarily pays insufficient respect to the importance of learning how the exquisite female cycle, so rich and complex, may contribute to the increased life span women enjoy in comparison to their male counterparts.
The natural fertility cycle is a great gift of nature. Until each of the above captioned physiologic systems has been carefully tested for adverse effects of “menstrual or cycle suppression”, I would remind all of us of the wisdom of the Hippocratic Oath. ABOVE ALL DO NO HARM. For now, I would caution my daughters and granddaughters: Revel in the cycles of your youth. They are the key to your health, your sex attractant pheromones, your longevity, your very femininity. And model your HRT regimens to mimic the cyclic nature of a woman whether you do or do not still possess a uterus (click for more).1
For details about this reasoning please see the monograph (available in medical libraries or for purchase) linked below named Wellness in Women After 40 Years of Age.
Winnifred B. Cutler, Ph.D.
President and Founder
Athena Institute for Women ‘s Wellness
For more research on this topic by Dr. Cutler and Elizabeth Genovese M.D, with scientific references that support their conclusions. Please click on these links...
Wellness in Women after 40 Years of Age