Thanks to recent published reports, specifically one entitled “The Hormone Hoax Thousands Fall For” in the October 2013 issue of More, assumptions about the safety of bio-identical hormone therapy (BHT) are again being called into question.

First comes the issue of the descriptor:  bio-identical makes it sound safer, less synthetic than any manufactured counterpart, and more natural.  But the reality is that none of those things is necessarily true.  The report in More exposes the fact that a compounding pharmacy is usually involved in the production of BHT, and these facilities are simply not regulated, monitored or required to provide the appropriate disclosures that manufactured treatments must carry.  This has led to the somewhat widespread belief that BHT is a far superior choice than traditional hormone therapy that undergoes stringent FDA approval processes.

I’m pleased to have been asked to comment for the article in More, as it gives me the chance to point out to patients that compounded BHT is not a better option, as is often assumed.  It’s another one of those instances that demonstrate patients need to seek advice from a knowledgeable health professional who can provide direction based on real expertise.  Without that, especially in the case of BHT, it is simply too easy to be influenced by marketing methods that fail to disclose some critical information.

 

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Eleven years after frightening findings in the Women’s Health Initiative caused so many women to abandon hormone therapy, medical practitioners continue to find benefits of hormone replacement therapy (HRT) for a wide variety of patients.

When the study’s findings were first reported in 2002, it created quite a scare about the detrimental impact of HRT. Millions of women, alarmed about the reports of higher risk of coronary disease, breast cancer, stroke and pulmonary embolism abruptly stopped treatments for fear that the risks far outweighed the benefits. In fact, the findings were so negative that the study, involving more than 16-thousand women between 50 and 79 years old, was halted three years earlier than planned so as to avoid further harm to the participants.

The practice of supplementing the sex hormones including estrogen, progesterone and testosterone, commonly referred to as HRT, had benefitted scores of post-menopausal women. They had suffered through a myriad of physical symptoms from the hormone imbalance and these therapies provided much-needed relief. That is, until the study suggested far more serious problems from the therapy than those encountered as a result of hormone loss.

Now that researchers and analysts have the benefit of hindsight and further study, it appears that the initial findings that caused a 70 percent reduction in prescriptions written for HRT may have been flawed in some areas. There is a growing number of doctors and other medical professionals who insist that HRT is still a viable option for many patients. They cite differences in risk based on age groupings, a factor that some believe wasn’t adequately considered in the original study. Specifically, they find that the risk factors increase for women who were deficient in their hormone support for a longer period of time. Conversely, for women in the younger age ranges of post-menopausal patients, there seemed to be no increased risk for the breast cancer, strokes, blood clots, heart attacks and gallbladder disease.

The advice is clear for women who’ve had a diagnosis of breast cancer – it is ill-advised to supplement hormone levels. But the drop in hormone levels that can impact diabetes, hyper- or hypo-thyroidism and adrenal fatigue can be successfully adjusted with HRT for large groups of women…and eleven years later, it appears that the alarm of 2002’s landmark study is fading into a more proper perspective.

 

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The use of testosterone as a form of hormone replacement for women emerges from time to time in the mainstream media as a little used, but effective therapy and it’s important to understand the many risks that come with it.

A little background: testosterone is generally thought of as a male hormone for a variety of reasons, but it is present and important to both sexes at different times in their reproductive years. In the aging process for both men and women, hormone levels drop which produces certain symptoms for each gender. In post-menopausal women, the list is well-known: weight gain, a lack of interest in sex, mood swings and emotion control issues, a drop in energy levels, loss of mental focus and a decrease in bone density and muscle tone.

Hormone replacement therapy, normally using estrogen, has been controversial and some patients have concerns about conflicting reports on side effects and long-term use. Because of this, sometimes alternatives are sought, and testosterone may be considered.

Having written a dozen or so articles and a book on this subject, I’m concerned that a more complete picture must be painted. There are risks that must be part of the equation when testosterone is considered as a therapy for women. Specifically, oily skin, excess hair growth, balding and a deepening of the voice can occur. These are significant issues for most women, and depending on the severity of the hormone loss and its impact on a patient, the offset may not be attractive.

As always, a qualified practitioner with a deep understanding of the risks and benefits of any hormone loss or replacement regimen can help you decide what’s right for you.

 

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Scientists have recently discovered a distinctive blood flow pattern in the brains of premenopausal women who are not interested in sex and unhappy about that. This distinctive pattern differs from that of women who have normal sexual function, and it may lead to a greater understanding of a condition called hypoactive sexual desire disorder (HSDD). That absence of interest in sexual activity (HSDD) currently has no known FDA approved therapies, and is an awkward problem that many women simply will not discuss with their doctors. Still it is estimated to affect one in five adult women in America.

The study was recently published in the journal Fertility and Sterility, and it measured the blood flow of 16 women – six with normal sexual function and ten with clear symptoms of dysfunction. The results indicated that there are marked differences in activation of brain regions involved in making and retrieving memories and determining how attentive women are to their response to sexual stimuli. These findings are significant not only in understanding the physiological differences in the two groups, but also in discovering ways to objectively assess the effectiveness of emerging therapies.

Women in the study with normal sexual function exhibited greater activation of brain areas in the right thalamus, which plays a role in sexual arousal, as opposed to dysfunctional group, which showed a different pattern, largely affecting other areas of the brain that are generally associated more with attention and reflection about emotion and mental state.

Scientists now plan to expand the study to include larger groups of women and eventually measure blood flow patterns to assess new therapies.

 

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New study links early menopause with heart disease and stroke

A study of more than 2,500 women ages 45 to 84 reported that those who experienced early menopause — either naturally or from surgical removal of the ovaries — doubled their chance of developing heart disease or stroke. This was true for women of all ethnicities.

What if I’ve had an early menopause?

I firmly believe that women who experience premature menopause should be on hormone replacement therapy (HRT) at least until age 50 — the average age of menopause. I know what you’re thinking…the Women’s Health Initiative said HRT increased a woman’s risk of heart disease and stroke. But further analysis of the data has shown estrogen doesn’t increase the risk of heart disease and may even lessen the risk for some. After menopause, the pros and cons of continuing HRT should be discussed with your physician. No two women are the same and HRT therapy needs to be individualized based on a woman’s medical history.

Heart disease is the number one killer of women

Finally, women need to know the signs of heart disease. Just as important, be sure to live a healthy life that includes a well balanced diet and daily exercise. If you’re a smoker, now’s the time to STOP.

Contributed by Lisa Larkin, MD, FACP, NCMP and James A. Simon, MD, CCD, NCMP, FACOG

 

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Menopause PhysiciansThese days, it seems like hormone “treatment centers” are popping up all over the place, and online “pharmacies” are constantly pushing the latest and greatest hormones for menopausal and postmenopausal women. But what about the woman who is looking for individualized evidence-based counsel and care to help guide her through the menopause transition? Why is it so hard to find a physician who specializes in menopausal medicine?

Part of the reason dates back to the Women’s Health Initiative, a first-of-its-kind, 15-year study that included a trial on the effects of combined (estrogen-progestogen) hormone replacement therapy. Before the trial’s abrupt end in 2002, menopause care was a developing area of medicine, with a growing number of continuing education classes being offered to healthcare professionals, and the use of hormone therapy among postmenopausal women on the rise. But then the combined hormone therapy arm of the study was cut short—four years ahead of schedule—and news quickly spread of its controversial results.

Results showed that women taking the estrogen-progestogen combination had a greater incidence of breast cancer, heart disease, stroke and blood clots—risks that far outweighed the benefits of hormone therapy. With this news, everything stopped. Patients were advised to discontinue treatment. Physicians were afraid to prescribe anything.

Unfortunately, the publicity surrounding the combined therapy results overshadowed the positive results of the estrogen-only therapy, which did not show an increased risk of heart disease or breast cancer. But the damage was done. The topic didn’t get much attention after that. And the impact on physician education was significant.

Ten years later, views on hormone therapy continue to evolve. For instance, recently released guidelines from the North American Menopause Society (NAMS) indicate that many women can safely take hormone therapy. (To view the latest NAMS recommendations, click here. But I suppose some physicians are still a bit gun-shy about what remains a controversial topic in the media and even the medical community—despite the rapidly growing number of women seeking menopause care.

The fact remains, however, that the alternative treatment options—the online pharmacies and “hormone houses”—are no substitute for evidence-based medical care by a certified menopause practitioner. Menopause treatment is highly individualized and requires a patient-focused approach to care.

So do yourself a favor, and seek out a healthcare professional specially trained in the care of women during menopause. If you live in or around DC, I’d love the opportunity to partner with you in your care. And if you’re not local to DC, simply visit the NAMS website to find a certified menopause practitioner near you.

 

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Over-the-Counter Menopause RemediesThere’s a vast array of drugstore products available that claim to treat menopause symptoms. Many patients want to know if these products truly provide relief. While there are certainly over-the-counter products that work for mild hot flashes, night sweats or other menopause symptoms, few will work on severe or persistent symptoms.

As a general rule, I suggest being wary of “miracle cures” when you go to select a product. Since these herbal and nutritional products are not regulated by the U.S. Food and Drug Administration (FDA), they are seldom tested for efficacy or safety the way pharmaceuticals are. So there’s no way to know for certain that they contain the amount of active ingredients that they claim to have or if the benefit claims on the packaging are valid.

When exploring over-the-counter products, be an extremely savvy shopper. There’s no way to know whether the amount of active ingredients listed is incomplete or incorrect. The packaging could also tout benefits that are exaggerated since there’s no testing required by the FDA on these products.  It’s very hard to know exactly what you’re buying, so if you want to explore over-the-counter products, be an extremely savvy shopper.

Overall, it is important to talk to your healthcare provider before taking any unregulated over-the-counter product. Most importantly, discuss the following:

  • Does this herb or dietary supplement have possible side effects?
  • Will this product interact with any of my other medications or affect an unrelated medical condition?
  • What scientific evidence is there about how effective this remedy might be for my particular menopausal symptoms?
  • What are the risks of over-the-counter menopause treatments?

Remember, there’s no one-size-fits-all approach to treating menopause symptoms. What works for one woman may not for another. Talk to your doctor or ask your pharmacist to help you choose a product for easing mild menopausal symptoms that’s right for you.

 

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