Seven Things To Know About Hormones – My Take

The Wall Street Journal gives a nice response to Oprah’s recent HRT hype with an article entitled “Seven Things You Should Know about Hormones. This, of course, is not to be confused with George Carlin’s Seven Words You Can’t Say on TV, which is really funny but won’t help you decide whether or not to take estrogen…

Here’s my take on the seven things –

1. ‘Bio-identical’ hormones are available in FDA-approved forms
I agree. The stuff Suzanne Somers and Oprah are getting compounded is exactly the same chemical ( probably purchased from the same supplier) as Big Pharma uses to make their estradiol patches and creams and progesterone pills.

2. Hormones from compounding pharmacies aren’t safer than conventional HRT.
I completely agree. Any compounding pharmacist or doctor who sells HRT without warning patients about the risks should be put out of business. We don’t stand for this behavior from Big Pharma, and we shouldn’t accept it from these folks. They are couching their sales pitch around women’s wellness and selling women a purported fountain of youth, while trashing Wyeth for doing the same thing with Prempro. FDA – Get on it. And if you don’t have the authority, Congress needs to give it to you. Women’s Rights Groups should be all over this one, but they are unfortunately being duped by these shysters into thinking they are all on the same side.

3. Don’t trust saliva tests.
Ditto. Most of the folks doing saliva testing make money on the testing. Be wary of any doc who has a financial interest in what test he/she orders. Or what vitamins you take.

4. There’s a critical window of time for starting HRT.
Not so fast. It’s a hopeful hypothesis, but it’s just not proven yet. A lot of the docs pushing the hypothesis are also consultants and speakers for pharmaceutical companies who sell HRT. In my heart of hearts I think and hope that they are right, but I’m not willing to tell a patient to count on it. We need studies to prove it.

5. The increased risk of breast cancer appears related to progesterone rather than estrogen.
The key words here are “appears to be”. It’s not written in stone yet, so don’t count on it. And don’t go taking estrogen without progesterone if you still have your uterus – that’s a recipe for uterine cancer. I’m not about to trade one risk for another with my patients.

6. Estrogen applied to the skin, in patch, cream or gel form, may have a lower risk of blood clots and strokes than in pill form.
Agree. This is the one piece of new data that makes the most sense to me and that I am willing to put out there. I prescribe transdermal estrogen preferentially over oral whenever I can. We know clot risk is related to dose and there are well-done studies showing the lesser impact of transdermals on serum clotting factors. There’s no reason to think this won’t translate this to lower incidence of blood clots. Stroke incidence is a little more tricky, since strokes are multifactoral, but if clotting times are closer to normal, that’s one less factor to worry about.

7. Stay tuned.
This, of course, is the hardest part about HRT. It’s not like your menopause is going to wait for the next big randomized, placebo controlled trial. You have to make a decision with imperfect information and uncertainty. And that’s difficult for some women to understand and accept.

Easier to do what Oprah and Suzanne have done and latch onto the compounding pharmacy crowd, who sell certainty and security along with their drugs. But it’s a false security and very dangerous. I find it so sad that these two intelligent women are letting themselves be taken in this way. And even sadder that they are bringing other women along with them into their fantasy of hormonal certainty.

If you’re interested
Here are TBTAM’s Ten Rules for Prescribing HRT.

Now if you’ll excuse me, I have to get back to You Tube…

7 Responses to Seven Things To Know About Hormones – My Take

  1. If the hormonal patches have a lower clot risk than pills, why is that not true with BCP’s too? (or am I remembering wrong? Seems like there were more problems with the BC patch, but maybe that was just because it was so new?) Or does it have to do with the differing levels/combos of hormones between the two?

    -lpnmon

    Reply

  2. Anonymous –
    The contraceptive patch has much higher estrogen exposure than most pills or the contraceptive ring. It is the overall dosing that is important.

    See my previous post on the patch –
    http://theblogthatatemanhattan.blogspot.com/2008/02/thoughts-on-contraceptive-patch-and.html

    Estrogen doses in hormone replacement are much lower than in contraceptives.

    The risk of blood clotting with estrogen is dose dependent – the higher the dose, the higher the risk.

    Hope this clears things up for you.

    Thanks for reading!

    Reply

  3. I was switched from pills to the gel/cream by my French doctor… but will be readddressing it with my new doctor – it’s been 10 years.
    Back to George Carlin…. I love/d him but I dare not go to that site, I have to fix dinner in a few hours…

    Reply

  4. Thanks for posting this. I asked my doctor about HRT– before the WHS results were release several years ago. He basically had no advice– just muttered something about it being my choice. Thanks a lot. I’ve read quite a bit on this topic over the years– including one of the Suzanne Sommers book about bio-identical hormones but found very little other information out there regarding the science behind bio-identical hormones vs regular hormone therapy. Basically, I ended toughing it out through menopause with “women’s vitamins” (which do seem to help the hot flashes), yoga, and regular exercise.

    Pamela Powers, MPH
    Managing Editor

    Reply

  5. Many women are at a loss when it comes to charting their best course through menopause – but they don’t have to be. In Hormones and Your Health: The Smart Woman’s Guide to Hormonal and Alternative Therapies for Menopause (John Wiley & Sons, Inc – publication date April 2009) author and reproductive biologist, Winnifred Cutler, Ph.D. offers clear, sensible, evidenced-based answers to the questions all women have, or will have, regarding; hormones and hormone replacement therapy, sexuality, bone and cardiovascular health, hysterectomy, memory and breast cancer.
    Written for women and their physicians, this groundbreaking book unveils the complex health issues of menopause and challenges the ‘one size fits all’ approach to hormonal replacement therapy. Dr. Cutler explains why the most commonly prescribed hrt regimen – which may be great for ‘big pharma’ – could be very wrong for many women.

    We hope you will visit the Athena Institute for Women’s Wellness website to learn more about Dr. Cutler’s new book and research;

    http://www.athenainstitute.com/hormonesandyourhealth.html http://www.athenainstitute.com/mediaarticles/moremag2.html

    Reply

  6. Dr I was told that Hormone therapy was not meant to take away all the symptoms of menopause but only to help you manage the symptoms. I really thought that if you were give the right dose of hormones that you wouldn’t have any symptoms at all. Could you comment on this.

    Reply

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