If I worked at the Centers for Disease Control (CDC) in Atlanta, I would ask to be put in charge of monitoring the financially and self-promotion-driven epidemics of "BIO-IDENTICAL HORMONE SURGE," a phenomenon that pops up about every 18 months. These epidemics are marked by short-term visibility with a new book, usually by the facially altered medical expert and former infomercial maven Suzanne Somers. The outbreak recurs when some women's media outlet decides to give a day, a week, a month to the odd idea that hormonal drugs compounded without oversight are not really drugs at all.
The most recent outbreak occurred in the Oprah Media empire -- as noted in a much-discussed cover story in this week's Newsweek.
Each time the epidemic occurs, you will hear the following mis-statements in the media:
- "There is great confusion over the term bio-identical hormones. Only those who take blood tests and then compound the individualized replacement of hormones that are just right for you can manage your menopausal symptoms."
- "In order to have the benefit of hormone therapy, blood or saliva tests are necessary -- both before starting and then throughout the therapy."
In truth, there is NO confusion about the term bioidentical hormone therapy. And those "tests" may do little but cost lots of money and drive business to the practitioners who are part of this consortium.
The North American Menopause Society and the American College of Obstetrics and Gynecology state clearly that spending increasingly scarce health care dollars on tests to measure hormones in a menopausal woman's body is not only financial inappropriate, it will not affect treatment.
Bioidentical hormones are those that chemically match those produced in the human body. How could this simple statement be confusing? But each time the epidemic occurs, the infectious agent who is promoting more business and more videos and more books always begins with this remark: "Bioidentical hormone therapy is confusing, and only someone who works with a compounding pharmacy can understand it."
The infecting agents on the PR trail always point out that doctors who follow general guidelines for treatment of menopausal symptoms either
- refuse to listen to patients, or
- prescribe only Premarin ("IT COMES FROM A PREGNANT MARE'S URINE !" they scream) and a dreadful chemical form of progestin, known as Provera.
The agents frighten women with floods of lists of side effects and potential bad outcome from hormone therapy.
I don't know any gynecologist personally who still prescribes Premarin and Provera as the hormones of choice for management of menopause syndrome. The truth is that most gynecologists who care for women in the menopausal transition do work with their patients to evaluate what works best for each of them. It may be that hormone therapy is not the right choice for each woman.
If the woman feels that she has symptoms that cannot be managed by non-hormonal therapy, then many doctors prescribe bioidentical horome therapy -- the type approved and monitored by the FDA, made by pharmaceutical firms and which come in varied strengths.
There are patients for whom bio-identical hormone preparations that are commercially available are not right. The dose might need to be smaller or the patient could have an allergy to some part of the commercial product. Doctors who need to offer a compounded hormonal preparation can find a pharmacist who can create a hormonal prescription for women with these special needs. But the doctor and the patient need to be aware that there is no FDA oversight of any compounding pharmacy products, and that certainly hormone drugs are drugs with risk no matter if they are prepared by a commercial pharmaceutical firm or a compounding pharmacy.
So why is Oprah spreading this epidemic?
In January, Oprah outed herself as menopausal at 55. She used her enormous media strength in her television show and in her magazine to promote compounded bio-identical hormones with Suzanne Somers as her expert with a new book, Ageless. Gynecologists everywhere are grateful to Newsweek for the outstanding investigative journalism of Weston Kosova and Pat Wingert (co-author of Is It Hot in Here or Is It Me? A Complete Guide to Menopause). The two award-winning reporters paint a sharp portrait of the chaos Oprah has encouraged.
Women respect Oprah because she is a self-made survivor and one smart cookie. She makes interesting recommendations for books her viewers might read. She has thoughtful experts in exercise, diet and counseling. But she over-stepped in January, when she showcased Somers, spokeswoman for the compounded hormone drug industry.
That day, Oprah relegated to the audience noted gynecologists and endocrinologists who had taken time from their work so as to be part of this national conversation. With the invited physicians hovering in the audience, Oprah featured on the dais Somers and the gynecologist Dr. Christiane Northrup, who has in recent years created a cottage industry of nurse practitioners who diagnose hormone deficiencies and prescribe compounded hormonal drugs. Thus were the pro-compounded drug shills, placed much closer to her, seen as clearly in line with Oprah's point of view.
The important issue here is that these bio-identical hormone drugs, compounded in a non-regulated pharmacy, carry the same risk as bio-identical hormones produced by FDA-regulated pharmaceutical companies. In addition, women who choose to take compounded hormone therapy have no assurance that the dose or purity is what the pharmacist or doctor claims it to be.
Most doctors felt that the Oprah show featuring Somers was outrageous. Many women in this country have counted on Oprah to introduce them to good books and weight-loss programs and psychological and fitness advice from reputable experts.
We are just exhausted from the onslaught of every Suzanne Somers media appearance and next book that repeats the same infomercial with just another PR-driven title. It took Newsweek to speak for us, and we are really grateful for this unbiased and clear reporting.
Patricia Yarberry Allen, director of the New York Menopause Center, is a gynecologist affiliated with New York-Presbyterian Hospital and a board certified fellow of the American College of Obstetrics and Gynecology. The publisher, co-founder and president of the board of , Dr. Allen is a spokeswoman on women's health. She was the inaugural speaker for the Iris Cantor Lecture Series on Women's Health at the American Hospital in Paris. Dr. Allen has been interviewed by The New York Times, USA Today, regional newspapers and major television news programs on womens health issues and is a contributing editor for More magazine.
(As a fellow WVFC member, I couldn't think of any more fitting use of this space than to hear hard facts from a physician who has been quietly fuming about this issue even before Newsweek broke the ice. -- EGH)