I was cleaning out magazines in my office and happened onto two journals that spoke to me of my blog post topic to write today. Here’s what the first one was about:
In 2002 everything changed for treating menopause symptoms for women and their clinicians. Prempro, the combination of Premarin and Provera – and the most sold prescription in US – lost the majority of its market after the Women’s Health Initiative study. Many providers were at a loss as to how to help women with these symptoms.
This study, or at least the media about it, concluded that women on this combination of hormone replacement therapy (HRT) were at a greater risk for cardiovascular disease and breast cancer. Clinicians and the general population were suddenly afraid of any type of hormone therapy. Many women were feeling desperate for help, miserable with hot flashes, night sweats, depression, poor libido, and sleepless nights.
It’s been 15 years since those alleged findings were reported. I say alleged not in a sour grapes way, but because every few years, we in women’s health hear a new analysis of the actual data.
In 2002 I had just moved into the first official location of my independent practice which eventually and ironically took off partly because of this unfortunate study press. I felt very confident about treating symptoms with bio-identical hormone replacement therapy (BHRT) and knew that it was in a totally different ballpark than the horse urine and Provera (not progesterone) combination pill that was studied in the Women’s Health Initiative study.
A few years later, Oprah featured some women and doctors who were raving about their success with and the greater safety of compounded bio-identical HRT. Women were voluntarily or involuntarily yanked off their HRT and this finally was an answer to their loss. In a previous post I had compared the difference between Prempro and BHRT so I won’t explain that here. But I happened on another analysis and solution of the WHI in Clinician Reviews which is interesting to me…
Dr. Andrew Kaunitz is a respected voice in women’s health and I appreciate that he was taking another look. He reviewed that women given any hormone replacement had a reduced risk of hip fractures, diabetes, and increased risk for stroke, blood clots, and gallbladder disease compared with the placebo group. However for breast cancer, the risk was increased for women in the Prempro group and significantly decreased for estrogen-only treated women. In women older than 65, cognitive decline was increased in the Prempro group but not in the estrogen-only group of women. In the women from 50-60 years old, the risk of death from heart attack and other cardiovascular disease, colorectal cancer, colorectal cancer, and endometrial cancers were all decreased. There was a comment that if starting HRT after 10 years into menopause, there may be a destabilizing effect on arterial plaques.
Options that the American College of Obstetrics and Gynecology recommend are:
- Use horse estrogen pills at a lower dose to treat hot flashes, along with a Selective Estrogen Receptor modulator
- Use a different “SERM” by itself
- Use Paxil
Dr. Kaunitz notes that compounded HRT is still worse or more dangerous than these other options because it isn’t regulated by the FDA and therefore doses aren’t reliable.
This view is a service to clinicians who don’t understand the accreditation process that is available to compounding pharmacies. This accreditation process assures us of reliable compounds and the prescribing doses and methods we can use to help HRT be safer. I’ve heard it said that it takes way too much time to learn how to prescribe BHRT so it hasn’t become widely practiced by clinicians.
I will write about the methods I use to feel safe prescribing hormones to women in the next post, which were described in the other journal that caught my eye today.