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Hormone therapy myths [Commentary]

Over the past 20 years, conflicting information regarding the use of hormone therapy — and in particular bioidentical hormone therapy, which chemically matches hormones the body already produces — has confused women experiencing perimenopause and menopause. This has prevented many women from getting the treatment they desperately need to alleviate the at times debilitating symptoms that often occur at this phase of life.

As a nurse-midwife specializing in menopause over the past two decades, I have been nothing short of shocked at the inaccuracies reported on the topic of hormone therapy. Many news stories continue to misinform, misinterpret and misrepresent the facts about hormone therapy research and treatment.

Perhaps the greatest disservice perpetrated on perimenopausal and menopausal women has been the years of negative headlines resulting from the Women's Health Initiative (WHI), a biased, poorly designed and often misinterpreted study. Results from this study in 2002 widely reported that hormone therapy seriously increased risk of heart disease, breast cancer, blood clots and other health issues. Previously, most doctors had believed that hormone therapy helped prevent these risks, so the study was a major news event.

New analysis of the WHI study reported in October continues to perpetrate these "facts," which apply to a very small segment of women. For example, out of 16,000 women, six were reported as having additional instances of heart disease. It is unknown what other health factors these women experienced that may have contributed to their condition beyond being given hormone therapy. The population of women studied within WHI was already menopausal and had high risk of heart disease, blood clotting and all the other health issues attributed to hormone therapy.

Even so, an incidence rate of 0.046 percent is not considered of significance among the scientific community. Neither would the nine women who experienced a stroke, nor the nine women diagnosed with breast cancer over the course of six to eight years. Yet many headlines reported that this recent analysis "confirmed" the original reports of the WHI.

An abundance of reputable research now shows that women who start hormone therapy before or within 10 years of the last menstrual period reap many benefits, both long- and short-term. In November 2012, findings from the Kronos Early Estrogen Prevention Study (KEEPS) reported favorable effects for newly menopausal women, including a decrease in the rate of atherosclerosis. Women in the WHI study were older, heavier, had higher blood pressure, were more likely to smoke and had higher levels of total and LDL cholesterol at baseline. They also had fewer menopausal symptoms than KEEPS participants. This was in part because KEEPS women, unlike the WHI women, were younger, but also because women with severe obesity, uncontrolled hypertension, a history of heavy smoking as well as those with cholesterol levels high enough to indicate a need for lipid-lowering therapy were appropriately excluded from the study.

Hormones are regulators. Their decline brings on the beginning of degenerative changes. When the thyroid gland begins to fail, as it does so often in aging women, medical providers are quick to prescribe a replacement for that hormone. Yet menopausal women are told we must do without the hormones that make so many of the processes in our bodies function optimally.

Even women who do not suffer perimenopausal or menopausal symptoms affecting their quality of life would be wise to weigh the risks and benefits of hormone therapy. According to a Centers for Disease Control report in 2009, only 54 percent of women recognize that heart disease is their number one killer, not breast cancer. In addition, Many women do not consider hormone therapy because they believe that taking hormones increases their risk of breast cancer, which is simply untrue. Even Dr. Marcia Stefanick, chair of the Women's Health Initiative Executive and Steering Committee, has been quoted as saying "…the jury is now in. Estrogen does not increase the risk for breast cancer, which is what most women thinking about using the hormone worry about."

In fact, estrogen therapy begun at the right time significantly decreases the risk of heart disease. A 2012 Danish study reported in BMJ, one of the world's oldest and most prestigious medical journals, concluded that after 10 years of randomized treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism or stroke. Where were the stories about this study and many others too countless to cite in this article?

Every day, I see women suffering from the symptoms of perimenopause and menopause. For me, this type of haphazard and incomplete reporting has done for hormone therapy what the movie Jaws did for beaches. Just as some of us have carried an irrational terror of swimming in open water after Mr. Spielberg's sensational movie, too many members of the medical community and the media have perpetuated incorrect and damaging fears about hormone therapy. Every woman needs to think through the issue of hormone therapy and come to an informed decision. That is hard to do when we cannot trust the headlines.

Sandy Greenquist is the director of Menopause Center of Minnesota and has provided OB/GYN and well-woman care in the Twin Cities for more than 32 years. Her email is sandy.greenquist@menopausemn.com.

To respond to this commentary, send an email to talkback@baltimoresun.com. Please include your name and contact information.

Copyright © 2014, The Baltimore Sun
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