Sign Out: Our 40-year ride on the hormone therapy rollercoaster

January 1, 2007

When I started practicing "menopause medicine" 40 years ago, Dr. Robert Wilson's book, Feminine Forever was on the bestseller list. Today, as I approach the pinnacle of my career, Suzanne Somers' Ageless: The Naked Truth About Bioidentical Hormones is on the shelves. The titles are different but the message is the same: the promise of eternal youth . . . .

In 2002, release of the results from the Women's Health Initiative (WHI) effectively ended Wilson's era by inducing women's fears about hormone therapy (HT), and jump-started Somers' touting of "bioidentical hormones" as the safe elixir against aging. I fear that her claims, too, will end in class-action lawsuits. Against whom? Probably Somers, the compounding pharmacies, and the complicit physicians who rubber-stamp the prescriptions for untested and uncontrolled compounded mixtures.

What happened between 1966 and 2007 that brought us full circle? Nowadays, we know more about menopause than ever before, and our patients seek information from many sources in an effort to make informed health decisions. But providing information about menopause has regrettably graduated to a "menopause industry" that's out of control.

As contemporary menopause management protocols developed, a "catch 22" situation arose: how to inform women about preventive health care without creating a climate of fear and anxiety? This dilemma of preventing illness, prolonging life, and enhancing its quality without being criticized for "medicalizing menopause" is partly due to the extreme positions taken by the "estrogen evangelists" recommending hormones for every woman and the "estrogen deniers" finding every possible reason not to prescribe for anyone.

Misguided reporting by WHI contributed to this dilemma. Extrapolating negative effects of HT seen in some older women caused unnecessary concern among perimenopausal women, reduced the level of trust between women and their doctors, and opened the door to the imaginative marketing of alternate "natural" therapies. And then "natural" became a less attractive marketing term, and was supplanted by a "bioidentical." This nonscientific term could be applied to substances identical to some FDA-approved sex steroids with "black box" warnings, but it usually is associated with custom-compounded hormones.

There is an astounding degree of hypocrisy in all of this. Hormones can't be the cause or accelerator of breast cancer if "synthetic," yet anti-cancerous if "bioidentical" or compounded. Nor, in the absence of long-term studies, can there be calls for more research on FDA-approved HT and simultaneous proclamations of the safety and effectiveness of "bioidenticals." The FDA must identify this entire arena as one in need of its scrutiny. The playing field needs to be leveled. Until that time, the public must be made aware of the fact that "bioidentical" is not necessarily natural or safe. There is no "alternative" medicine, only good medicine.

It is one thing to bring scientific clarification to all issues about menopause, or to deliver state-of-the science, high-quality, preventive, and therapeutic health care to all women going through (and beyond) the menopause transition. It is quite another to use menopausal women as a "market," to knowingly attempt to industrialize, commercialize, and sell inappropriate "remedies" purely for the sake of gathering the almighty dollar. The obscene haste with which some health-care professionals have jumped onto this bandwagon is troublesome. Remember-ultimately, when you sign the "compounding" prescription, you accept the liability.