Last week, the New York Times published an update on the ongoing controversy surrounding hormone therapy for midlife women.
According to the NYT, one full decade after the Women's Health Initiative launched its $625 million study to examine the risks and benefits of menopause hormones, supplements, and low-fat diets – the issues surrounding women's perimenopausal and menopausal health appear more unsettled and confusing than ever.
But just because the issues are complex doesn’t mean we shouldn’t be paying attention.
The Women’s Health Initiative is a landmark study that originally recruited more than 160,000 women as research subjects, including 26,000 for hormone research in particular. Scientists fully expected the study’s results to be predictable, including that hormones could prevent chronic illness in women, including heart disease. But the findings have consistently surprised us:
- The Women’s Health Initiative first shocked the world in 2002, when it stopped its largest hormone study because it showed that a common combination of estrogen and progestin was harmful, increasing a woman’s risk for heart problems and breast cancer.
- Later, other data suggested that the news wasn’t all bad, and that the risk of menopause hormones might vary depending on a woman’s age.
- Still more reports from the research initiative suggested that estrogen increased the risk for stroke, and that the cancers associated with a combination of estrogen and progestin drugs were the most deadly.
- Earlier this month, the study’s latest finding surprised again: Certain woman who used only estrogen during the study had markedly reduced risk for breast cancer and heart attacks.
The confusing, whipsaw effect of these study results has led some midlife women to losing confidence in menopause studies altogether. Fearing harmful side effects, they now refuse to even consider hormone replacement therapy.
One Vibrant Nation blogger put it this way: “There are such serious health risks to all these estrogen-based hormone replacement products. I remember way back when we were told that HRT was perfectly safe. Then breast cancer rates soared, strokes occurred. Now women are once again being told that these creams and vaginal pill inserts are ‘perfectly safe.’ Why should we believe the drug companies yet again? And for what? Not at 60. No thanks.”
But some medical experts warn that this reaction may deprive some midlife women of their best option for treating the debilitating symptoms of menopause.
According to Dr. Holly Thacker, menopause specialist and author of the Vibrant Nation Health Guide, Recognizing and Treating Menopause Symptoms, “Hormone therapy is still the best treatment for recently menopausal women who are having significant symptoms. Women have no reason to fear hormone therapy or to doubt its efficacy as a solution to the uncomfortable and potentially debilitating side effects of menopause. The key is to tailor HT to each woman’s individual needs. With so many products available, this is easier today that it ever has been. The important thing to remember is that one size does not fit all. Every medicine – prescription as well as non-prescription – carries potential risks as well as potential benefits. All treatments have to be individualized and periodically assessed.” [Click here for Dr. Holly Thacker's report on which health conditions may preclude you from having hormone replacement therapy.]
“We have a history in the U.S. of wanting to believe that if we take a pill, we can prevent bad things from happening to us, and of wanting to take those pills before the evidence comes in,” Dr. Andrea LaCroix said in the New York Times. “The fact that women are frustrated by the twists and turns the Women’s Health Initiative has taken, and possibly more skeptical about the drug industry, may be a good thing.”
Women concerned about menopause health should insist that doctors make recommendations based on scientific evidence, rather than allowing drug companies or marketing hype to dictate patients’ health care choices. Of course, this is a lesson that many members of the Vibrant Nation community learned long ago.
As VN member girlygirl says, “My dad was an OB/GYN for over 50 years. He explained a lot [about menopause] to me and also talked about so many of the studies that are done that truly don’t show the entire picture.” Bliss1249 adds, “I found that many OB/Gyns really don’t delve too deeply into our menopause symptoms. Rather, they just throw the latest whatever at us. I used creams, suppositories, tablets, injectable creams – I can’t imagine I missed putting anything into my body to overcome the fuzzy-headedness, adult onset acne, sleeplessness, bloating, and so on!”
VN blogger Lisa Mallett explains the gap in menopause care that many of us experience this way: “Most medical schools provide only about four hours of training on the endocrine system, the basic building block of hormones. And for most doctors, that four hours of med school training was m-a-n-y years ago. And, I believe most doctors are still men – and so can’t have a clue about what menopause is like.”
Fortunately, as a community, we VNers tend to be savvy consumers who enjoy being full partners in their own healthcare. We understand the value of ongoing research on menopause health and remain fully engaged in this topic as well as skeptical, in order to best reap the benefits of current medical thinking.
One key way VN members keep up with the complex and rapidly changing menopause health landscape? The Vibrant Nation community itself. VN members realize that on the complicated issue of hormone replacement, other vibrant women are often their best information resource. As VN member Spirit Seeker says, “As women, we should all listen to our ‘sisters’ and learn from one another about how to care for ourselves and support our own health.”
As a result, Vibrant Nation is frequently the site of lively discussion and debate as VN members exchange views and personal experiences on key menopause health issues. One particularly hot menopause-related topic for Vibrant Nation members? The benefits of bioidentical (natural) hormone therapy vs synthetic hormones.
Should you consider bioidentical hormone replacement therapy?
Over recent years, studies like the Women’s Health Initiative have reported health risks associated with standard synthetic hormone therapy, resulting in the rise in popularity of bioidentical hormone therapy. Another reason for increased interest in BHRT is celebrity endorsements. Actress Suzanne Somers, for example, has written several books about her positive experiences with bioidentical hormones, including Ageless and The Sexy Years. Such public exposure has led many other women interested in safer, effective menopause relief to investigate bioidentical hormone options.
Within Vibrant Nation, many women are enthusiastic believers in bioidenticals.
VN member Leighanne has been using bioidentical hormones for about five months now and says, for her, “It has made all the difference in the world. I feel so much better, have lost weight without trying, and finally have hope.”
“Add me to the list of women who love BHRT,” says VN member Helloitsme. “I had become some other person until I went on the BHRT program: weight gain, glum, moody, hot flashes, apathetic to life. I was a walking zombie. Now I have my life back. I feel more like 35 than 55. I intend to stay on BHRT as long as I live. I have really had no adverse effects, minescule if any. I highly recommend BHRT to every woman who feels like there’s something not quite right with them.”
VN member Irish211 agrees. “I am 55. After my hysterectomy five years ago, I was miserable. I needed to do something before I fell into a bad depression so I read all the books, then went on bioidentical hormones. Within one week I was back to my old self. They are the best! I will do without everything else before I will go back to having no hormones.”
The term “bioidentical” means the hormones in the product are chemically identical to those your body produces. The underlying rationale is that by introducing a hormone that is identical to your own body’s, your body will know how to better utilize and dispose of that hormone.
“Bioidenticals are recognized and accepted in our bodies by our human hormone receptors the same way that our naturally occuring hormones would work,” says VN blogger Lisa Mallett. “Suzanne Somers’ book Breakthrough (probably the best book I’ve read on menopause and bioidentical hormone replacement therapy) explains all of this. Standard hormones such as Premarin (synthesized in a lab from the urine of pregnant mares) contains about 24-26 substances that our human bodies do not recognize and that do not ‘fit’ with our hormone receptors. Plant-based bioidenticals on the other hand do not contain substances not found in our bodies.”
Marketers of bioidentical hormones summarize their advantages over standard hormone therapy:
- They’re derived from plants, not synthesized in a laboratory (therefore safer and more effective)
- They’re produced in doses and forms that differ from those in FDA-approved products.
- Compounding pharmacies can customize bioidenticals to meet your particular needs.
Bioidentical does not mean risk-free
Many medical experts have concerns about the glowing claims made regarding bioidenticals, however.
“The way the media, the National Institutes of Health, and many physicians and patients handled the results of the WHI study made the situation ripe for charlatans and marketers to take advantage of menopausal women in need of symptom relief, promising them great benefits with no risk,” says Dr. Holly Thacker, menopause specialist and author of the Vibrant Nation health guide Recognizing and Treating Menopause Symptoms. says “Women have been inappropriately told that all traditional prescription hormones are risky, and they have therefore turned to alternatives, especially in the treatment of hot flashes. Women have been hoodwinked when they’ve been told that ‘natural bioidentical hormones compounded individually are safer and risk-free.’ But any hormone, including those hormones mixed on the premises by a compounding pharmacist, carries potential risks.”
“I do prescribe some medications that have to be compounded,” Dr. Holly Thacker says. “But do not assume that because you get treatments from a compounding pharmacy that they’ve been proven effective and safe. Quality, purity, safety, and efficacy are not monitored at compounding pharmacies, and that is of great concern. I see women who want to avoid any risk of hormone therapy taking unmonitored substances and putting themselves at greater risk! All compounded hormones begin with chemically synthesized hormone powders. When you visit these ‘customized compounding pharmacies,’ you don’t know how much or exactly what you are receiving. Be wary of anything that sounds too good to be true. And do not order hormones in the form of creams or pills over the Internet.”
Mayo Clinic gynecologist and obstetrician Dr. Mary Gallenberg adds, “The term “bioidentical” means the hormones in the product are chemically identical to those your body produces, and in fact, they are – but so are the hormones used in many FDA-approved hormone replacement products. Bioioidentical hormones are not safer or more effective than traditional hormone therapy for menopause symptoms. According to the FDA and several medical specialty groups, bioidentical hormones may be riskier than standard hormone therapy – and there’s no evidence they’re any more effective. Some women may benefit from nonstandard doses and forms of hormones in bioidentical hormone preparations, but there is almost no scientific support for an advantage of these compounds over common commercially produced preparations.”
While the jury is still out on the science behind BHRT, how do we balance healthy skepticism and risk-taking for potential menopause relief?
Vibrant Nation members who have experienced firsthand the benefits of bioidenticals sometimes find many medical practitioners’ conservative viewpoint frustrating.
When VN member Sahayoga went into full blown menopause overnight, she says, her family doctor “wrote a script for Premarin even though I handed him an article to read on the cons of it. He said it was the gold standard. ‘BS’ was my answer to that. I found a new doctor and am now on bioidentical hormones, feeling more myself than I ever have.”
VN blogger Lisa Mallett, one of the most outspoken supporters of bioidentical hormone therapy on Vibrant Nation, says, “Western medical schools don’t teach anything about this area, and don’t promote the right thinking and attitudes in their graduates towards patients. If doctors can’t perform surgery for a problem and/or prescribe synthetic, patented drugs, then they aren’t interested in the patient or the issue.”
VN member Angel1070, married to a retired general surgeon who now focuses on medical weight loss and natural hormone therapy, has witnessed her husband’s successes and knows that “Natural hormone therapy simply works. We have many woman who have gained their lives back by simply using what is natural and easily accomplished. [But] most physicians do not understand this process. As my husband often says, ‘They belong to the church of traditional medicine.’ With all of the paperwork thrust at physicians and all that they must do to simply make ends meet, many doctors simply stop learning and looking.”
VN blogger Robin Donovan agrees, and includes alternative practitioners in her criticism. “Even newer thinkers are more intent on their bottom line. I love my bioidentical hormone doctor – she ‘gets it’ – but she’s always trying to sell me extra meds or supplements that I don’t need. It’s not true of everybody – but it is true of many.”
VN member Pink Wrangler is more critical yet of providers of natural alternatives. “I’m officially fed up with menopause websites that slam hormone replacement therapy in order to sell some so-called natural menopause treatment. The natural alternative, they claim, is a miracle product that fixes all your menopause symptoms and makes you feel like a million bucks. Or, at the very least makes them a million bucks. Proponents of these natural solutions claim they have no side effects. Well, if there are no side effects, there are probably no benefits either. To get the benefits of estrogen, you have to take estrogen – and in the right dose. There’s no science behind the products. I mean none. And testimonials don’t count because we all know what works for one person won’t necessarily work for another. Anyway, anyone can make up a glowing endorsement.”
If you’re considering bioidenticals: What VN members think you should know
VN member BeverlyK’s doctor prescribed BHRT for her, but she still hadn’t filled the prescription four months later. “Fear of negative side effects is holding me back,” she said.
If you’re considering bioidenticals for your menopause symptoms, here are some of the tips VN members had to share:
- Arm yourself with information. Registered nurse and VN blogger Lynette Sheppard suggests doing traditional research and also considering anecdotal experience. For Lisa Mallet, “the best source of information on bioidentical hormone therapy is Suzanne Somers’ book Breakthrough. It explains everything.” VN blogger helenw agrees. “I’ve been learning heaps by reading Breakthrough. It’s worth getting a copy so you can get a thorough understanding of the processes involved [in BHRT.]” Another resource: the books of Dr. C.W. Randolph, who often lists sources of BHRT assessment and prescribing.
- Healthy skepticism is a good thing. VN member Jangirl says, “Suzanne Somers sells a lot of books claiming what she does, but even my doctor who prescribes BHRT says there are risks associated with it. My hot flashes have improved since I’ve been on BHRT, but I know the ideal is not to have to use it at all. Do your research, then decide. If it sounds too good to be true, it probably is!”
- Look for the science behind every product. VN member Pink Wrangler’s motto is ‘Show me the data.’ “If you want me to pay you money to put something in my body (and a hormone no less) then you better have a good scientific reason for it, along with a good clinical trial or twenty.”
- Find a qualified BHRT doctor to guide you and monitor you throughout your treatment.
- VN blogger helenw recommends checking the list of BHRT practitioners in Suzanne Somers’ book Breakthrough.
- Try calling the pharmacy closest to you and ask them to recommend a doctor who uses bioidentical hormones.
- “One virtually foolproof way to track down BHRT professionals,” says Lisa Mallet, “is through your local compounding pharmacy. Compounding pharmacists can tell you who the doctors are in your area who are sending them BHRT prescriptions to be filled.”
- VN member Grrltawk says, “Naturalwoman.org has a list of doctors that used to be available online; that’s how I found my doctor. Now you need to email them for the list. They do have online a list of compounding pharmacies.
- Find a doctor who listens. You’ll want to be a full partner in this process, so VN member Clarity suggests that you try to find a good doctor who really listens to you. Carry a list of questions and concerns, and schedule an appointment for the very end of the day. If you’re her last appointment, she can answer your questions without rushing to get to the next patient.
- Expect plenty of testing. It’s very important to find a BHRT specialist who can properly test you. Then, you should expect “lots of blood tests for many different kinds of hormones,” says Lisa Mallett. Demand careful interpretation of those lab test results in order customize a BHRT regimen that is right for you.
- If your initial results aren’t successful, don’t give up immediately. It is ongoing work to determine what to do, how to do it, when to do it. “It’s a process to get the right dosage for you.” says VN member Clarity. “Be ready to try different dosages to get the right fit. It may take three to six months before you decide on one.” Lisa Mallett adds, “I really encourage you to keep trying with BHRT.”
- Choose a compounding pharmacy with an excellent reputation. There are no regulations on compounding pharmacies, so make sure you go to a reputable one.
- Realize that there is no one right answer and every woman’s body is different. Registered nurse and VN blogger Lynette Sheppard says, “As a nurse, I have to say that each woman is individual in her response to remedies for menopause symptoms. Standard HRT is a viable option for many women. Many women do fine with a natural progesterone cream or soy. Some women do receive relief from natural remedies like primrose oil, dong quai, or even cod liver oil. I personally tried many “alternative” treatments – and finally achieved balance with an estradiol patch (estrogen – bioidentical) and Natural Woman progesterone cream. We have to educate ourselves and do our own “risk-benefit” analysis no matter which remedies we wish to try. Depending on your physical makeup and family history, some remedies may not be indicated for you.”
- Insist that more medical research be done on bioidenticals.
One of the stumbling blocks for medical professionals and patients interested in bioidenticals is that a hormone found naturally in the body cannot receive a patent. “Funding is not available for studying bioidenticals because there is no money to be made, really,” says Lynnette Sheppard, VN blogger and former nurse researcher. “We women must insist that more research be done in these areas so we can truly make informed choices.”
Ultimately, hormone replacement therapy, whether standard or bioidentical, is a very personal choice. Every woman must educate herself, find a doctor she can trust, and then decide.
VN member Lilly, who uses BHRT, says, “I did my best to go into this with as much knowledge as possible. I was amazed at the relief I got after a week. I don’t plan to stay on this the rest of my life but [for now] I just can’t tell you what a relief this has been for me. I don’t see BHRT as a means of dealing with aging, and it’s no fountain of youth. For me, it’s a quality of life issue.”
For more information on your menopause treatment options, check out the Vibrant Nation Health Guide, Recognizing and Treating Menopause Symptoms.