(Talk given at Toastmasters Club in Foster City, California)
Ladies and gentlemen of the jury, You have the opportunity today to right a terrible wrong.
I am here today for only one purpose: to show you how hormone replacement therapy (or HRT, as it’s commonly known) came to be wrongly convicted of causing harm, so that you, thought leaders in our American society, can overturn this conviction, and help truth take its place.
Our story begins 14 years ago, when another trial began publishing its conclusions.
This was a medical trial, called the Women’s Health Initiative, or WHI.
When I was in my OB/GYN residency in the early 90’s we lamented that only 15% of women in menopause used hormone therapy. Our discussions were about how to get more women to use hormones.
That all changed in 2002 when the WHI first published some of its findings and the media got hold of the information before most doctors could read the study.
The headlines declared that hormone replacement therapy increased the risk of breast cancer in women.
They might as well have taken a match to a nationwide pile of dry tinder.
At the time I was trying to sell my house in Manhattan Beach, California. My realtor, who at the time was in her 50’s, walked into my house looking beet red, dripping sweat, and she plopped down onto my living room couch. She had been taken cold turkey off of her HRT and was feeling lousy.
Even that early in my career, and well before seeing the WHI data, I knew that the headlines weren’t telling the full story.
It was years later until I got to look at the actual data of the study and here’s what I learned:
The WHI study consisted of three major wrongs:
- The wrong women,
- the wrong hormones, and
- the wrong route of administration of these hormones.
The wrong women: One of the reasons the WHI study carried so much weight is that it was a randomized controlled trial. That means that the women in the study were divided into two groups. One group was given real hormone pills and the other group was given sugar pills (placebos). Now, if you have a group of women who are having hot flashes because they recently went through menopause, your study participants will know whether they received the hormone or the sugar pill. Therefore, on average, women in the WHI were in their late 50s and 60s, well into menopause and no longer having hot flashes or night sweats. This older group of women had already had the opportunity for illnesses of aging to take hold in their bodies.
Here’s what we now know: The benefits of HRT may not be as great in women who have had low hormone levels for an extended period of time. There’s a window of opportunity for starting hormones for menopause.
The wrong hormones: There are two major areas of fear around HRT for women – breast cancer and cardiovascular disease. The hormones used in the WHI were an estrogen called Premarin made from pregnant mares’ urine, and Provera which is a synthetic progestin. Neither of these hormone molecules have the same structure as the hormones naturally produced by a woman’s ovaries before menopause.
Here’s what we now know: Several large studies, also randomized controlled trials, both in the United States and in Europe before and since the WHI have now shown that it is the synthetic progestins that increase the risk of breast cancer. When you use a progesterone that we refer to as bioidentical, meaning that it is the same structure as the hormone that a woman’s body makes before menopause, her risk of breast cancer is not increased.
The wrong route of administration: the hormone Premarin, given as an oral pill was shown by the WHI to increase cardiovascular risk. The women who received Premarin had a higher incidence of heart attacks, stroke, and blood clots in their bodies.
Here’s what we now know: When estrogen is taken orally it goes from the stomach to the liver and stimulates the formation of clotting factors. Again from several large studies, both American and European, we now know that estrogen, when it is given any other way besides by mouth, does not increase the risk of cardiovascular illnesses. (“Not by mouth” includes being given as a patch or gel or implanted under the skin.)
So: wrong women, wrong hormones, and wrong route of administration of the hormones.
And as we know, 3 wrongs do not make a right.
The last piece of medical information that I want to give you this morning probably will surprise you, maybe even shock you:
One of the two arms of the WHI study included women who had had hysterectomies. A woman who has had a hysterectomy has been thought to only need estrogen for menopause, so the women in this arm of the study were only given either Premarin or placebo. The women in the Premarin part of this group actually had a lower incidence of breast cancer.
How did this never make the news?
Well, it just seems that bad news makes better news than good news.
A doctor in San Francisco who I heard give a talk related to menopause told us a story of when she went to a conference in Italy of menopause experts from all over the world. She almost got rotten tomatoes thrown at her. ”What are you American doctors doing to your women! You are making them suffer!” Suffer by NOT encouraging women to use hormones to feel their best during and after going into menopause.
Hormone replacement therapy was wrongly convicted by the American media in 2002 and since, of being dangerous – of causing breast cancer and heart disease in women.
Now you know that when used in the right women, in the right forms, and in the right way, HRT is innocent of these charges.
What will it take to change the mind of our entire culture that has become afraid of hormone replacement therapy for women in menopause?
It begins with you.
You now know the truth. You now know more about the actual details of the WHI study than most American doctors.
I hope you will join me in helping to right this terrible wrong done to HRT and to American women.
I rest my case.