Posts made in May, 2010

HRT – How do you stop?

Posted by Liz on May 10, 2010 in HRT | 15 comments

A Twitter friend recently asked me about stopping hormone replacement therapy  (HRT). It was a question that I hadn’t explored on this blog. Although the foundation of Flashfree is to provide information about alternatives to HRT, I’ve never really considered the “what now” of the issue, as in, what if you decide to go off hormones or try alternatives after you’ve been on HRT? So this post is dedicated to her, and to those of you who want to know if there is a safe and effective way that HRT should be stopped.

Interestingly, when I looked into the issue, the answer seemed to be even less clearcut than the therapy. In fact, there are no guidelines for stopping HRT.  To be honest, this disturbs me quite a bit; don’t you believe that if a physician is going to recommend that you take hormones, that he or she should have some clear guidelines as to how to take you off of them? Granted, until the Women’s Health Initiative started to reveal the dangers and risks of HRT, there was no real reason to stop therapy, (although, I’m of the mindset that there’s really no good reason to start HRT).

Fortunately, researchers are finally starting to look into this issue although study findings (which are published in the online edition of Menopause) highlight that the practice of stopping HRT is intuitive and not evidence-based.

So, what did they learn?

Among 438 group practice physicians surveyed, an overwhelming majority believed that women should taper HRT, with most believing that the best strategy was not only to slowly decrease the dose, but also to reduce the number of days HRT was taken per week. However, they had no suggestions with regards to how to taper use of HRT patches, even though the patch is increasingly being recommended and touted as a safe solution to oral hormone therapy. (Notably, like the evidence from this particular study I am talking about, the evidence that shows the safety aspect of the HRT patch is mostly observational, meaning that it is subject to personal bias.)

More interesting, however, was the finding that the majority of the physicians who participated in the study were more strongly influenced by their personal beliefs than by colleagues’ actions or most importantly, by a woman’s preference. In other words, physicians are not asking their patients about what they would like or if they have any thoughts about stopping therapy. More shocking was the fact that only 2% of physicians surveyed relied on actual evidence to stop hormone therapy. Physicians who indicated that they believed that some action should be taken if symptoms returned after stopping hormones overwhelmingly turned to behavioral changes or exercise, not  to alternative therapies such as herbs.

In an era of evidence-based medicine and strategies that integrate eastern and western philosophies, why are our physicians relying on their own personal belief systems rather than real facts? Why aren’t they asking their patients how they feel about stopping therapy or if they have fears about symptoms returning and then thoroughly exploring alternatives with them.  Are these findings in a vacuum or will they be found on a broader basis?  Does the problem lie in fact that there are no standards?  What’s more, why hasn’t the American Medical Association or American College of Obstetrics & Gynecology devised guidelines for stopping HRT therapy? Why hasn’t the Food & Drug Administration demanded this guidance in labeling?

Finally, why do we continue to play Russian Roulette when it comes to women’s health? Isn’t it time for a change?

Let’s start with HRT. There are a lot of folks out there who continue to espouse the benefits, deny the risks and ignore the facts. Clearly, this story continues to unfold. Unsafe medical practices are even more unsafe when they are not backed by evidence, right? Is HRT the exception?  What do you think?

Friday Folly

Posted by Liz on May 7, 2010 in Uncategorized | 0 comments

I’ve noticed lately that the more overloaded my work and personal life has become, the less I am able to focus, feel centered and operate at full capacity.

So, I’m taking today off to Play, Dream & Create.

I believe that there’s a role for all that and more when we need to refuel.

See you next Monday. And Happy Mother’s Day!

Wednesday Bubble: HRT – Ask the Hard Questions

Posted by Liz on May 5, 2010 in HRT | 3 comments

Your doctor has just recommended that you try hormone replacement therapy, better known as HRT. You’ve heard the horror stories about increased risk for breast cancer, lung cancer, ovarian cancer, heart disease…yikes!  And yet, you are flashing like nobody’s business, sweating like you’ve just run a marathon and moody as all hell. What should you do?

Ask the hard questions.

Anyone who reads this blogs knows that I am not a huge fan of hormone replacement therapy. There are numerous reason for my personal biases, ranging from the inherent health risks to the belief that menopause has been treated as a disease for far too long and that the paradigm needs to change. These reasons represent the initial driving force behind this blog, which is to explore viable and evidence-based alternatives to HRT and discover strategies for dealing with the emotional and physical aspects of midlife and the transition in more positive and empowering ways.

However, I also support  any woman’s decision to use HRT. Your life is your life and only you can control the decisions that feel right for you.

Nevertheless, it’s critical to ask the hard questions.

So, what do I mean by that?

Medications are meant to heal, sometimes even cure what ails. But medications can be dangerous if they are misused, overused, or inappropriately prescribed. It can be confusing, because who can you trust to deliver the truth? And where should you turn when the media can’t agree on the story, when doctors are misinformed or too busy to take the time to thoroughly vet a patient or when one internet source states one thing and the other, another? What’s more, what’s at stake?

So, I’d like to put forth some initial questions for your consideration.

For your doctor

• Why is your doctor recommending HRT? What does he/she believe it is going to help? What are your personal risks, based on your current health status, family history, genetics and disease profile? Are you a smoker, drinker? have heart disease, lung disease, diabetes, etc?
• Does your doctor have any personal investment in HRT, i.e., has he/she done research on HRT on behalf of companies who manufacture it?
• What is the risk/benefit ratio for you? Are the risks higher than the benefits or visa versa?
• How long does the doctor expect that you will need to take HRT? How does this affect your risk/benefit ratio?
• Has the doctor had any patients who have had bad experiences with HRT? Would he/she be willing to discuss those experiences generally?

About your information source

• What is the source of information about HRT? Is it/he/she reputable? Have you taken the time to follow the trail and looked into its/her/his personal interest in HRT?
• Is he/she/his/her company or association sponsored by manufacturers who have a financial interest in HRT?
• How accurate is the news report? Do you thoroughly understand the news report? Does the news report seem like it has a bias? Has it throughly explained the study that it is basing its information on? (Gary Schwitzer’s HealthNewsReview provides excellent guidance on reading health news and what you should be looking for.)
• Who sponsors the website you are getting my information from? Is it industry sponsored? What is the background of the people who are writing the information that is highlighted on that website?

I am sure I’ve missed some important considerations or questions but these represent great starting points.I’d love to hear your thought. Or if you feel that I’ve missed the boat entirely.

Always…if you want the truth, you’ve got to ask the hard questions.

Gimme an “O” – all in the name of research

Posted by Liz on May 3, 2010 in sexual health | 0 comments

Seriously, I couldn’t make this up. It seems that scientists are studying the mechanisms in the brain that are activated when a woman is aroused during orgasm…in an MRI machine. Somehow, masterbating in a confined space with an endless drone in my head, while researchers look at my brain doesn’t sound very appealing. Nor does giving them a hands up after I’ve come. The goal? By understanding what happens to cause arousal, it might be possible to teach women who have difficulty climaxing to overcome their challenges.

Now mind you, scientists have been studying orgasm through MRI for over a decade. And while I am all for research, especially for women who suffer from sexual dysfunction, well, some things are sacred.

Gimme an “O” sure. But in the privacy of my own domain with either a great vibrator or an amazing partner. Not in an MRI tube with a bunch of researchers literally waiting for the next wave.

How can anyone get turned on with this in their ear?