Why Does Your Doctor Not Offer Hormone Replacement Therapy?
It is time to make a change. No longer should only a small number of menopausal women receive the medical attention they deserve. According to a Yale University study that examined insurance claims from over 500,000 women in various stages of menopause, while 60% of women with significant menopausal symptoms sought medical assistance, more than 75% went untreated.
If you’ve had problems getting the help you need to deal with menopausal symptoms; you’re not alone. Despite the discomfort women experience throughout menopause and therapeutic options that could improve their quality of life and possibly prevent a number of chronic illnesses, only a small fraction of women are treated properly.
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Why is this happening?
- Unfortunately, menopause education is not taught in most medical schools or residency programs. According to an AARP article, “What Doctors Don’t Know About Menopause“, a recent survey revealed that only 20% of ob-gyn residency programs give menopausal training.
- The AARP article quotes Philip M. Sarrel, professor emeritus of obstetrics, gynecology and reproductive services, and psychiatry at the Yale School of Medicine “Doctors are not helpful. They haven’t had training, and they’re not up to date.”
Apart from the fact that many practitioners are unprepared to deal with menopausal symptoms and believe that menopause should be accepted, a frequent misunderstanding about hormone replacement therapy (HRT) is a major contributor to the lack of safe and effective treatment options. Many of these misconceptions and the concern and misunderstanding around HRT may be traced back to the Women’s Health Initiative studies.
What are the misconceptions surrounding HRT?
- The Women’s Health Initiative (WHI) was a multi-state study that looked into ways to keep postmenopausal women from acquiring heart disease, breast and colorectal cancer, and osteoporosis.
- The WHI study gave birth to the now widely believed – but false – belief that all hormone replacement therapy raises the risk of cardiovascular events and breast cancer.
- According to participants in the study, the early findings associating hormone replacement treatment (HRT) to breast cancer and heart attacks were deceptive. According to a leading researcher for the WHI project, “good science became corrupted and eventually caused substantial and ongoing harm to women for whom proper and useful therapy was either terminated or never began.”
- The WHI study consisted of two research arms with two different outcomes, which have been extensively misunderstood.
- In one part of the study, women were given both horse estrogen (Premarin) and synthetic progestin (Provera), while in the other, just equine estrogen was used (Premarin).
- Surprisingly, the estrogen-only part of the study found no statistically significant increase in the risk of breast cancer. Despite the use of a stronger, significantly more estrogenic medicine, the incidence of breast cancer remained the same.
- In contrast, the study’s arm that took equine estrogen (Premarin) and progestin (Provera) reported a modest increase in breast cancer risk over time.
- While the study’s objectives were noble, subsequent media coverage, news disinformation, and medical community misinterpretation of the study’s findings planted anxieties and suspicions about hormone replacement that have persisted to this day. Fear and sensationalism triumphed over science, and, for both doctors and patients, hormone replacement therapy became a source of anxiety.
What can you do?
The fact that you are reading this blog and educating yourself about menopausal women’s health issues is a fabulous first step. The more you know, the less likely you are to be one of the menopausal women who spend a third or more of their lives coping with menopausal symptoms and issues and having no understanding of what to expect, how to respond, or what treatment choices are available.
Effective treatment not only alleviates symptoms such as hot flashes, mood swings, sleep difficulties, and visceral “belly fat” growth, but it also plays an important, if not critical, role in preventing chronic diseases that beset aging women.
I strongly encourage you to continue learning, asking questions, and advocating for the best possible quality of life for yourself.
- Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association