The following discussions are provided to help clear up some of the most glaring (and potentially dangerous) misconceptions women may have about menopause and hormones.
Q. I'm only 42 but have symptoms. Can I be going into menopause this soon?
A. Yes. About 25% of us enter menopause before age 47. Almost all women (95%) are menopausal by age 55.
Q. What's the difference between "natural" hormones and those "bio-identical" hormones I've heard about? And can I buy them at the store?
A. Bio-identical means that a hormone is exactly the same, chemically, as the hormone nature produces in the human body. That's why people often refer to them as natural hormones.
The bio-identical hormones (BIHs) used for hormone replacement therapy (HRT) are manufactured, typically from substances in certain yams or soybeans.
Drug manufacturers may mix these BIHs with other ingredients (including other hormones that may or may not be BIHs) or package them in certain forms (pills, patches, creams, etc.) that are sold to pharmacies under brand names.
The generic pharmaceutical-grade (USP) hormones may be sold to "com-pounding pharmacies" who can mix up custom hormone products prescribed by your doctor.
Some of the USP hormones may also be sold to supplement manufacturers for over-the-counter (OTC) products like those you find in a health food store.
However, not all OTC "hormone" products contain hormones the human body can use. Those that do are much weaker than prescription products.
Q. If I want bio-identicals do I have to go to a compounding pharmacy?
A. Not necessarily. With a doctor's prescription you can get brand-name BIHs from almost any pharmacy.
You DO need to use a compounding pharmacy when the brand-name product's hormone type, dosage, combination or delivery media (pill, patch, cream, etc.) do not meet your personal needs and you want a custom BIH solution.
Q. I took Prempro before that study came out saying it's bad. Am I in danger? Should I file a lawsuit?
A. Not necessarily. First, the overall risks observed in the WHI Prempro study were very tiny. Even in the most extreme example (blood clots) the risk increased from less than one-fourth of one percent to double that, or less than one-half of one percent.
Second, you can't sue unless you have been diagnosed with one of the diseases (heart disease, stroke, breast cancer, blood clots) the study found to be negatively influenced by Prempro.
Third, while there is always a chance you can win the case if a jury is manipulated properly by a clever legal team, the fact is that the data fluctuated on both heart disease and breast cancer during the 5.2 years of the study, with the Prempro group being more at risk sometimes and the placebo group being more at risk at other times.
Fourth, if it's breast cancer you've got, you'll have a hard time proving a causal connection. (See below.)
Q. Did the WHI study prove that Prempro causes breast cancer?
A. No. It only indicated that Prempro may accelerate the growth of an existing breast tumor. The study was too short to determine whether Prempro causes breast tumors, since breast cancer takes 7 to 10 years to grow to a detectable size. The fact is that any woman diagnosed with breast cancer during the study al-ready had it when she enrolled.
Q. Is it true that since I'm past the hot flashes I don't need any treatments?
A. No. The hot flashes, night sweats and heart palpitations are symptoms primarily of abrupt withdrawal of estrogen. Once your brain realizes that your estrogen supply is not going to be raised to previous levels, no matter how loud it yells at your ovaries, things usually calm down and those symptoms fade.
However, those obvious and annoying symptoms are only the tip of the ice-berg when it comes to what's happening inside your body as a result of having chronically low or imbalanced hormones (usually both).
Without the right treatment, you will remain at higher risk for heart disease, stroke, certain cancers, osteoporosis and memory loss.
You are also likely to continue experiencing any other symptoms you currently have, including: dryness (eyes, skin, mouth, vagina), mood swings or depression, insomnia, urinary tract infections, thinning or unwanted hair, high cholesterol, worsening allergies, weight gain and sexual problems.
In some cases, diet and herbs or vitamins may be effective in helping re-uce symptoms and certain disease risks.
Q. Is it safer to take regular drugs for things like hot flashes, cholesterol, osteoporosis and moods/depression, since the FDA says all hormones are just as risky as Prempro?
A. No. But let's address the second part first. The FDA's advice that all hormones should be considered to have the same risks as Prempro and Premarin is a precaution. In the past 60 years, only Premarin-based hormones have been tested in large studies; no other HRT products are nearly as well researched.
It can be argued that the safety of our native hormones has been proven by the many thousands of years human bodies have been making and using them. However, it is also true that the chemically identical (bio-identical) pharmaceutical counterparts to those native hormones that we use for HRT have never been comprehensively studied to see if they work just as well or are as safe.
But don't hold your breath waiting for those BIH studies. Since nature's formula cannot be patented, few (if any) drug companies will be eager to fund expensive research on products that they can never claim exclusive rights to sell at a premium price.
So the FDA's advice is sound: until proven otherwise, assume that all hormone products have about the same risks as Premarin and Prempro. (Just remember that even their risks were not as scary as the news made them seem.)
Now to address the first issue: using non-hormonal drugs instead of hormones. Realistically, the FDA's advice about hormones should be extended to include all drugs. Only a rare few drugs have been studied for 5+ years in over 10,000 people like Premarin and Prempro have. That means the risks of those drugs you take for your heart, bones, bladder, mood, insomnia and "personal summers" are at least as unknown as those of bio-identical hormones.
Each drug has its own side effects, and there may be interactions between one drug and other drugs (or with foods) that enhance or diminish the impact of one or more of the drugs you're taking.
Then there's the complexity of taking several drugs on different schedules, with different rules for each.
Multiple conditions that arise from a single cause should, logically and most simply, be treated by addressing that single cause-in this case, low or imbalanced hormones. The logical, simple answer would be to replace and/or balance the right hormones. But if hormone re-placement is not an option you're comfortable with, don't assume multiple "regular" drugs are any safer.
Q. The new FDA guideline says that women should take the "lowest effective dose" of hormones for the shortest possible time. Is Prempro the only product available in that strength? And is it safer than the Prempro they used in the WHI study?
A. "Lowest effective dose" means what-ever amount is appropriate for your body to solve the targeted problems. Each woman is different; therefore, no product can realistically offer a universal "lowest effective dose," though many products offer low-dose options.
The fact is that even Prempro's lowest dose may be too strong for some women, while its highest dose may be too weak for others.
Since only one strength of Prempro was used for all women in the WHI (0.625 mg Premarin + 2.5 Provera), and the low-dose product has not been studied to the same extent, there is no proof that the low dose is any safer than the higher dose. The new option merely ad-dresses the belief that less of something risky is better for you than more of it.
Q. Did that big WHI study really prove hormones don't make you feel better?
A. No. The WHI's Quality of Life (QOL) study was so poorly designed that its conclusions are downright laughable.
First, women with severe symptoms were discouraged from participating or were encouraged to drop out, leaving mostly "happy campers" in the study.
Second, even the researchers said their tests were "too crude" to really track important factors like memory.
Third (and most importantly), the majority of the subjects scored high on the initial baseline QOL tests. So when later tests showed their happy campers weren't any happier after taking Prempro, they merely proved that "if it ain't broke, Prempro won't fix it."
Somehow, that bit of useless information has since been translated into the completely unfounded claim that "if it IS broke, the right hormones won't fix it."
What you won't hear in the news is that despite the claim that hormones won't improve anyone's QOL, the study did show that among the 12% of subjects with moderate to severe symptoms, QOL improvement was 77% (vs. 52% for those taking the dummy pills). Now that's a significant difference!
Q. My sex drive is gone. Can Viagra work for me?
A. Maybe. There are Viagra-like products for women available now or on the horizon, but the truth is they can't improve your libido (sex drive). What they can do is draw blood to your genitals to make that area more sensitive and, presumably, more responsive during sex.
But if you have no sexual desire, those drugs won't solve your problem.
Testosterone is the hormone of desire in both women and men. And when we are deficient in it, we can lose not only our sex drive, but muscle tone, bone density, memory, energy, creative passion and fantasies as well.
Unfortunately, there is only one testosterone product currently available for women (Estratest) and it's not a BIH.
Intrinsa, a new bio-identical testosterone patch for women, passed all the standard tests for FDA approval, but was sent back for additional testing in light of the controversy over hormones in general, and over using testosterone for women, in particular.
Women can use certain products de-signed for men, though many doctors are hesitant to prescribe them. And because of the potential for abuse, these steroids are closely regulated.
Q. I'm told I don't need to take progesterone with my estrogen since I've had a hysterectomy. Is that good advice?
A. No. Unless the surgeon also removed your brain, bones, muscles, breasts and just about every other organ in your body, you still need progesterone to sup-port normal physiologic functions.
Most importantly, you need progesterone to counteract potentially harmful effects of the estrogens remaining in your body. Even if you have no ovaries and have never taken estrogen, your body still makes estrogens in fat cells and in your adrenal glands.
But at menopause your body produces almost no progesterone, which creates a dangerous "estrogen dominant" condition. So even if you don't take estrogen, you probably still need progesterone to restore hormonal balance.
Q. Isn't breast cancer the greatest disease risk women face?
A. No! Women are 9 times more likely to die of heart disease than of breast cancer! Plus, doctors are more likely to misdiagnose heart disease in women or to treat it less aggressively than in men.
Q. Isn't lowering cholesterol critical for preventing heart disease?
A. No. At least half of those who suffer heart attacks have perfectly normal cholesterol levels!
In fact, cholesterol is not bad for you. All your hormones are made of it. Only oxidized cholesterol is bad for you. (Which is why we take antioxidants like vitamins C and E.)
It's far more important to test for chronic inflammation as reflected in C-reactive protein and homocysteine levels, which are much more reliable predictors of heart disease than cholesterol.
