Oprah no expert on hormone replacement therapy

Oprah is rich, popular, internationally known, and media smart. But, is she a legitimate doctor dispensing hormonal advice to women? Two internationally known endocrinologists claim she gets an E for misinforming women about this issue.

Oprah stated that menopause caught her "off guard" so she now takes natural bio-identical hormones. This is a hormone supplement identical to the ones produced by her own body. Oprah claims they've made a difference in how she feels. But are natural hormones better or safer than other hormone therapy?

Dr. Robert Reid, an endocrinologist at Queen's University in Kingston, Ont., posed this question at the meeting of the Society of Obstetricians and Gynecologists of Canada in Halifax.

Reid reported that young women whose periods start at age eight instead of age 14 receive six extra years of their own natural hormones through ovulation. Many consider these natural hormones to be healthy. So why then have studies shown that six extra years of natural hormones increase the life-time risk of breast cancer?

He pointed out another valid point. If a woman's menopause starts at 58, rather than at 48 years, this gives her another 10 years of her own naturally produced hormones. But studies show again that this increases her risk of breast cancer. Moreover, if a woman's ovaries are removed at 30 years of age, her risk of breast cancer has been shown to decrease dramatically because her natural hormones have been eliminated.

Dr. Michelle Warren, of Columbia University in New York, suggests Oprah's promotion of bio-identical hormones is "celebrity science." And that there's no evidence that natural bio-identical hormones are any safer than other synthetic hormones.

Unfortunately, Oprah and newspaper headlines do not give a balanced appraisal of hormone replacement therapy (HRT). The debate about HRT started in 2002 when the Women's Health Initiative issued a report that long-term use of HRT increased the risk of breast cancer and cardiovascular disease. This headline resulted in many women discontinuing HRT.

The headlines failed to stress that there were only very small increases in breast cancer, heart attack, stroke and blood clots among HRT users. For instance, there were eight more cases of breast cancer and seven more cardiovascular problems for every 10,000 women per year of use.

In this column I pointed out another practical fact. Millions of women had been using synthetic estrogen for 60 years. Good sense would indicate that, after all this time, if this estrogen caused breast cancer, there would be a raging epidemic of this disease. It hasn't happened. Moreover, estrogen has proved to be a prime way to prevent osteoporosis.

What should women do when menopausal symptoms occur? They should be skeptical about celebrities who make dogmatic statements about natural bio-identical hormones as being superior to others available. There is no evidence to support this fact.

The first question any woman should ask is how do the symptoms affect her? Menopause can and does sometimes present major problems for women.

For several years I've seen a female high school principal for annual checkup examinations. Her job is not an easy one, but she was competent and up to the task. But this year, she burst into tears as soon as she entered my office. She had lost control of her emotions, she said, and couldn't handle the job. She was prescribed estrogen therapy, and in a month was back to normal. At the other extreme, it's illogical to propose HRT to patients who say, "Yes, I'm having a few hot spells during the day or night, but I can easily live with this."

Both Drs. Reid and Warren stress that the risks of HRT have been blown out of proportion.

Republished from the Winnipeg Free Press print edition November 20, 2009 A23