In part one and part two of this four part series, I reviewed the history and findings of the WHI, the impact of those findings on the medical establishment, and the newer data that have gotten us all muddled up again in our thinking about estrogen.
Please do not ask me if I am “pro-HRT” or “believe in HRT”. Health care is neither politics nor religion, despite that picture up there. It is, however, an uncertain science. Therefore, one must be wary of anyone expressing extremes of opinion about HRT, either for or against its use, and of anyone claiming to have the final word on HRT.
- I am willing to prescribe HRT for any of its approved indications (vasomotor symptoms, vaginal dryness, osteoporosis), provided you understand the risks as well as the benefits and know about alternative treatments for these conditions.
- I will give you the best data I can find that defines your personal risks and benefits from using HRT. Unfortunately, that data is imperfect, and may change in your lifetime. This will be frustrating for both of us.
- I am willing to prescribe HRT for reasons of well-being, mental or physical, provided you are willing to accept the risks and can describe the benefit for me as best as you can.
- If you are at increased risk for or have had breast cancer, I am willing to prescribe HRT provided you accept the risks and we have exhausted the non-HRT solutions to your problem, assuming, of course, that it is a problem that HRT can address. (I can count on less than one half of one hand the number of my patients with breast cancer who would fit this rule, but for them, I have it. )
- I will not prescribe estrogen without progesterone if you have an intact uterus. If you use anything less than standard progesterone regimens, you must undergo frequent monitoring of the endometrium.
- I am unwilling to prescribe estrogen if you are at increased risk for blood clot or stroke. I will do everything I can to find you an alternative that will address your symptoms or condition.
- I am not willing to prescribe HRT for cosmetic reasons alone.
- I am happy to prescribe bioidentical hormones, but you must assume they have the same risks as Prempro until there is data to prove otherwise.
- I consider vaginal estrogen to be safe in almost every woman. (I’ll let you know if I think you are the exception to this rule, and why.) If you feel otherwise, I completely understand.
- I will support your decision to use or not use HRT, and will work with you to find the optimal way to manage your menopause, whether it be through lifestyle changes, diet, exercise, hormones and/or medications. It is, after all, your body and your menopause.
Up next: A few words about bioidentical hormones.
Image: I mutilated The Ten Commandments Pressbook Cover. (I just ordered it from Ebay, and can’t wait to get it and see what other images are inside. It is one of my favorite movies of all time.)
Category: Second Opinions