A friend of mine was having daily hot flashes, unexplained weight gain, and recurrent urinary tract infections. Just one of this trio of symptoms would have been enough to make her cry, but living with all three was devastating.
She’d read about bioidentical hormone replacement therapy (BHRT) for menopause symptoms. So, at her yearly well-woman exam, she asked her gynecologist to prescribe compounded BHRT for her.
To her dismay, the doctor refused. She said hormones had “too many risks.”
Sadly, some doctors are still afraid to prescribe BHRT because of misguided fears that it will harm women.
Many patients are afraid of hormone therapy too, and some have never even heard of bioidentical hormones. Recent research has shown that many of these fears are overblown and may still be preventing women who could benefit from hormone therapy from getting the help they need.
WHY are women and physicians afraid of hormones?
Providers are wary of hormone therapy for a several reasons, including:
- Undereducation: Doctors get minimal education about menopause and hormone therapy in medical school.
- Inexperience: Many doctors get little to no experience with menopause management in their clinical training.
- Misinformation: Misleading study results from >20 years ago still have a strangle hold on patients and providers.
Let’s peek a little deeper into each of these problems.
Doctors get minimal education about menopause and hormones
Truth be told, the medical education provided to training doctors deprioritizes menopause, therefore, providers are underprepared to care for us as menopausal women.
In a poll of 361 third-year medical students, only 6 out of 10 said they had been exposed to the clinical management of menopause. That means 4 out of 10 of those soon-to-be doctors had zero experience in helping menopausal women.
More specifically, many of our doctors don’t learn about the benefits of hormone replacement therapy (HRT) for menopause symptoms.
In a survey of 510 OB/GYN residents in the US, two-thirds of them stated they did not adequately understand HRT. So, menopause is a condition that 100% of women will experience, yet two-thirds of residents who chose the specialty of women’s wellness say they don’t fully understand how to manage it.
The bottom line? Some doctors simply don’t know enough about menopausal hormone therapy to feel comfortable prescribing it.
The Women’s Health Initiative trial instilled fear about hormone therapy
Prior to 2002, hormone replacement therapy was commonly prescribed to women for menopausal symptoms. But that year, data from a controversial study from the Women’s Health Initiative were released. The study concluded that women taking synthetic hormones were at higher risk of life-threatening conditions, including a risk for breast cancer.
Patients and doctors panicked, and providers stopped prescribing hormones. About 2 out of 5 symptomatic postmenopausal women were on HRT before the WHI study was publicized, but the use of HRT in the US dropped by almost half afterward.
While the medical establishment and media accepted the results without question at the time, there were problems with the study. The study design was flawed, which made the conclusions uncertain. And the hormones used in the study were two synthetic drugs, not bioidentical hormones.
How experts debunked the WHI study results
A critique of the WHI trial was published several years later, where the authors pointed out problems with the original data analysis. Based on his reevaluation of the data, they concluded that the women on estrogen and progestin actually had no significant increase in breast cancer risk. That’s a big deal, because the chance of higher breast cancer risk had terrified women and scared doctors.
Researchers also addressed problems with the WHI study subjects. The average age of the women in the WHI study was 63, way past the typical age of menopause onset of 51. So, those ladies at 63+ were already at a higher risk for heart disease, stroke, and cancer, which most likely skewed the results. That’s important, because how long it’s been since menopause influences the risks and benefits of HRT.
Recent news is not scary at all. A 2024 review in the Journal of the American Medical Association scrutinized 20 years’ worth of WHI study data. The conclusion? Menopausal hormone therapy is appropriate to help women in early menopause who are struggling with symptoms. Hooray!
Choosing BHRT for your menopause symptoms
Instead of the synthetic hormones used in the WHI, the bioidentical route may be a good choice for many women. Bioidentical hormones, which are derived from plants, match the chemical structure of natural hormones made by your body.
Research suggests that BHRT may be associated with less risks for breast cancer and cardiovascular disease, and is a viable option for addressing menopausal symptoms.
If you’re struggling with hot flashes or other symptoms in perimenopause or menopause, don’t let fear keep you from improving your own wellness. Ask your doctor if BHRT may be right for you.
If, like my friend’s doctor, your provider is reluctant to help, check out this article on finding a practitioner who understands menopause and hormone therapy.