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A Fresh Look at Hormone Therapy

Women Who Need It Should Take It, Experts Agree, but at Low Doses
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WebMD Health News

Oct. 5, 2004 -- The nation's leading menopause group is speaking out against a popular alternative to traditional hormone therapy, saying there is no clinical evidence to back up claims that so-called "bioidentical hormones" are more effective or safer than the conventional treatments.

The North American Menopause Society's (NAMS) third annual report on the status of hormone therapy strongly endorsed the use of traditional estrogen or estrogen plus progesterone therapy as the best available treatment for menopausal symptoms such as hot flashes, sleep disturbance, and night sweats.

The safety of these treatments has been in question for the past three years since a large study known as the Women's Health Initiative (WHI) linked their long-term use in older women with an increased risk of heart disease, stroke, and breast cancer. The latest NAMS recommendations are based on findings from that trial as well as clinical trials reported since then.

The Suzanne Somers Effect

The NAMS panel concluded that the popularity of the alternative treatment known as bioidentical hormones is of concern because there is virtually no clinical evidence to show that it is safe and effective. The alternative to traditional hormone therapy has become wildly popular since the publication of a book earlier this year by actress and author Suzanne Somers touting its benefits.

The custom compounded formulations are supposedly tailored to an individual woman's hormone needs, which are determined through hormone testing. Because they are considered natural formulations, bioidentical hormones are not regulated by the FDA the way traditional hormone therapy is.

NAMS Executive Director Wulf Utian, MD, PhD, says there is no evidence that testing hormone levels during menopause or tailoring hormone therapy is beneficial.

"Women have been sold a bill of goods by people who have conveyed these products as better and safer," he says. "The fact is these are the same hormones in different combinations and permutations, and they are therefore subject to the same risks and benefits."

It's OK to Stay on Hormone Therapy

In addition to urging caution in the use of bioidentical hormones, the NAMS panel concluded that:

  • Women with menopause symptoms can take estrogen or estrogen plus progesterone for as long as they need to. The panel placed no limit on treatment duration but noted that women on hormone therapy should be monitored by their doctors.
  • Hormone therapy can still be considered as a preventive treatment for osteoporosis, along with the other drugs approved to prevent the condition.
  • Hormone therapy should not be used for the prevention of heart disease. The WHI report found that long-term use increased heart risk in older women, but there is some evidence that the opposite is true for women who begin treatment before menopause.

New evidence from the WHI trial also suggests that the increase in breast cancer risk associated with hormone therapy is limited to estrogen plus progesterone combination treatment. Estrogen alone is recommended for women who have had hysterectomies, while estrogen plus progesterone is recommended for those who still have their uterus.

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