Specialist responds to article

Doctor provides information about menopause and treatment options

I am writing in response to an article printed in The Morning Star July 6.

Yes, many symptoms of menopause such as hot flashes are effectively treated with hormone therapy. However, I would like to clarify the definitions and safety information in the article.

The article detailed that women can safely take bio-identical hormones with no risk and with many health benefits.

Bio-identical is is a term to be used with caution. Authorities, including the US Food and Drug Administration, the Endocrine Society, the International Menopause Society, the Society of Obstetricians and Gynecologists and the North American Menopause Society have all issued statements cautioning women that bio-identical custom-compounded hormone therapy carries the same risks as traditional therapy. It is important to know that hormones are hormones and they all have risks.

Every woman must know her personal risks and determine if she can safely take hormones. Many women will have tremendous benefit but should be prescribed effective therapy, screened thoroughly and followed for the duration of therapy.

Bio-identical is a term used to describe medication containing estrogen, progesterone and other hormones that replicate those hormones produced in the ovaries. Traditional brand name hormone therapy exists that replicates ovarian hormones and has been tested thoroughly over decades in large studies of tens of thousands of women. The side effects and the delicate balance of risks/benefits are well known with these therapies.

Custom-compounded, bio-identical hormones are untested and unregulated by Health Canada. There is no evidence — good or bad — to support the use of these products. Even though custom-compounded therapy comes from plants, they still need to be commercially processed to to become bio-identical.

These products are often formulated in methods that are absorbed to unpredictable levels in the blood and tissues which can lead to significant health risks.

Further, testing hormone levels through saliva and blood is not credible for midlife women. Hormone levels vary throughout the day, and from day to day, making results unreliable and inconsistent. Hormone therapy should be prescribed to treat each woman’s unique symptoms effectively, not titrated to to blood or saliva results. Therapy should be stared at the lowest dose possible and graduated upwards if needed for symptom control only. Dosing should not be increased or decreased to attain saliva and serum levels. This can overshoot or under treat symptoms and may not provide adequate protection against risks.

Hormone therapy should not be used to treat chronic disease or general medical problems.

For detailed information about both extensively studied hormone therapy and custom-compounded bio-identical therapy, see menopause.org, menopauseandu.ca and www.endo-society.org.

Dr. Unjali Malhorta, medical director, Options for Sexual Health B.C.; program director, Women’s Health Residency Program UBC; clinical instructor, University of B.C.; creator and director of HPV@Options for Sexual Health; CCFP Women’s Health; certified menopause practitioner