Consumer Reports Talks about Menopausal Therapy

A recent Consumer Reports article has raised concern among those considering therapy for menopause related symptoms.  Because of general interest and concern over this article, I’d like to address several comments they have made.  Many of them are good medical advice, and some others…well, read on to hear a differing opinion.

They say: “First, you should know that medicines containing various forms of the female hormones estrogen and progestin are highly effective at reducing the symptoms of menopause. Studies show that 70 to 90 percent of women experience an average 75 percent reduction in the frequency of hot flashes and night sweats. The drugs also reduce vaginal dryness.”  I would add: Yes, although the use of progestins is probably the Number 1 reason traditional hormone therapy (HRT) is a risk for breast cancer.  My advice:  avoid progestins for HRT whenever possible, as multiple studies have implicated this version of the progesterone family as the key HRT risk factor for breast cancer.

They say: “Don’t take hormones if your symptoms are mild and can be managed by changing your lifestyle and habits, such as quitting smoking, sleeping in a cooler room, reducing stress, exercising regularly, and limiting caffeine and alcohol.” I would add: I agree wholeheartedly.  My advice: Work these factors first, or along with any other therapy choice.

They say: “Don’t take hormones if you have heart disease or have had a stroke or cancer of the breast, ovaries or uterus. Don’t take hormones if you have diabetes, high cholesterol or high blood pressure, all of which are risk factors for heart disease; hormones may add to that risk. Also consider avoiding hormones if your father or mother died early from heart disease.”

I would add: HRT for in women in the above categories has to be considered in context.  Good therapy always takes into account individual variations of risk vs. benefit.  If you have ovaries, either before or after menopause, you have hormones in your system.  The question is the amount, the relative ratios, and how they are delivered.  My advice: Blanket advice to NEVER consider a therapy is more likely written by an attorney than a physician.  Find a qualified professional who can thoroughly review your individual profile, intelligently discuss your potential risks, and help you to determine what form of hormone therapy, if any, makes sense for you. 

They say: “Always take hormones for the shortest time possible and at the lowest dose.” 

I would add: This trite and generic phrase is generally true for large populations; as the time frame over which hormone therapy is beneficial can vary dramatically among individuals. 

My advice: You should always have a treatment plan tailored to your specific needs.  It may take years of ‘one year at a time’ decision making to know over time what version worked best for you.

They say: “Tell your doctor about your complete medical history. Ultimately, every decision about hormone use must be made on a case-by-case basis.”  I would add: I agree entirely.  But also note how this balanced advice contradicts to a degree what they said previously about who should NEVER use hormones.

They say: “Hormones should never be used to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. They don’t help these conditions and could make them worse.” I would add:  Once again the NEVER qualifier denies a women the consideration of how hormone support can benefit multiple body parts.  Perhaps we should say that any ONE of those symptoms should not be the SOLE reason to give HRT.  My advice: Each one of the problems mentioned can to some degree be related to hormone deficiency or imbalance, and can see benefit, at times dramatically, when an appropriately individualized HRT plan restores beneficial levels.

They say: “Be cautious if a doctor or pharmacist recommends using so-called bio-identical hormone products made in pharmacies. They are not regulated by the FDA and have not been shown to be better or safer than commercial products.” I would add: Note the “so-called” disclaimer, a commonly used pejorative by the pro-pharmaceuticals establishment.  The pharmacies that make compounded products of all kinds, not just hormones are state, and now federally regulated, although not by the FDA (historically, the FDA loves to get their regulatory mitts on just about anything health related, and I’m sure compounded treatments are near the top of their ‘we would love to control that’ list).  My advice: Rather than saying that bio-identicals are ‘better or safer’ than commercial products, it might be more accurate to say that they can be more readily individualized.  Compounded bio-identicals can also be prepared with several complementary ingredients in several delivery modes, most commonly transdermal.  I believe that this flexibility has the potential to make them a superior choice for getting you the hormone support that meets your specific needs.

They say: “More important, women differ in their responses to hormone products. For example, pills work better for some women while patches work better for others. Research has shown that hormone products containing estrogen alone pose less risk of heart disease and breast cancer than those containing both estrogen and progestin. However, women who have not had a hysterectomy (surgical removal of the uterus) should take both because estrogen-only products have been conclusively linked to a much higher incidence of cancer of the uterine lining (endometrial cancer).”  I would add: Yes, note the various options different women need.  The best prescription for you is the one meets your unique hormone support needs.  If that turns out to be a pharmaceutical pill or patch, that’s fine.  My advice: if you need a dose, combination or delivery system not made by a major drug company, compounded bio-identical may be the custom fit option you need.

Always keep in mind that any communication (and that includes this posting) be it internet, TV, radio, or paper publication has an underlying agenda.  Figuring out the what and why of the spin which is inevitably applied to any reporting is the challenge for all of us as responsible adults.  My goal in this blog is to round out what you hear with an integrative and sometimes alternative view of your health care options.  Thanks for listening!