Posts made in February, 2009

Wednesday “Bubble:” Bioidentical “hormones”

Posted by on Feb 18, 2009 in bioidentical hormones | 12 comments

Quotation marks are used to signal the reader that something is important. Sometimes their use works counter to their intention. In this highly sarcastic editorial in Menopause Management, the esteemed Dr. Wolf H. Utian, president of the North American Menopause Society (NAMS), demonstrates what happens when quotation marks and information, go wrong.

The first indication that something was awry was a press release I received from NAMS confirming the Organization’s support of the FDA position on bioidenticals and reiterating their dangers. This release, like many others, was a direct response to informercial actress Suzanne Somers (who looks to be age 30) and her two-day miracles of plastic surgery bioidenticals sound-off on the Oprah Winfrey show last month.

No wonder the wagons have started to circle.

And yet, Dr. Utian’s assertion that supporters of bioidentical hormones be thrown into one categorical cult set out to acquire/garner the publicity around so-called “natural” therapies” does a huge disservice to the very women he proports to be protecting.

Warning that this new “cultlike” phenomenon of compounding bioidentical hormones will end in the courtroom and that folks should not anticipate supporting evidence from real experts, Dr. Utian states that the majority of the most significant national medical associations and societies are now coming out with statements of reservation about the bioidentical cult.

To healthcare practitioners everywhere, he warns that the responsibility to counsel women about risks and benefits of all pharmacotherapies is yours. You sign the prescription, you carry the liability. It’s time to tell women, “Buyers beware!”

I think it’s time to tell women to do their research, consult with an accredited practitioner, and follow your heart and head. I believe it’s time to take back our bodies and stop treating menopause like a disease for which “one size fits all.” And I think it’s time to tell government that we know the reach and influence of Big Pharma and that it time to question the rationale behind applying Western methodology to every type of integrative therapy in order measure its effectiveness.

Don’t drink the Kool-Aid

So, dear readers. Dismiss Suzanne Somers and her promise of youth forever. Don’t drink the Kool-Aid.  But do your homework, talk to real practitioners not cutting edgers trying to cash in on the latest craze, and assuage your symptoms responsibly.

I wrote about bioidentical hormones last June. I am reposting it now rather than sending you back in time. The more things “change,” the more they stay the  “same.”

Be safe. Be well.

Bioidenti what? [originally posted, June 13, 2008]

Bioidentical hormones (also known in many circles as “compounded biodentical hormones”) are compounds that have exactly the same chemical and molecular structure as hormones produced in the human body. The term is most often used in the context of estrogen and progesterone (and androgens), although any hormone can be made this way. Notably, there are a few of these agents that are actually FDA-regulated and available from retail and not compounding pharmacies (meaning that dosage and purity are theoretically on par with synthetic types).

There’s been a lot of hullaballoo over these products from many of the major associations that are involved in women’s health (e.g. The Endocrine Society, North American Menopause Society) primarily because: 1) they are not regulated by the FDA or have any oversight whatsoever and 2) potency is inconsistent. In fact, the FDA sent warning letters to nine pharmacies in January due to what the agency felt were unsupported claims about safety and effectiveness.

FDA does not just randomly go after pharmacists who practice traditional compounding and who don’t make false claims about their products. Traditional compounding, in fact, involves the preparation of a drug for a specific patient based on a doctor’s request.

Consequently, FDA action might have been driven, in party, by Wyeth Pharmaceuticals, who filed a Citizens Petition that claimed: 1 that compounding pharmacies were not actually compounding but “manufacturing” mimics of approved agents; 2) that they used a form of estrogen known as “estradiol” not commonly found in “traditional” hormone therapies; 3) that they were engaging in illegal promotional practices. (BTW, Wyeth manufactures several estrogen products, including Premarin, Prempro, and Premphase.) You can read the rest of the petition here.

It’s important to recognize that not all compounded products are bad. In fact, compounding pharmacies continue to provide options to patients with contraindications to commercially-produced therapies. An article in a large monograph sponsored by the North American Menopause Society explains that pharmacies were compounding micronized progesterone years before an agent (Prometrium) was approved in the US. It also goes on to highlight several advantages that compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

Organizations such as the International Academy of Compounding Pharmacists (IACP) have become quite outspoken about what they consider to be the FDA’s interference in physician decisions to prescribe estriol to their patients. Congress has even introduced a bipartisan-sponsored bill (Resolution 342) to reverse the FDA’s decision on estriol. There’s a website that further explains these efforts.

In the meantime, if you decide you want to try bioidentical hormones, speak to your health practitioner. S/he can devise a regimen that best meets your needs (and not the needs of the masses) and may be able to recommend a credible compounding pharmacy. The IACP might also be able to assist with your search.

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Hi ho, hi ho….

Posted by on Feb 16, 2009 in Meditation/mindfulness therapy, menopause, work | 3 comments

It’s off the work we go.

I’ve seen this joke a zillion times. And I’m not amused.

But seriously. A study reported in ‘Ahead of Print’ edition of the journal Menopause suggests that a majority of menopausal women report daily physical or emotional symptoms that significantly affect their daily personal, professional and social lives.

Researchers surveyed 961 members of the National Association of Female Executives about their knowledge and understanding of hormone replacement therapy. The participants were divided into subgroups based on whether or not they were pre-, peri-, menopausal or post-menopausal.

Among study participants, 88% reported personal experiences with menopause, 95% had physical symptoms and 79% had emotional symptoms. Some 40% said that these symptoms caused problems in at least one area of their lives. More than a third of women who used HRT to treat symptoms cited the health concerns as a reason for discontinuing.

Undoubtedly, individualized care is critical to improving quality of life for women in or around menopause. Indeed, the researchers cite this in their conclusion. But when it comes to our professional lives, how can we improve our daily experiences when hormones are wreaking additional havoc on daily stressors and challenges?

I would like to suggest that integrative therapies may offer a path to salvation. For example, pace respiration or meditative breathing can easily be done at your desk or even on a park bench during a lunch break.  A 1995 article in Menopause found a decline in the number of hot flashes and average skin temperature among women who practiced breathing exercises.

Paced respiration involves deliberate inhalation and exhalation of air.

  • Sit comfortably
  • Inhale for 5 seconds through your diaphragm (the goal is to fill your diaphragm, not your upper lung area), pushing your diaphragm out
  • Exhale for 5 seconds, pulling your diaphragm in and up
  • Repeat several times

Another technique is known as “counting breath:”

  • Sit in a comfortable position with your spine as straight as possible
  • Count your inhalations and exhalations. When you inhale for the first time, think “one.” When you exhale, think “one.” Next, think “two,” and so on. Continue until you reach 10
  • If you have time, start over again and do another set of 10
  • The ultimate goal is to 5 sets

Meditation takes time and practice so try not to beat yourself up if your mind wanders while doing either of these exercises. The primary goal is to focus on your breathing and to calm your inner and outer fire.

Any other practices that work for you? I’d love to hear!

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Just when you thought it was safe…

Posted by on Feb 13, 2009 in exercise, hot flash | 1 comment

Researchers now say vasomotor symptoms, such as hot flashes, night sweats and sleep disturbances, can last more than five years after menopause ends.

Clearly, this has a lot of implications of how we approach therapeutic interventions for hot flashes and other symptoms, as well as for planning ahead.

In this study, which is published on the advanced online edition of the journal Menopause, data were colllected from 438 menstruating women (ages 45-69 years) and then analyzed over a period of 13 years.

The findings showed that the mean duration of hot flashes over the study period was 5.5 years, regardless of whether or not women had ever used hormone replacement therapy. What’s more, study participants started experiencing hot flashes around age 53, and roughly a quarter of them continued to report having symptoms after the 13 year endpoint.

Importantly, the one factor that was associated with a shorter duration of hot flashes was exercise, with more exercise/physical activity associated with shorter symptom duration.

I’ve posted previously about the benefits of exercise and physical activity, which range from positive effects on bone health, sleep and mood to heart health and of course, overall symptoms. This study suggests an even more important reason to keep moving: slowing and perhaps eliminating menopausal symptoms sooner rather than later.

Move your bodies ladies – the evidence is in and it says it’s safe to step back in, one foot at a time.

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Wednesday Bubble: Vitameatavegamin

Posted by on Feb 10, 2009 in Uncategorized | 6 comments


I Love Lucy. But, today’s bubble is  no laughing matter.

New evidence suggests that multivitamins do not offer protection against common cancers (i.e. breast, colon/rectum, endometrial, kidney, bladder, stomach, ovary and lung), heart disease and overall mortality in postmenopausal women.

These findings, which were published this past Monday in the Archives of Internal Medicine, offer combined evidence from three overlapping trials in the Women’s Health Initiative Clinical Trial and Observational Study which included women assigned hormone therapy, dietary modification or calcium and vitamin D.

Over a time period of roughly 8 years, researchers collected and evaluated data on the use of multivitamins, multivitamins with minerals and stress supplements in 161,808 women, including  number of pills weekly and length of use for each supplement.

Supplements were also grouped according to ingredients: 1) multivitamins alone = 10 or more vitamins with no added mineral meeting 100% of RDA; 2) multivitamins with minerals = 20 to 30 vitamins and minerals and nutrients less than or equal to 100% of RDA, and  3) supplements containing more than 200% of the RDA of B-vitamins and high doses of vitamin C or selected minerals).

Overall, 41.5% of study participants used multivitamins (most commonly, multivitamins with minerals). Analysis showed no association between multivitamin use and cancer, heart disease, or overall mortality risk, although a possible association between stress-type supplements and a slightly lowered risk of heart attack was seen.

Based on these results, the researchers concluded that “multivitamin use has little or no influence on the risk of common cancers, heart disease or total mortality in postmenopausal women.”

In the study’s discussion, the researchers questioned the value of using multivitamins for chronic disease prevention, and while they acknowledged the importance of nutrition for preventing chronic illnesses, they suggest that supplements are not likely to play a major role in these efforts.

What do you think? (BTW, Dr. Hubbard from My Family Doctor Mag has a great post on this issue.)

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Poor man’s plastic surgery, and even better!

Posted by on Feb 9, 2009 in breast cancer, exercise | 5 comments

Exercise! Benefits aside, loved this poster! But that’s not the reason for this post.

Not only can exercise help improve mood and keep bones strong during menopause, but it appears that physical activity after menopause may help to lower the risk for breast cancer. Yet another reason to keep moving that body of yours.

German researchers evaluated the health records from 3,414 postmenopausal women who were participating in a study on breast cancer. Physical activity (sports, cycling, walking) was assessed during two periods — ages 30 to 49 and over age 50 — and compared to non-recreational physical activity (occupational, household activities).

Study findings showed that physically active women had a .71 lower odds of developing breast estrogen and progesterone receptor positive breast cancer. A similar effect was not seen on estrogen/progesterone receptor negative cancers.

Notably, these results remained even after the researchers took into account weight gain, body mass index and caloric intake, leading the researchers to conclude that continuing to be active after menopause may help to reduce the risk of developing certain breast cancers. This effect appears to be related to specific hormonal pathways and not body composition.

The study was published in the December 1 issue of Cancer, Epidemiology, Biomarkers & Prevention.

Strong motivation to keep moving, right?!

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