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What? No Hormones?

January 7, 2018

The US Preventive Services Task Force (USPSTF) is at it again! They have recommended against the use of menopausal hormone therapy (HRT) for the prevention of chronic conditions such as breast cancer, osteoporosis and heart disease, among others. Their recommendation includes statements indicating that hormone therapy actually increases the risk of some of these conditions.

Keep in mind, this is the same task force that, without a single urologist on their committee, recommended against routine PSA screening several years ago. The subsequent decline in routine PSA screening has led to a significant increase in the number of men diagnosed with advanced prostate cancer. This is also the same task force that recommended against taking vitamin D for the prevention of osteoporosis.

Key points the USPSTF failed to take into account are that no distinction was made between synthetic and bioidentical hormones and their mode of delivery (oral vs transdermal). This is critically important because the majority of the data used to formulate their recommendations comes from studies using oral CEE (estrogens from horse urine), with or without medroxyprogesterone (a synthetic progestin).

• Medroxyprogesterone is known to increase the risk of breast cancer whereas bioidentical progesterone is protective against breast cancer
• Medroxyprogesterone increases the risk of blood clots whereas bioidentical progesterone does not
• Oral estrogens (pills) increase the risk of blood clots slightly. Transdermal estradiol (in the form of creams and patches) does not.

The task force also chose to ignore other literature showing that “Women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality (40% less!), heart failure, or myocardial infarction (heart attack), without any apparent increase in risk of cancer, venous thromboembolism (blood clots), or stroke.” http://www2.cenegenics.com/e/49072/content-345-bmj-e6409/7m6fzc/414035922

Most notably, they ignore the Position Statement of the North American Menopause Society (NAMS) which directly contradicts numerous assertions made by the task force. See http://www2.cenegenics.com/e/49072/pdf-Menopausal-Hormones-pdf/7m6fzf/414035922

While they state that their recommendations do not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness, that caveat is lost in the overall message.

With proper patient selection and close follow up, the use of bioidentical hormones, given in the proper dose and route of administration, are essential to obtain the benefits and minimize potential side effects of menopausal hormone therapy.

This blanket recommendation by the USPSTF is clearly biased against the use of HRT. It will reignite fears generated by the Women’s Health Initiative (WHI) 15 years ago, fears that have largely been proven unfounded. Ironically, while the USPSTF recommends against the use of HRT to reduce the risk of chronic diseases, a great deal of evidence indicates that, in many cases, HRT actually does lower the risk of certain chronic diseases!

 

Posted in Blog by jbosiljevac

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