06-21-2023 Primetime Living - Flipbook - Page 25
A Special Advertising Section of Baltimore Sun Media Group | Wednesday, June 21, 2023
the menopausal transition.”
In the ensuing years, study after study
shows that hormone replacement therapy
is beneficial, and women should not be
deprived of its advantages in managing
menopausal symptoms and aging.
Current Data and Options
Dr. Avrum Bluming has been a medical oncologist for over 50 years and is
the author of Estrogen Matters along with
Carol Tavris, Ph.D., a social psychologist.
For more than two decades, he has been
studying the benefits and risks of hormone replacement therapy administered
to women with a history of breast cancer.
“We wrote the book,” he says, “to be used
by both doctors and patients. It takes
difficult information and makes it understandable for the lay person.”
Bluming commented on the WHI study.
“It was a seriously flawed study. It stated
it had enrolled healthy post-menopausal
women, but the reality was that many of
the participants were much older than
those normally treated for menopausal
symptoms and who had numerous other
risk factors. Thirty-five percent were considerably overweight, nearly 36 percent
were being treated for high blood pressure, and nearly half were current or past
smokers. The median age was 63, long
past the onset of menopause.
“Since then,” Bluming, continues, “the
investigators have walked back almost
every one of their alarmist statements
released in July 2002 – such as those on
increased risk of heart disease, cognitive
decline and increased risk of death from
all causes. They now acknowledge that
HRT/ERT is the safest and ‘most effective treatment for menopausal vasomotor
symptoms.’
“In other words, HRT/ERT does reduce
the risk of heart disease, does lower the
incidence of breast cancer by 40 percent
even for those with a risk factor, does
prevent osteoporosis, and does stave
off cognitive decline and Alzheimer’s
Disease.”
In follow-up studies, the WHI investigators reported in 2012 that estrogen
replacement therapy decreases the risk of
breast cancer by a significant 23%; then
in 2019 they said they decreases the risk
of death from breast cancer by 45%.
“Are HRT and ERT perfect?” asks
Bluming. “No. There are risks. It’s incumbent on a woman’s medical practitioner to
provide information that balances benefit
and risk. But women are not being given
the option. When they ask about hormone
replacement, too often their caregivers
won’t broach the subject because they’re
working off old inaccurate information, so
patients are being denied participation in
the discussion they should have. Make
sure you are informed – and that your
doctor is informed.”
Shen agrees wholeheartedly. “Since
the WHI, much more research has been
done, and we’re taking a closer look at
what that WHI data actually showed, so
the interpretation of the data has progressed.”
Educating and Counseling Patients
Women should be aware that most
doctors have very little education or training in menopause.
“In obstetric and gynecological medical programs (OB/GYN),” says Shen, who
teaches internal medicine students and
OB/GYN residents at the Johns Hopkins
School of Medicine, “menopause is
becoming more of an established subject. Still, most medical residents in the
U.S. who responded to a survey say they
had about an hour of education on the
subject.”
For practicing OB/GYNs, it is only
when their practice morphs to include
more menopausal patients that they educate themselves.
Minkin made it a point to educate
himself and is now more balanced in
how he counsels his patients. “There’s so
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much misinformation and disinformation
out there. One of the biggest mistakes in
medicine in the last 20 years is how the
WHI had all of us running scared from
prescribing hormones. It caused a huge
disservice to our menopausal patients,
especially those with symptoms. Even
after much of the WHI was discredited,
I still get notes all the time from the various insurance companies about taking
women off hormone replacement.
“When I talk with patients, I have to
look at the whole patient, their individual
health issues, and what will do them the
most good. For those getting closer to
menopause, I’ll explain, ‘This is important foundational information, what you
need to know and think about so can you
make informed decisions to be healthy
and strong for the next part of your life.’
As for HRT, I have the conversation with
my patients, whether or not they have
symptoms, because of its benefits. The
point is to have the discussion, to provide
guidance, something too many physicians
are reluctant to offer.”
Minkin added a final comment.
“Doctors are overwhelmed when trying
to stay current. But I am lucky. All the
members of our practice are in tune, and
we discuss medical issues often, like prescribing hormone replacement. Patients
shouldn’t have to struggle when they’ve
trying to manage their menopausal symptoms. What do we gain by withholding
HRT?”
Shen put together the Women’s
Wellness + Healthy Aging Program
because there is still a lag in education. “There is a shortage of doctors, so
patients don’t always have a choice in
who to see. Many programs are staffed by
nurse practitioners or physician’s assistants. We’re also seeing more women’s
health fellows, so there can be further
progress in post-reproductive health management. A woman spends a third of her
life in this stage. It’s important to improve
the playing ground for women. One common complaint is brain fog due to estrogen receptors in the brain. You’re not firing on all cylinders if you spend the night
before with night sweats and the days
filled with hot flashes. When it comes to
managing symptoms, our program can
help.
“In addition, there are now more types
