EDITOR'S NOTE: This is the second in a three-part series on menopausal hormone care.
The following is a hypothetical but typical scenario.
Leann is a 50-year-old woman whose menstrual periods have stopped. She is gaining weight, flashing all night and devoid of sex drive. Her brain is in a fog. Ralph, her husband, is beleaguered by his wife's crabby, Gorgon-like transformation. She repeatedly rejects his sexual advances. Leann's attitude is, "It's painful, but then who cares anyway?" She is terrified of menopausal hormones. Her general doctor encourages her to "tough it out," feeding her fears that hormone therapy would make her gain more weight and cause breast cancer.
In deciding what medical advice to give Leann, it is helpful to look at recent reputable expert opinions. New, slightly more permissive guidelines were published in March in "Menopause: The Journal of the North American Menopause Society". To disclose, I have been a medical speaker for pharmaceutical manufacturers of bioidentical estrogen.
As previously noted in my first article in this series, the North American Menopause Society Advisory Panel on hormone therapy made a landmark conclusion from the extensive study known as the Women's Health Initiative that estrogen therapy did not increase breast cancer risk.
Here is a summary of the other advisory panel conclusions and recommendations, based on their review of the health initiative , and other recent relevant medical research, regarding use of hormone therapy in the menopause:
1) Individualization of therapy is key in the use of hormone therapy.
2) Recommendations for duration of hormone therapy vary depending on whether artificial progesterone is used.
3) Low-dose, local, vaginal estrogen therapy is advised when only vaginal symptoms are present.
4) Candidates for hormone therapy can use it until at least age 51, or longer if needed for symptoms (think of Leann).
5) Scientific evidence has not yet proven that different estrogen therapy regimens are safer than those used in the health initiative , although estrogen therapy in lower doses, given across the skin has been associated with less risk of blood clots in veins and stroke.
6) Compounded hormone therapy regimes are not recommended unless the patient has allergies to government-approved products.
Visit the NAMS website at http://www.menopause.org.
I advise readers not to get caught up in the barrage of media blasts on opinions derived from the WHI. This study of 24,000 American women asked many questions whose answers we did not want to know. There were limited and unfavorable treatments used, namely oral estrogen made from pregnant mare urine, (hence, the name Premarin), with or without an artificial progesterone (Provera).
The data has spawned a tiresome stream of résumé items for those vested in the results. Dr. Alan Altman, past president of the International Sexual Society, and medical coordinator of the documentary film, "Hot Flash Havoc," (check it out at HotFlashHavoc.com), offers insights on the politics and science of the WHI, informed by his 30 years as an assistant clinical professor in Obstetrics and Gynecology at Harvard Medical School.
In a recent interview, he states, "The WHI looked at the wrong people, with the wrong medications, at the wrong time in their lives, and frightened millions of women into needlessly throwing their hormones away. The vast majority of women who are post-menopausal would benefit over the longer term from using estrogen."
I remind you that it is estimated that only 15% of menopausal women are currently on hormone therapy.
The U.S. Preventive Services Task Force has recently issued sweeping opinions warning women against hormone use. Their advice is, again, based primarily on the same worn out results from the sub optimally designed Women's Health Initiative.
Their new conclusions, reported recently in the L.A. Times, were published in the "Annuals of Internal Medicine" in May. How credible are their conclusions when we consider the outspoken, coherent, and vociferous criticisms of experts such as Dr. Altman?
So, back to exhausted, dripping Leann. The new NAMS guidelines allow for her to start hormone therapy , reclaiming her sleep, her energy and her sexual relationship. Ralph will be thrilled.
Hopefully, Leann won't have to be the one to inform her doctor that expert opinions on hormone therapy have liberalized.
The [Women's Health Initiative] did show that the limited study group who started estrogen therapy right as they went into menopause had a reduction in mortality, owing to less breast cancer and heart disease. Wouldn't it make obvious sense to follow such a group long-term, on more favorable forms of hormones? We can only hope that this research will be pursued.
The third article in this series on hormone therapy will demystify the topic of "bioidentical hormones."
Dr. JANE BENING is a board certified gynecologist who has lived in Laguna Beach and practiced in Newport Beach for more than 20 years. Send questions or comments to firstname.lastname@example.org or call her office at (949) 720-0206.