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“BHRT–Nature’s
Alternative to drugs…”
“Rejuvenate…Youth
Enhancing…Feel Younger”
“Clinically
Proven…Important Medical
Breakthrough”
“Organic…All
Natural…Boost Your Sexual
Performance…”
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,
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
unfortunately not safer than
“synthetics”.
3.
There is an exception
to #2:
transdermal
estrogen (absorbed through
the skin and 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 “…a lot 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.
Michael
P. Goodman, M.D., F.A.C.O.G.
is a menopause practitioner
and menopause author in
practice in Davis,
California.
His websites are www.caringforwomyn.com
and www.pelvicsupport–aesthetics.com.
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