Newsweek last week tried to expose the risk Oprah Winfrey takes as oracle of all things important with regard to health and self-improvement. I must admit it's very hard for a gynecologist not to cringe these days upon hearing the words "Oprah," or "Suzanne." If I hear them, usually it means my patient wants me to know about the recent episode she viewed, or to read the latest book Suzanne Somers has written so I can report to her what my "opinion" is about the issue. I am not really being asked for expertise, as my patient has been warned about "What your Doctor May Not Tell You..." Instead, I am usually being asked if I am "for or against hormones," or do I "believe" in bioidentcals, as if it is not a matter of science, but a debate based on my personal beliefs; something she could easily take or leave. My co-workers must be wondering why I have come to the defense of the phenomenon of media driven perceptions about hormonal therapy. The answer is simple, I agree with Oprah on a very important message underlying much of what she proselytizes:
Quality of life does matter.
Oprah's desire to communicate information and try to incite personal responsibility is undeniably sincere and well motivated. However, regardless of her intentions, most of us in the trenches of women's health care have been spending many extra hours trying to help patients sift through the maze of questions left by the endorsement of bioidentical hormones promoted by Suzanne Somers and others during her recent series.
There are several challenges to informing patients about options in a fair, unbiased, accurate manner. A patient may assume risk by getting in her car to drive to my busy parking lot, but if I say the word risk to her, she often hears "don't do this" instead of "everything of value has a price." She may be willing to go to her alternative practitioner four times in a month, but if I ask her to make a separate appointment to discuss hormone issues, she often feels that I am not willing to spend time with her today. If I suggest that FDA regulated hormones may have an advantage with regard to proven product information, she may suspect I am receiving kick-backs from big pharma (believe me, my ballpoint pen is not worth more than 25 cents), while the compounding pharmacy down the street really cares about her, you see they want blood tests that I never seemed to order. (Disclosure: I'm a fan of compounding pharmacies, particularly when there are no FDA approved options to fit my patients' needs).
The truth takes a little time to explain, but Oprah and Suzanne Somers are absolutely right that menopausal changes for many women can be life and relationship interrupting. It is also true that many women may benefit from hormone therapy. What is not true is that the word "bioidentical" means safe. Hormonal creams are not like make-up (although topical prescription estrogen can do wonders for skin). Treatment needs to be supervised by someone who can give women information in a fair and educated manner. This is something else that Oprah would endorse, and that Suzanne Somers promotes in her books; she encourages her readers to spend time with their doctors, and to be willing to keep working to "get it right," rather than accepting a practitioner who doesn't want to explain the risks. This takes someone who is aware that information changes daily, and that what we know today may change completely tomorrow.
Current evidence suggests benefits of HRT for the menopausal woman include:
• For many, relief of hot flashes and night sweats associated with declining estrogen
• For some women marked improvement in mood, verbal memory, and sleep quality
• Lower risk of Osteoporosis and hip fractures
• Improvement in vaginal blood flow and elasticity
• Improvement in collagen content and function, particularly in bone and skin
• Estrogen alone therapy (for women who have no uterus): less coronary artery build up...or plaque
• In combination (Estrogens and Progestins or Progesterone) therapy: lower incidence of colon cancer
Current evidence suggests risks of HRT for menopausal women include:
• An increased tendency for blood to clot, resulting in an increase in stroke and deep clots (such as those that may travel to the lung known as pulmonary emboli)
• An increase in gall-bladder disease
• Estrogen in combination with Progestins or Progesterone -- all of the above and:
o An increase in heart disease risk
o A tendency to increase breast cancer risk
o An increase in the death rate of those who have lung cancer
When pondering the current bank of knowledge about HRT it is universally true that each woman has her own set of needs and issues that mandates an exquisitely individualized approach. Many women may opt to accept some risk and are willing to change or maintain a lifestyle that can help moderate those risks.
At the end of the day: living is risky; it's important to live well...worth some risk, but transparency is not just for corporate America, it's for all of us in service to those who seek our leadership and advice. In an effort to deliver information that affects the ability of how to negotiate the changes Nature delivers us; an open mind is mandatory -- open to the risks and the benefits.
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