The Estrogen Myth in Boston

by Jerilynn C. Prior
Thoughts on my 40-year MD graduation visit to Boston Medical Center

Last week I was the guest speaker at “Grand Rounds” (meaning the major, usually weekly, academic lecture) in the department of Obstetrics and Gynecology at my alma mater. This was an important occasion for me personally, because I became a physician at Boston University 40 years ago this year.

Besides being very happy to have the opportunity to return to Boston and to speak in the school where I graduated, I was also apprehensive. How would this upscale medical community in Boston, the “Medical Mecca” of the Western world, view this woman professor from Vancouver, Canada? How would these gynecologists, who traditionally love estrogen and accuse progesterone, approach my new book—The Estrogen Errors—Why Progesterone is Better for Women’s Health? But most of all, I was concerned because—I admit, stubbornly—I vowed to present what I know, and to say what I believe. Therefore, the title of my talk was “The Estrogen Myth—Implications for Perimenopause and Hot Flushes.”

I became even more apprehensive in the week before my talk when I received a form to complete and sign that outlined my conflicts of interest. Normally, those forms are simple for me—I have no shares in, and personally receive no honoraria, research funds or consultant fees from pharmaceutical manufacturers. I usually just scrawl “None” across such forms. However, being more alert and quite excited about a Boston visit, I read the form carefully and got a major shock. The form required me to declare and sign saying that everything that I would present “had been peer reviewed!” “Peer reviewed” is a term that means it has been published in a peer-reviewed medical journal.

My experience with peer review is that it is biased in favour of estrogen—as I outline in “The Estrogen Conspiracy” Afterword to The Estrogen Errors. My experience is nine rejections on a randomized, double-blind, placebo-controlled trial showing that cyclic medroxyprogesterone treatment significantly increased bone density. I also know that it took almost 13 years and more than two dozen rejections by such medical journals before I could get published a double-blind, randomized trial showing that medroxyprogesterone was as effective for hot flushes as estrogen.

I have written nothing peer-reviewed about The Estrogen Myth and am unlikely to be able to unless the current women’s health paradigm changes. If I signed that form I could not talk about evidence that oral micronized progesterone helps hot flushes and night sweats because we’ve not yet published the results of our just-completed randomized, controlled trial. After a lot of anguish, I answered that conflict-of-interest form by protesting to the Chief in an email that new hypotheses and ideas involve complex integration of clinical, theoretical and published data, and were rarely published or peer reviewed. So I declared “when I am presenting peer-reviewed data, I’d indicate that by providing a reference.” But I didn’t say I would avoid talking about new ideas and clinical information.

My apprehension was needless. I was warmly introduced by Dr. Linda Heffner, the Head of Obstetrics and Gynecology who mentioned the Centre for Menstrual Cycle and Ovulation Research and the CeMCOR website, as well as my position and publications. The audience was composed of a full room and some standing of white-coated folks, including midwives, students and professors, and was more than half women. They listened intently, asked good questions, and were open to my ideas. But they indicated that they would treat a 42-year old regularly menstruating woman with heavy flow and night sweats with the birth control pill even though there is no evidence that oral contraceptives are safe or effective in perimenopause. They also indicated that they would not think to use medroxyprogesterone for treatment of menopausal hot flushes, even though there are six randomized, controlled trials saying it is highly effective.

I walked through the golden leaves and past 7 Worchester Square—my old $17/week fourth floor walk-up flat-with-bathroom-down-the-hall—that area is now unrecognizably gentrified. I met a colleague committed to exercise as a way to health at a Starbucks near Harvard School of Public Health. And I gave a small but rewarding seminar for some researchers at the Connor’s Research Center for Women’s Health at Harvard Medical School. A highlight of the trip was a lovely dinner at the home of Judy Norsigian, executive director of Our Bodies Ourselves (formerly Boston Women’s Health Book Collective) and a few women in that group. I also got lost trying to find 1620 Tremont Street because it changes its name three times as it circles its way from downtown to Harvard. (I found the street naming and numbers in Boston totally wacky to my grid-accustomed mind.) I lugged copies of The Estrogen Errors and Estrogen’s Storm Season to give to the Boston University Medical Library, Harvard School of Public Health and individuals who were grateful to receive them.

All in all, my Boston trip was an amazing experience—I revisited my life as a penniless student, traced my steps of 40 years ago, going to the end of the MBTA subway lines just for the fun of it and walking for hours through what is now parkland following the Fens (a formerly wild and muddy waterway) that eventually ends in the Charles River. I spoke with a lot of people from all walks of life. And I left bookmarks for The Estrogen Errors at the many bookstores and colleges and libraries I passed in my travels. In short, I feel like I have the sown seeds of change in women’s health.