The truth about hormone therapy - wsj.com

The Truth About Hormone Therapy - WSJ.com Dow Jones Reprints: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your col eagues, clients or customers, use the Order Reprints tool at the bottom of any article or visit Mainstream medicine has been given a wake-up call on a matter critical to the health of 65 millionwomen in the U.S. At issue are the options for treatment of menopause symptoms that cause significanthealth problems for women in mid-life as their bodies produce fewer hormones. It doesn't seem like acomplicated problem, given advances in medical science. Yet hormone-replacement therapy has becomea textbook example of how special interests, a confused medical establishment, and opportunists cancombine to complicate the issue and deny patients access to safe and effective treatments.
Until seven years ago, women going to conventional doctors were prescribed the FDA-approvedsynthetic hormone Premarin, derived from the urine of pregnant horses; Provera, a synthetic progestin;or Prempro, a combination of the two. Premarin was the bestselling drug in the U.S. in 2001, generating$2 billion a year for Wyeth.
In 1994 a study led by the National Institutes of Health called the Women's Health Initiative (WHI) wasstarted with the hope of establishing that Premarin and Provera would, beyond relieving menopausesymptoms, protect aging women from heart attacks, strokes, osteoporosis and cancer.
On July 9, 2002, however, the WHI came to an abrupt halt. The study proved unequivocally that thedrugs were unsafe and significant factors in increasing the risk of heart attacks, strokes and breastcancer in the more than 16,000 women studied.
This led doctors to take millions of women off Premarin, Prempro and Provera overnight. Predictably,these women started to feel horrible in the aftermath of the drugs' sudden withdrawal, and theirphysicians told them there were no alternatives. Instead they prescribed antidepressants or birthcontrol pills with shoddy results.
One year after this disaster, the American College of Obstetrics and Gynecology developed newguidelines that encouraged physicians to prescribe the same drugs in lower doses for shorter periods oftime. Yet, and this is key, the safety of this "low dose option" was never proven scientifically.
Meanwhile, many conventional physicians have ignored the effectiveness of "bioidentical" or naturalprogesterone, which is formulated to be identical to the progesterone molecule that is produced by thehuman body.
There are 25 years of scientific research with hundreds of studies in the U.S. and Europe that havedemonstrated that bioidentical hormones, estradiol and micronized progesterone, are equally or moreeffective than synthetics -- and safer. Yet mainstream medicine has buried its head in the sand and http://online.wsj.com/article_email/SB123717056802137143-lMyQjAxMTIwMzA3MjEwNzIwWj.html#printMode The Truth About Hormone Therapy - WSJ.com effective than synthetics -- and safer. Yet mainstream medicine has buried its head in the sand andrefused to take these studies seriously.
While Europeans have long used bioidenticals, no commercially available bioidentical hormones existedin the U.S. until 1998, when a few pharmaceutical companies obtained FDA approval for an array ofbioidentical estrogen preparations and one progesterone preparation. Unfortunately, due to drugcompanies running the medical profession by controlling what goes into medical education, mostdoctors never get educated about bioidentical hormones or the way in which different hormonemolecules work. With Premarin and Provera dominating the market, drug companies had no incentiveto spread the word.
Today the distinction between bioidentical/natural progesterone and the synthetic progestin Proveraremains widely misunderstood. Progesterone is used by fertility specialists to protect pregnancy, whilemedroxyprogesterone (Provera) is used in the morning after pill and in birth control pills to preventpregnancy. Their actions are totally different and antithetical.
Sadly, seven years after the WHI study finding Premarin/Provera unsafe, the hormone-replacementdebate can be summed up in three words: confusion, ignorance, misinformation. Meanwhile, millionsof women have embraced bioidenticals, leaving their conventional physicians looking stubborn andfoolish.
The medical establishment must stop kowtowing to drug companies and start serving women's bestinterests -- and that involves widely prescribing bioidentical hormones. This will lead to healthier,happier women and, in the long run, help reduce America's skyrocketing health-care costs.
Drs. Schwartz, Holtorf and Brownstein are founding members of the Bioidentical
Hormone Initiative, a nonprofit group of physicians dedicated to patient and physician
education (www.bioidenticalhormoneinitiative.org).
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