February 2008 - Vol 3 Issue 2

The Maddening State of Menopause
A review of hormone replacement therapy
by Michelle Gibeault Traub, R.D.

With baby boomers reaching the age of menopause in droves, their cries for better, safer treatments are being addressed through research and new consumer products. But, study results have not proved favorable for options that previously offered relief such as hormone replacement therapy (HRT). In addition, the newer “bio-identical hormone” treatments are being questioned by the FDA because they haven’t undergone the necessary research to determine long term safety or efficacy. All of this is enough to drive any menopausal woman mad.

My Menopause Story

My first knowledge of menopause occurred when I was 18 and working in a toy factory on summer break from college. On one particularly hot day, I was stationed across from two female employees, both in their early fifties. I noticed the women had their own fans positioned so they had a constant cool breeze. I was a bit envious, until one of the women caught my eye and said, “hey kid, don’t ever get old…you ever hear of hot flashes?” I really hadn’t at that point. My new friend continued to lament about how troublesome the waves of heat and sweat were, especially at night when they kept her awake. The news was very upsetting to me. As if it wasn’t bad enough that I would spend much of my teen and adult life suffering from monthly cramps and PMS, now I had something seemingly worse in my future. I went home that evening and asked my mother why she never complained about hot flashes and night sweats, she laughed and said, “I don’t have those problems, I take hormone replacement.” I knew my Mom was a participant in the Women’s Health Initiative, but that never meant much to me until years later when the WHI released some scary findings. At that time (2002), study participants who had been taking estrogen-plus-progestin were advised to discontinue treatment due to increased risks of breast cancer, heart attack, and stroke. Just a few years later participants taking estrogen-only were advised to stop as well. My Mom was one of those warned, mostly by my incessant phone calls begging her to seek other options.

Risks vs. Rewards

For my mother, the treatment options were easy. Her doctor was a strong ally since he was well aware of her medical history, along with the WHI study details. But, I realize through my interactions with other women, that the decision to use hormone replacement therapy (HRT) also known a menopausal hormone therapy (MHT) is not always that easy. For women who have a family history of breast cancer or heart disease, the risks of estrogen replacement are simply too high. For others, the symptoms of menopause aren’t severe enough to warrant a daily medication. And, for still other women, the amount of conflicting information makes it difficult to confidently decide on any option. Regardless of their situation, every woman needs to consult with a trusted, licensed physician and ultimately weigh the risks versus the rewards for estrogen replacement which include the following:

The Great FDA Debate

Following the negative results of the WHI study, “bio-identical hormones” rose in popularity. Many natural health advocates believe that these hormone preparations, which are individually-produced by a compounding pharmacist, provide a safer and better alternative to the synthetic hormones produced by the pharmaceutical industry. Last month the FDA voiced strong objections over these allegations. Their concern is that bio-identical hormones have not undergone any testing, which means there is no way to determine how safe or effective they are at managing menopausal symptoms. While patients are still able to take bio-identical hormones if prescribed by a physician, the FDA is warning that without the type of stringent testing that pharmaceuticals undergo, there is no way for consumers to know if they are getting the amounts that they have been prescribed. In addition, the FDA has gone so far as to warn seven pharmacies that they are violating federal law by making claims that could be misleading to consumers.

It is Your Decision

The bottom line with menopause treatment is that the choice is ultimately up to the woman. There are no “one treatment fits all” answers. Most women’s health providers believe that hormone treatments should be individualized to alleviate symptoms while minimizing risks generally through the smallest possible dose for the shortest period of time. A woman experiencing menopausal discomfort must be her own advocate by discussing her health risks with her physician and exploring different treatment options to determine what works best. When you sort out the information, menopause doesn’t have to be maddening after all.

Next month we will discuss drug-free options for managing some of the worst menopause symptoms in “No More Menopause Madness: Natural treatment options for menopause relief”

Menopause Treatment Resources

• National Institute on Aging: Hormones and Menopause Tips Sheet  - an excellent overview of hormone treatments including natural hormone therapies.


• The NHLB Women’s Health Initiative Web site -  WHI Site


• The North American Menopause Society - www.menopause.org

References

1. Cruzan, Susan FDA Takes Action Against Compounded Menopause Hormone Therapy Drugs, January 9, 2008, retrieved 2/11/08 LINK


2. National Institute on Aging Hormones and Menopause:Tips from the National Institute on Aging Web page last updated: September 29, 2006, retrieved 2/11/08 LINK


3. NHLBI Questions and Answers:About Estrogen-Plus-Progestin Hormone Therapy, retrieved 2/11/08 LINK