Published May 9, 2014, Everyday Health
Between the “expert” at Whole Foods, your hairdresser, and your most savvy friend, it’s hard to know who or what to believe when it comes to hormone replacement therapy (HRT). Even your gynecologist and internist may give conflicting recommendations! My new book, Love Sex Again, is your go-to guide for comprehensive, medically accurate information on hormone therapy risks and benefits. Here’s the scoop on some common hormone replacement therapy myths.
Myth No. 1: Local vaginal estrogen carries the same risks as oral estrogen.
The facts: FDA class labeling requires all products with the same ingredient to have the same warning, even if the problem indicated by the warning has never been demonstrated in that product. That’s why risks associated with oral estrogens are listed on vaginal estrogen rings, tablets and creams even though not one single complication, warning or risk listed on the package insert (dementia, blood clots, breast cancer, oh my!) has ever been shown to result from using a local vaginal estrogen product. There is a movement among scientists to get these dire warnings off the label, since there is no evidence of truth, and many women who would benefit are too frightened to use vaginal estrogen products.
Myth No. 2: Bioidentical hormones are ‘natural.’
The facts: The only way to really get a natural bioidentical hormone is to drink the horse urineor eat the soy plant. All plant-derived hormone preparations, whether they come from a compounding pharmacy or a commercial pharmacy, require a chemical process to synthesize the final product, which can then be put into a cream, a spray, a patch, or a pill.
Promoters of compounded, plant-derived hormones use the terms “natural” and “bioidentical ” because they are appealing to consumers and imply an advantage over manufactured pharmaceutical products. FDA approved plant-derived products from your corner drugstore are just as “natural” as the products you get from a compounding pharmacy.
Myth No. 3: Saliva levels are a useful way to determine hormone therapy dosage.
The facts: No one argues that estrogen and progesterone levels are detectable in saliva, and it would be great if a drop of spit could actually unravel the mysteries of menopause. Unfortunately, salivary hormone levels, which are used to create the illusion of individualized therapy, are not biologically meaningful; do not correlate with blood levels; vary depending on diet, time of day, and other variables; and have not been proven useful in any scientific studies in determining the appropriate dosage for hormone replacement.
Likewise, blood tests, while more accurate, are not routinely used to determine the appropriate dosage of hormone therapy since there is a wide range of “normal” blood levels. What matters is not a target number, but how someone feels.
Myth No. 4: Estrogen therapy is a leading cause of breast cancer.
The facts: This is the one that will have a lot of you shaking your heads and thinking, “Is she kidding?” But the facts speak for themselves. Over 80 percent of women who have breast cancer have never taken hormones. In addition, the risk of developing breast cancer from hormone therapy is lower than the risk associated with daily alcohol use or obesity. According to the 2002 WHI study (the one that made women across the nation flush their estrogen down the toilet) only the women who took estrogen and progestin together had a slight increase in breast cancer.
The news flash that didn’t make it to the news is that in the estrogen only group there was an 18 percent decrease in breast cancer. It is now clear that the modest increase in breast cancer in women who take hormone therapy is due to the progestin, not the estrogen.
Myth No. 5: Orgasms require estrogen.
Rejoice! Even if your estrogen tank is on empty most women can still experience the big O. Appropriate local or systemic estrogen therapy goes a long way to make intercourse more comfortable if pain or dryness is an issue, but it does not appear that addition of hormone therapy is necessary for most women to have an orgasm. Having said that, there is data that suggests that supplemental estrogen alone or with testosterone in some post-menopausal woman will facilitate orgasm by increasing blood flow and sensitivity to the clitoris.