Editor's note: This is the first of a three-part update on menopausal hormone care.
I know, the headline is not what your mother, doctor, TV, women's magazines, and walking buddies tell you. But, it's true. Of tsunami importance, it falls into the category of bad news travels fast, and good news dies away in a flash.
In March, the North American Menopause Society's Advisory Panel on Hormone Therapy issued new, liberalized guidelines for use of estrogen in the menopause. To disclose, I have been a medical speaker for numerous pharmaceutical companies manufacturing bioidentical estrogen.
One crucial conclusion from the menopause society's experts: The large government – funded and now infamous Women's Health Initiative showed a decrease in breast cancer in the group taking estrogen alone.
These women had undergone hysterectomies. They were given oral conjugated equine estrogen (CEE), brand-named Premarin. This data was available in 2002 – (10 years ago.) when the negative outcomes seen primarily in women taking combined CEE and a synthetic, oral progesterone (Prempro), caused a misleading media blitz that inappropriately condemned all hormone use.
A follow-up study in the Journal of the American Medical Assn. in April 2011 of the women who took only CEE showed a statistically significant reduction in breast cancer over time.
On that fateful morning in 2002 when the bad news hit the air waves, 50 patients called my office asking "Should I stop my hormones?"
This debacle sent many generations and millions of American women reeling into hot-flash hell. Other symptoms include sleeplessness, weight gain, mental fogginess, sexual dysfunction, and thinner bones that fracture.
So, what do the experts say now?
In a recent interview with me, Dr. Holly Thacker, director of Specialized Women's Health at the prestigious Cleveland Clinic, stated that hormone therapy has been shown to decrease overall mortality in women by 30%. Check out Dr. Thacker's newsletters and blog at http://www.speakingofwomenshealth.com.
Dr. Philip Sarrel, professor of gynecology and psychiatry at Yale University for decades, estimates that only 15% of post-menopausal women are using hormone therapy. In addition to the spectrum of contemporaneous symptoms noted above, he is concerned about potentially more serious, long-term effects of low hormones, namely atherosclerosis and heart disease.
Importantly, the integrity of our cardiovascular system may be the main determinant of our cognitive abilities as we age. It is estimated that one-half of people older than 85 will have some dementia. With the elderly, often obese and overweight population redounding, the public health implications of millions who will need care are staggering, to say nothing about their quality of life.
Questions linger, such as, who will pay for all of this?
The full guidelines liberalizing hormone therapy recommendations and a companion editorial by Sarrel were published in the March 2012 issue of Menopause: The Journal of the menopause society.
They include: (1) regimens must be individualized and; (2) compounded hormone therapy is not recommended unless women are allergic to government-approved products, (a rarity in my experience.) Future articles in this series will further explain the recommendations, and will discuss compounded versus pharmaceutical hormone therapy (both of which can be defined as "bioidentical," actually a marketing term.)
Check this all out on the menopause society's website, http://www.menopause.org.
As we observe some of the aged crumple from osteoporosis and dementia, think what bang-for-your-buck may come from taking low dose hormones. Many prominent experts believe that we can live longer, more alert, active, healthy, and sexually-functional lives with potentially no increase in breast cancer.