Oprah’s Talking Hormones

I should have expected it. Today, while counseling a patient about hormone replacement, I heard those three little words that I predict will haunt me from this day forward – “But Oprah says..”

Yes folks, Oprah’s in menopause.

“You feel flat and you feel tired, you haven’t had a good night’s sleep in two years [and you’re] just going through the motions, trying to get through the day,” Oprah says. “You feel like your life force is being sucked out of you.”
Now Oprah’s taking hormone replacement, which of course means that America’s women are heading back on the HRT roller-coaster, wondering if they should be forgetting everything they heard in 2002 and doing the same thing as Oprah.To get the conversation going, Oprah’s doing a two-part series on her TV show and running special issue on the topic in her magazine next month. (Thanks, Linda, for the heads up.) I figured I’d better head over to Oprah’s web site and see what ‘s going on.So what exactly is Oprah saying?

To her credit, Oprah seems to be trying to frame the HRT issue as a debate – “Should you replace your hormones?” she asks. A reasonable question, I’d say.

Her magazine features a well-written article that frames the issues nicely and is medically up to date and fairly well-balanced. Everything you need to know is in there, albeit with a little too much paragraph space given to the theories that support HRT use and not enough to the facts that recommend against it. Still, it’s a good start.

But Oprah’s blowing it with her show.

She gets points for working with Christiane Northrup, the author of the book The Wisdom of Menopause, and the leading medical guru to the public on HRT. While Northrup’s book is a bit too long and a bit woo-woo for most of my patients, it is medically correct, and I really liked her Public TV Special last year.

Oprah also featured a short segment with Dr Wolf Utian from the North American Menopause Society, who faced off against Suzanne Somers on Larry King last year. Utian warned about the risks of HRT – and both he and Northrup recommended that women work in close partnership with their doctor in managing their menopause.
Unfortunately, Northrup’s measured wisdom and Utian’s warnings were no match in grabbing the audience’s attention compared to the anectodal testimonies of Robin McGraw and others about bioidentical hormones.It’s the “HRT changed my life and you should take it too” school of menopause management by girlfriend.
HRT is touted as the cure for everything from weight gain to depression, and as long as its bioidentical, there are no risks. These folks have free rein to spout whatever theories and beliefs they have, unchallenged by Oprah, Northrup or Oprah’s own medical guru, Dr Oz.

Dr Oz dropped the ball

To my disappointment, Dr Oz failed to question the unsubstantiated statements made by Dr Prudence Hall, a practitioner he interviews who prescribes ridiculously high doses of estrogen and progesterone to her patient without once mentioning their potential risks.

This is not informed choice – it’s pure salesmanship, and both the patient and Oz fall for it hook, line and sinker. Oz even puts Hall’s crazy regimen up on the screen as if it were gospel – 2 mg of estradiol and 150 mg of progesterone twice a day – 8 times the starting doses I use in my practice, and much more than most women need even at the start of treatment.

DR OZ – Who should take hormone replacement?
DR HALL – Anyone who has a low hormone should have that hormone replaced.

Huh????? I though we got away from this craziness with the WHI.

Oprah, I’m disappointed.

You had such good intentions, but you’re giving way to the hype, and taking your viewers along with you. Like poor Michelle, who you promise to take to Dr Hall for her “Oprah Hormone Makover”-

OPRAH:…It’s ultimately up to you to make the choice for what’s right for your body. We just want women to start to feel better and to be in charge of your own health. Because you don’t have to feel this bad. Look at Michelle. Michelle, there is hope for you.

MICHELLE: I’m going to get myself some of these hormones.

OPRAH: Yeah. Yeah.

MICHELLE: Sign me up!

This is not letting Michelle make her own decisions, Oprah. This is pulling her into your club. HRT is not a makover that you offer your viewers for free. It’s a medical treatment, with risks and benefits about which every woman deserves to be properly informed. Your show, unfortunately, is not informing. It’s hyping.

Things are no doubt going to get even worse when Oprah gives the stage over to Suzanne Sommers later this week for part 2 of her HRT series. (Northrup will be airing a Webcast Thursday evening that will be worth listening to, but I don’t think is going to be on the show again.).

Disclaimer

I take HRT, and I prescribe it to my patients who want to use it for treatment of menopausal symptoms. Every one of my patients who takes HRT is informed of the potential risks, and their decision to use it or not is made in light of their own risk factors, symptoms and concerns.

In the end, most of my menopausal patients don’t need HRT or don’t want the risks, and we either find them non-hormonal alternatives or they find other ways to handle their symptoms. It’s called informed choice.

I prescribe FDA-approved regimens, mostly bioidentical but not always, and sometimes custom-made formulations for women who can’t find the right regimen among the approved products. I recommend the lowest dose for the shortest time, and prefer transdermal estrogen over oral forms if possible.

I also offer alternatives to HRT, including SSRI’s and neurontin for hot flashes, low dose vaginal estrogen for dryness (along with over the counter non-hormonal remedies for the same), and encourage all my patients to eat well, exercise, avoid dietary and stress triggers for hot flashes and take care of themselves.

If you want to learn about HRT

Check out the readings listed at the bottom of this post. Or my series on HRT. Or talk to your doctor.

And remember, just because Oprah’s doing it, does not mean it’s right for you. Use her show to start the conversation, but take the responsibility to inform yourself and do what’s best for your menopause.
Not Oprah’s.
_______________________________________________Menopause Reading listThe Menopause Guidebook by North American Menopause Society – The Cliff Notes of menopause management. Everything you need to know without the hype.
Is It Hot in Here, or Is It Me? by Barbara Kantrowitz and Pat Wigert Kelly – The What to Expect while you’re in Menopause book. Q&A format, easy to read in short segments.
The Wisdom of Menopause by Christiane Northrup. The Torah of Menopause – Everything’s there, along with the book of Job. Read it and believe.
Our Bodies, Ourselves for the New Century. If you liked the original, you’ll love this version.
Medicine Net answers FAQ’s about bio-identical HRT and Oprah.

TBTAM on HRT – my four part series. Everything I needed to say.

23 Responses to Oprah’s Talking Hormones

  1. I feel flat and I feel tired, I haven’t had a good night’s sleep in years [and I’m] just going through the motions, trying to get through the day. I feel like my life force is being sucked out of me.

    I’m a 40 year old male.

    I just sort of figured the above goes with the territory of practicing primary care medicine.

    Hmmmm…..maybe I’m menopausal!

  2. Dr Peggy, This entire “Oprah Hits Menopause” series concerns me, both as a 54 yr old menopausal women and a healthcare worker. Oprah’s influence as well her so called guest-authorities, give women-patients the false security to think they know more than they do. I smell the potential for a disaster here.

    In my not so humble opinion it’s dangerous.

    Little disclosure, I know (and you can ask my husband, God bless him,) I’m definitely menopausal.

    However I’ve never took a hormone replacement other than my thyroid Rx ever. Why? I have a long family history of the females in my family having cardiac problems, in which 50% of us drop dead with heart attack #1. That was enough for me to READ THE LITERATURE. For me, along with my Pharmacist husband and a great doctor, I’ve attempted to make sense of most of the literature or trust their guidance. To date, I’ve gone through menopause without a single drug, be it OTC or Rx.

    Has it been easy? No. Do I get as cranky as a warthog and suffer from some of the symptoms? Oh hell yes! (Pass me the Chocolates, please!)

    But is it worth me investigating some type of treatment so I lose this feeling of always being tired, or never getting enough sleep– without excessive risk to my health?

    I know HRT is still putting additional drugs to my system whether they are “bio-identical” or not. For me I would never do it unless it can be done safely and with regular and serious monitoring.

    But the question I find myself asking is: How do you go about figuring out what is the right thing for me, that my insurance will pay for (without a fight,) and still not affect my future health adversely?

    Women to Women… what is a good place to start to get the real answers without all the drug company hype? I’d really love to know! Thanks!

    P.S. A long time ago I found myself realizing that if Oprah says you should do this or that… You need to start asking a LOT OF QUESTIONS before you do it! Too many women believe everything she puts on the tube as Gospel.

  3. Great post.

    Speaking of WHI, have you been to an ob/gyn conference lately? I went to an ACOG and ACOOG meeting last year, and each had a headline speaker refuting the WHI. So did the main ob/gyn professor at my med school. However, the cardiology and neurology professors have reported the increased risks revealed on the outcomes of the study as accurate.

    Maybe we should have Oprah come in and talk about it.

  4. Thanks. I knew if I got TBTAM on the case, you’d positively add to the dialogue. (Insert Wonder Woman Super Hero music here).

  5. I recently went to the annual Women's Health Expo sponsored by my local hospital. The last topic of the day was "Menopause: Myths & Facts" presented by a prominent local OB-GYN. They introduced him as a speaker for 3 pharmaceutical companies. His entire Powerpoint presentation was on the wonders of HRT. I had no idea that it was the panacea for all conditions ranging from dandruff to toothaches to ingrown toenails. If only I had known!

  6. Is there a difference between Menopause and Premenopause? I’m 44 and am not experiencing hot flashes (I don’t think) but mood swings, horrible sleeping, poor metabolism… I bought Dr. Lee’s “What your Doctor may Not Tell you about Premenopause” but I’m a bit leery…
    Any suggestions?

  7. damned right that oprah hawking the glories of HRT is a good reason to ask questions, and lots of them. the idea of a hormone “makeover” absolutely astonishes me, and not in a good way.

    my predisposition is to avoid HRT like the plague, if possible. apparently my body is on a slow track to menopause — i’ve had perimenopausal changes over more than a decade [different periods, followed by lighter ones, hot flashes, bad sleep, the odd skipped month, etc.], and i keep hoping i’m in sight of the goal line. ’cause, i am SO not reproducing any more. [ya hear that, ovaries?]

    other women may have more disturbing changes, or maybe i’ll get more later. but i kind of think, my body is not supposed to act like it is 20; i’m not in the “who’s the most fabulous in their 50’s” competition; and there are places i’d rather spend my limited time and attention. plus, there are the risks with HRT.

    one thing that very much affected my attitudes about menopause was working closely with many strong, hilarious, open women about 15 years ago — several of them were “going through the change,” and they stuck together with training us youngsters and the guys.

    in my humble opinon, more people need to attend office meetings in which a nationally-known expert in something or other gives a presentation that begins with wild fanning and, “woo. is it hot in here, or is it just me? anyway — i’ve got to tell you about blippety blip…” it goes without saying that those were the years of the office heater wars, as well.

  8. p.s. — my little rant doesn’t address any of the medical considerations that might lead an MD to suggest HRT as a possible therapy, or that a patient should look into if that is suggested. your series on HRT is very good.

    but oprah saying, “this is what i’m doing” is a powerful popular force. and my small point is that menopause is not to be feared unduly. every single wonderful woman of a certain age or so has gone through it and lived to do what she does. i’d really like to see more public conversation about living with menopause and perimenopausal symptoms.

  9. Sorry guys for delay in reply – It’s been a crazy week –

    Anon – Very funny!

    Mary Lu – I recommend the readings at the end of my post as a place to start for information before talking to your doctor.

    RL – Thanks!

    MomTHF – I know. I’m starting to view every meeting now with skepticism, and wish that our professional organizations would cut the ties with Big Pharma already.

    Linda – Thanks – Your post got me started.

    Anon – What I cant understand is how folks are letting these bioidentical folks get away with their snake oil salesmanship – don’t they know these folks are making millions actually selling the hormones they are hyping?

    Withoutarulebook – See this blog post below for distinction between perimenopause and menopause – but if one is still menstruating and having menopausal symptoms with no other cause found, she is probably perimenopausal. I’d avoid Dr Lee., and recommend instead the readings at the end of my post.

    http://theblogthatatemanhattan.blogspot.com/2008/05/menopause-defined.html

    Kathya- Your comment reveals just how different each woman is in terms of her physical response to menopause and her acceptance or avoidance of the small but real risks associated with HRT. What we need to do is respect one another’s choices and focus on informing not hyping. Thanks for reading!

  10. Help!

    I’m 61 and an emotionally wreck. My daughter will verify this! My family doctor refuses to even discuss HRT with me because of family history. I’ve just been to a clinic regarding bio-identical hormone therapy and have been told that I can take it. I’ve just sent in a saliva test (this morning) and now that I have come upon you blog I am completely confused and can’t think rationally most of time anyway. Background info: My sister had breast cancer and died of ovarian cancer. I entered menopause at the age of 58.

  11. Anonymous –

    I hope you understand that I can’t of course give out individual medical advice on my blog. So I’ll make some general statements that could apply to anyone.

    If you are confused, that’s because it isn’t simple.

    Try to decide what is most important to you – getting relief or avoiding risks. If it’s both, try to decide how much in the way of syptoms you are willing to put up with in return for a lower risk. Is vaginal dryness your worst symptom, but hot flashes tolerable? Then vaginal estrogen may be the way to go. If hot flashes are the issue and you are willing to accept the risks of HRT, and your other medical conditions do not contraindicate its use, then maybe you wnat to try HRT. If mood swings are the primary issue and you want to avoid hormone-related risks, then maybe an SSRI like prozac or paxil would be useful.If you really want the HRT but want to minimize risks (notice I did not say elimiate- I said minimize) then low dose transdermal HRT may be an option.

    I don’t know your health history (nor do I want to know it), but all of this has to be considered in light of that and any risks presented by other medical conditions that may contraindicate hrt or change the risk-benefit balance.

    Good luck and thanks for reading.

  12. I know I’m awake because I get a hot flash.

    It’s easy to tell someone to manage their stress in order to decrease the incidence of hot flashes, but as a dentist, whenever I start a fullmouth reconstruction, I get the most wicked hot flashes ever. I open the window (it’s minus 20C) and put a blanket on the patient. My assistant is used to it: she wears layers.

    It’s rather unfortunate, but surgical work and ‘change of life’ seem to be at odds with one another.

    As an aside: I’ve used HRT at half dose for ages. When I increased the dosage I got hot flashes. I attribute this to: any changes in hormone levels will cause hot flashes.

  13. gabriella — you’ll probably never see this, but my hot flashes have now wandered from “occasional” to “wicked.” holy cow! fortunately, i usually get them at night, ruining sleep and disturbing teh cats, but the day ones are ugly, too.

    it’s a good thing i’m set against HRT, because it turns out my family history contraindicates it, and my doc would not prescribe it for me anyway.

  14. I'm 51 and missed my period for the first time ever this month.
    I have no symptoms of menopause apart from insomnia off and on…

    I don't take any medication at all and chose not to take the Pill. I've used the Billings Method and condoms (on fertile days) since I became sexually active when I met my husband 27 years ago….
    If I develop symptoms, I was planning on increasing my intake of foods that contain oestrogen…but then a friend said that would be no different to HRT…except I wouldn't know exactly how much I was taking…HRT might be a more precise dose.
    Is there anything in this argument?
    As I say, I hope to ride it out without meds of any kind.

  15. I might be considered one of those who rushed out after watching Oprah's show to get hormones – but in my defense, it was not because I was blindly following Oprah. It was because of something said on the show that just woke me up. It was the term "brain fog." Only when I read about HRT nothing like that turns up. It's not "mood swings" as you mention here. It has to do with just not being able to think. Not so much not thinking clearly as just not being able to think at all. Where somehow the synapses are just not connecting and I wander through my day confused and unclear as to why. It wasn't every day, or all the time. I do think it was a lot about sleep because like many post- menopausal women, a good night's sleep was elusive. That was what changed first for me when I started HRT. I do think I got good advice from my doctor. I chose the transdermal approach and the lowest dose but mainly because bioidenticals are not covered by insurance. I entered menopause at age 54 and started HRT at age 65 so I'm in a fuzzy place statistically but I've only been on it for a year. I find myself in a much better place emotionally and physically in just one year yet I think I want to see if I could keep that good health going without HRT because I'm starting to have some symptoms that suggest a problem. I kind of feel like I'm tempting fate. I have a good, healthy heart, improving bone density scans, no osteoporosis, energy, focus in my work (new) and ambition, a positive view of my future. And I have plans. I would just like to see if I could do it without the hormones. Maybe go back to drinking coffee instead. Any thoughts on the effect of HRT on mental alertness and clarity, memory skills etc.? No one ever seems to bring that up except for the people on this Oprah show.

  16. Ellen-

    Thank you for your thoughtful comments, and Im glad you are feeling better.

    First of, you should be aware that you ARE taking bioidentical hormones. All the patches on the market are 17 beta estradiol,which is the same hormone your body makes. What Suzanne Somers and her croniew are selling is this hormone compounded by a pharmacist rather than a pharmaceutical company. Both makers of HRT buy their estradiol from the same place – one mixes it in an unregulated pharmacy with no outside quality control of the product, the other in an FDA-inspected facility that is mandated to prove that what's in their product is what they say it is. See my post on bioidenticals here –

    http://theblogthatatemanhattan.blogspot.com/2006/10/hormone-replacement-part-4.html

    As for the whole "brain fog" thing – it is anecdotal, not unioversal and no study has yet captured the biologic phenomenon that represents it. I hear it from patients fairly often, most memorably from writers.

  17. I am now following your blog – thanks for this post – I am at a point in life where I am checking all these things out. I am not a fan of HRT, nor is my doctor, but I was referred to a doctor, by a friend, just to get info on it. I have Christine Northrup's book and am trying to follow it to better my life, my health and rid myself of stress and panic attacks – that have both come with menopause. Growing old ain't fun!!!LOL

  18. you don't need to take pills for vaginal dryness. haven't you women ever heard of Astroglide or similar products??

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