Posts Tagged "hormone replacement therapy"

Hot Flash Havoc: fear and loathing in the menopause

Posted by on Sep 17, 2010 in HRT, menopause | 12 comments

Author Louise Foxcroft, writing in Hot Flushes, Cold Science, points out that “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”

We have also been victims of the fact that menopause has been “thoroughly medicalized in Western Culture.” The result?

Our bias is to think of menopause as a disease, something that needs to be fixed, treated and eliminated. The solution is inevitably hormone replacement therapy or HRT.

Supporters of HRT will fight tooth and nail against evidence from the Women’s Health Initiative Study that showed that the risks associated with hormone therapy may outweigh the benefits. Their argument lies with the contention that the findings relate to women who were on average, 63 years of age, considerably older than the average age that women start menopause, and that the data are not applicable to younger women. Moreover, had these very women been given hormones earlier, they would have had protection against a multitude of diseases, including heart disease and osteoporosis. Critics of HRT, on the other hand, point to data showing that length of time on hormones, timing of hormones and genetic disposition can increase or decrease a woman’s risk for disease, that HRT doesn’t protect against heart disease or stroke and may in fact, significantly increase disease risk, in particular, breast and ovarian cancer, and death from lung cancer.

Last weekend, I sat through Hot Flash Havoc with a group of female friends. Together, we range in age from 47 to 57. Two of us have had multiple bouts of cancer while three of us have lost loved ones as a result of cancer. Our mothers have had hysterectomies, mastectomies, hot flashes or no flashes. Some are still alive and others have passed.  In composite, we are representative of the modern woman: savvy healthcare consumers, avid data hounds, curious, communicative and sometimes outspoken. As one of my friends stated, we are “rolling into a new phase” or have already rolled into it: menopause.

I couldn’t think of a better, more objective way to screen Hot Flash Havoc, “the most provocative and revealing film ever made about menopause.”

Provocative? You bet!

Revealing? Yes!!!!! But not in the way that the director, producers, writers or underwriters intended. Rather than debunk myths about menopause, they have produced a documercial that the women in the room described as:

“Condescending.” “Patronizing.” “Not very well done.” “One-sided.” “Unhelpful.”

And my favorite: “a giant estrogen dildo.”

Hot Flash Havoc promises to “set the record straight about the Women’s Health Initiative study released in 2002, which misrepresented that the hormonal replacement therapy being used by millions of women to treat the symptoms of menopause could actually increase the risk of heart attacks and cancer” and further, “shed insightful light on the confusion stemming from a decade of misguided facts [through] poignant personal stories shared by real women and in-depth interviews with the world’s most noted experts.”

However, the reality is somewhat different. This film of “menopausal proportions” is a meandering, sometimes cartooned montage of HRT hype and bias. Attempts to turn ‘women’s anatomy 101’ into humorous animations of talking vaginas, vulvas and ovaries begs the question: have we somehow stumbled onto a grade school class on menstruation? (By the way, the only thing missing were the tampons and sanitary napkins, which of course, would have no place in the menopause medical cabinet. )

Along with a dash of failed humour is the film’s dose of intrigue, not about the mysteries of a woman’s body but rather surrounding accusations of a government conspiracy underfoot to undermine decades of evidence supporting the use of HRT.  Indeed,the National Institutes of Health, which halted the hormone arm of the Women’s Health Initiative study is blatantly accused of attempting to rob women of HRT in a selfish quest fueled by self-promotion.

Wait! The government is conspiring against women who need their hormones???!

The circus-like atmosphere of Hot Flash Havoc is beautifully orchestrated by pro-HRT doctors disputing evidence, ‘enlightened experts,’ and of course, a bevvy of Botoxed babes who went through terrible withdrawal when their doctors made them stop taking their HRT. The message? Women: you’ve been duped!

Hot Flash Havoc misses the mark because it robs the viewer of any objectivity or information about how women and practitioners in different cultures and countries address menopause. Moreover, with the exception of a token naturopath thrown in for good measure, alternative strategies are portrayed as ineffective shams and their proponents, as greedy blood suckers who care more about profit than the women they serve.

One of my friends asked if the film’s intention was to provide enough information to make an informed decision. If so, she said, it fails terribly. Another friend commented that the film portrays menopause as an illness and said that she thought that the film’s underlying message is that menopause is not natural and needs to be cured, that there’s something wrong with you.; ‘it makes me angry,” she said. The overriding complaint was the clincher: this film is really about instilling a fear of aging and illness and the need for a remedy, a ‘miracle’ drug: estrogen.

Hot Flash Havoc is an infomercial of menopausal proportions, a messy mash-up of HRT hype and fear and loathing, a big estrogen dildo just waiting for an opening. Do yourself a favor: don’t let it wreak havoc on your psyche. This one’s a dud.

A huge thank you and love to my Roller girls and partners in crime — Turn A Head, Wendy Wildstar, Biker Babe and Red — for their comments and insight. Couldn’t have written this one without you!

p.s. Bob Dylan wants his album cover back.

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Hormone therapy and bones – fuggedaboutit

Posted by on Aug 16, 2010 in bone health, breast cancer, HRT | 1 comment

Another HRT-busting post…straight from the archives of  the Ahead-of-Print edition of Menopause. I’m afraid to say that yet, another analysis of the now infamous Women’s Health Initiative Trial, you know, the one that was halted due to links between HRT and significant increases in breast cancer, suggests that hormones might not be so great after all, especially when it comes to bone protection.

The loss of lean body mass as we age contributes to redistribution of fat and  apparently contributes to falls and fractures in the later years. This is one reason why many physicians prescribe hormones. However, in the latest nail in the HRT coffin, it appears that despite earlier reports of significant reductions in fractures among women taking HRT based on body mass index, age and bone mineral density, the ability of hormones to preserve lean body mass is a fallacy. In fact, when researchers looked at almost 2,000 women who had been enrolled in the trial who were assigned estrogen plus progestogen, estrogen alone or placebo, they were unable to find any differences in lean body mass after six years, even though there was some indication of protection at the three year mark. What’s more, the researchers say that although women who took most of their hormone medication before the trial was halted seemed to fall less, it wasn’t because their lean body mass was preserved.

The main point in relaying this bit of information is experts want us to believe that HRT is the panacea for everything that ails as women age –from bone health to heart disease to dementia. And despite evolving evidence to the contrary, they continue to seek reasons why the data are wrong and look for ways to question every negative finding. Some Associations whose mandate it is to defend women’s health, like the Society for Women’s Health Research, take money from companies whose hormone products have been found to cause significant adverse effects in certain populations of women and yet, they continue to lead the charge favoring hormone therapy.

In general, I take no issue with Western medicine or pharmaceutical companies. If you look at my background, I have spent years writing favorably about many products and the research that backs them. But I maintain a standard of transparency and don’t choose to hide who’s paying the bills, And, when it comes to hormone therapy, I continue to smell a rat. Be assured that  I will continue to write about what’s really going on until more women understand how fucked up HRT really is.

If you choose to take HRT and it works in alleviating your flashes, sweats, mood swings, headaches, sex life and the like, more power to you. I support your right and decision to take HRT. But like any drug, be sure you know the facts before you believe the hype. Be certain to be diligent and ask the hard questions, even when the information comes out of seemingly expert sources or associations. Always, always, follow the trail. You might be surprised at what you learn.

This particular trail, the lean body mass trail? It’s a dead end. Fuggedaboutit.


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HRT – How do you stop?

Posted by 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?

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Wednesday Bubble: HRT – Ask the Hard Questions

Posted by 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.

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Wednesday Bubble: herbs and breast cancer

Posted by on Apr 21, 2010 in breast cancer, herbal medicine | 1 comment

Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?

If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.

The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.

The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early.  Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.

If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.

Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.

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