Saturday, December 12, 2009

Women and Hormones

Just when you thought it was there is another article in the NewYorkTimes about the pharmaceutical industry pushing hormones for post menopausal women. It is a long and somewhat "shocking" article about how women have been sold a bill of goods regarding estrogen and progesterone after menopause and Wyeth Pharmaceutical paying multimillion dollar claims for women who took hormones and developed breast cancer.

Let me say...don't believe everything you read. As readers of EverythingHealth know, I am not a shill for big Pharma and have written critiques of their corporate tactics many times. But when it comes to Estrogen replacement it isn't just doctors and Pharma pushing drugs on unsuspecting women.

The link between breast cancer and endometrial cancer and estrogen (ERT) has been open dialog for decades. The pharmaceutical companies have had it listed in their marketing literature and good physicians make it part of the risk/benefit discussion. I have never felt pushed to prescribe ERT when it was not indicated and good evidence remains about the benefits of female hormones for bone strength and symptom control. Patients should know that for every 10,000 women who take estrogen, 8 more cases of breast cancer are seen. Other factors influence breast cancer like smoking, radiation (excessive chest X-rays, cat scans or mammograms), alcohol etc etc etc.

Now let's talk about menopause. Many women breeze through it but many others really hit the pits at "change of life" time. The herbal remedies just don't work for most women. Double blind studies have shown little or no benefit from black cohosh, soy, evening primrose, progesterone cream, dong quoi, chickweed and numerous others. I say if it works for you...go ahead and take it but if we give you placebo, you won't know the difference.

What does work for hot flashes, sleep disturbance, crankiness, depression, arthralgias and foggy brain is replacing the hormone that has declined in the body...Estrogen.

The studies show that women can safely take estrogen replacement to get them through menopause. There is no evidence that "bio-identical" estrogen is any safer than estradiol or Premarin. Suzanne Sommers is not a scientist. I would rather women use pharmaceuticals where we know the absorption rate and the ingredients are standardized.

Telling symptomatic women to avoid spicy foods, hot drinks, hot weather and "intense exercise, specially lovemaking" as some websites do is really an injustice. Scaring women by emphasizing the risks without the benefits is also an injustice.

Whenever I see that $79 million was paid in a lawsuit, I am not necessarily compelled by the evidence but instead think "follow the money". We will surely see more settlements, whether they are warranted or not, and they do not always serve the common good of women.


Adrian said...

cool stuff!!

bioidentical hormone doctor said...

I think pharmaceutical companies must be very careful in providing hormone to the customers. This has become a major threat for women to get breast cancer.

Michael Kirsch, M.D. said...

There's another lesson that ERT offers. When I was a medical resident, we were taught that every woman should receive ERT, unless there was a contraindication. What a difference 20 years makes! Physicians and the public should be skeptical about new medical breakthroughs, or even standard treatments. Today's 'cure' may be considered to be snake oil in the future.

Toni Brayer, MD said...

MichaelKirsch,MD: It shows, I guess, that training varies, depending upon time and place. We were never taught much at all about women's health at all.

I completely agree about being skeptical about new "breakthroughs" and new wonder drugs. We should also be ready to change our prescribing and treatments as new evidence is found.

My premise, however, is that lawsuits are not scientific evidence and ERT does have its benefits for menopausal symptoms.

Anonymous said...

When my mother was going through menopause about 27 years ago her primary care doctor was a male internal medicine doctor whose speciality doctor was cardiology. She was healthy and did not have any cardiology problems. He put her on HRT that caused her to have bad headaches and feel depressed which she did not have before. After telling him about these side effects he just told her she needed to see a therapist for counseling. which was just dismissing himself from dealing with it.

He did NOT work with her on regulating the dose to work for her body as I have see good doctors do that care and listen to their patients. He also never told her to have a mammogram or a colonoscopy.
This doctor is in his late 70's and still practicing.

Cary said...

Ugh, going through this now. Not fun.

Bryan said...
This comment has been removed by the author.
Bryan said...

Being a hormone doctor I advise women with post menopause stage to be careful in injecting hormones into the body since there is a possibility to develop breast cancer.

OMDS said...

Hormone imbalance is quite common for women with age above 50. Taking hormone injections can reduce the imbalance in a long run.

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