The Selling Of Menopause

"BHRT" "Nature's Alternative to drugs"

"Rejuvenate" "Youth Enhancing" "Feel Younger"

"Clinically Proven" "Important Medical Breakthrough"

"Organic" "All Natural" "Boost Your Sexual Performance"

"Skinny Hormones, Happy Hormones, Youthful Hormones"

"Natural Hormone Expert"

When you see these, and other related phrases that almost always shout SCAM, run the other way. Someone is out to take your money and sell you something of dubious benefit.

Watch Out for Snake Oil Salesmen! Using words that sell things successfully is a modern, fully developed science. Text books are written on how to sell effectively. You expect this when buying cars, clothes and appliances; not necessarily medical care.

But times have changed. Quoting Wulf H. Utian M.D., Executive Director of the North American Menopause Society, "Selling is a science, menopause is an industry, products are being sold and a gullible pubic is buying." Women too often see the healthcare provider as the scientist, close-minded member of the medical establishment. The sharp marketer is trading on that to promote and sell unproven remedies.

Look at hormonal therapy. Since its introduction in the 1960s and 70s as a youth-enhancing supplement for postmenopausal women, oral HRT has been subjected to multiple long-term intensive studies. These studies, until recently conducted with oral estrogen and a synthetic progesterone only, have shown a very slight increase in the risk of breast cancer and blood clots (along, by the way, with several health benefits, balancing these risks). Unscrupulous marketers, along with healthcare providers not fully up-to-date, have seized upon this data to damn all hormones and promote the use of other, non-tested compounds, relying on the theory that if it hasn't been truly tested (progesterone and many supplements fall into this category), it "must be safe".

What these poorly informed individuals fail to reveal is that, while estrogen has been "studied to death", progesterone has never been subjected to any rigorous scientific study. "What we don't know won't hurt you" should have been their mantra!

Newer studies are in and, guess what, the reveal:

1. Low dose estrogen is quite safe, showing no increased risk of breast cancer for up to ten years of usage after menopausal age. The increased risk to the breast shown by the WHI and other studies came with the addition of a progestin (progesterone-like compound) to the estrogen, just as normal cycling ovulatory women have a greater risk of breast cancer than hysterectomized women taking replacement estrogen.
2. Although there are very good reasons to use BHRT, there is no evidence it is any safer than synthetics (and by the way, Premarin is not a synthetic; it is a true "natural," being produced directly from an animal source!). Although it makes common sense to use a product which more closely mimics what your own body used to produce (a "bioidentical"), and to be sure, I personally prescribe both commercial and compounded bioidenticals in my own practice, they are not necessarily safer than "synthetics".
3. There is an exception to #2: transdermal estrogen (absorbed through the skin; all transdermal estrogens both compounded and commercial are bioidentical) is safer than oral preparations (whether synthetic or bioidentical).

There is little place, given present knowledge, to use oral estrogens when transdermals work better, give more constant blood levels, bypass the liver, thereby not increasing the risk of blood clot and stroke and, since they can be used in lower doses, may have less adverse effect both on the breast and gallbladder.

Progesterone alone, especially in large doses, may be no safer than estrogen alone! It is revealing to note that most all breast cancers that are "estrogen receptor positive" are "progesterone receptor positive" also.

Don't get me wrong. There are many helpful and healthful uses of progesterone. But not, as many pseudo-scientists say, as a "healthy alternative to estrogen."

What is safest? Safest is low-dose transdermal (patch or cream) estradiol alone, adding a short course of sufficient-strength progestagen (bioidentical or synthetic) for ten-12 days every two-three months, to produce a period in those individuals that may build up tissue with estrogen supplementation.

Other hormones, such as testosterone, DHEA, pregnenolone and thyroid hormones may be useful and helpful supplementations in the postmenopausal years, when adrenal and thyroid function may wane. But consult a qualified medical practitioner to guide you through these waters.

Beware of snake oil salesmen! Anytime someone tries to hook you in by proclaiming "Safety!," "New!," "Alternative to Synthetics!," "All Natural!," find out exactly what is in what they are selling and don't accept an empty slogan such as "...alot of studies show..." Ask to see that data and make sure it is from a reputable scientific journal.

How do you know where to go? Check the North American Menopause Society website (www.menopause.org) or seek out a "Certified Menopause Practitioner" near you.