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Sexual health: A to Z
Nanette Santoro, MD
NAMS Board Member
In my practice, I have seen smart, professional women who really ought to know better endure these horrors:
All these women believed that they were taking natural hormones that were reasonable alternatives to mainstream medicine, and all of them had suffered as a result. But why would they take them? And how did we get here?
The stage was set for the bioidentical hormone movement well before its spokesperson, Suzanne Somers, ever went through menopause. The bioidentical hormone movement is an unintended consequence of the Dietary Supplement Health and Education Act (DSHEA) of 1994, which purpose was to exempt substances that were considered dietary supplements such as vitamins and herbs from FDA oversight. This is an important distinction to make, because FDA requires relatively stringent standards for efficacy and safety for drugs. All drugs must go through this process to get the FDA stamp of approval, a process that usually costs millions of dollars and takes up to 10 years or more.
The thinking behind the DSHEA was that it is un-American to make the consumption of herbs that you could grow in your backyard or other relatively unprocessed substances that you could eat regulated by the government. But it hasn’t quite turned out that way. The DSHEA took a very broad view of what it considered a supplement, and for reasons that are not entirely clear, compounded hormones that are not eaten but that are rubbed into the skin, injected, or given as pellets are also considered supplements.
The only basis on which FDA will intervene to regulate a dietary supplement is if there is reason to suspect that it is causing harm. So far, FDA has intervened only three times.
So let’s talk about menopause. It’s not pretty for many of us women. A series of changes occur to a woman as she approaches 50. All of a sudden, sleep is a precious gift to which she is not necessarily entitled. Then she gets a few hot flashes. She thinks: what’s the big deal? I can do this. Then she gets a few more. And they are worse. Then sex can become painful. And sometimes she feels exhausted, moody, and even depressed.
That’s the time to turn to an expert in hormones—an endocrinologist. We will give you behavioral strategies and, when appropriate, medication to help you deal with these symptoms, and we will tell you the best news: for most women, this is a temporary state. Treatment need not be a lifelong commitment. We will explain to you what is happening in your body. We have hormone and nonhormone treatments that can help menopause symptoms. We will talk with you, get a sense of your worst symptoms and your preferences, and make recommendations based on your medical history and the scientific evidence. There’s actually a lot of scientific evidence, and the experts are more in agreement than ever on the risks and benefits of the various treatments for menopause. We are in an era where high-quality clinical trials are being conducted all the time.
Why, then, do women turn to predatory, nonscientific methodologies for coping with this common life passage? There is nothing inherently evil about producing compounded medication. It is a choice that is made when FDA-approved alternatives either do not exist or are not appropriate. It is a technique that our pharmacist colleagues wish to preserve, and it is an important option for the rare patient who is allergic to the colorings or fillers in common medications. Yet, the marketing of bioidentical hormones as a truly safe and effective alternative to FDA-approved hormone treatments for menopause cannot be condoned when FDA-approved preparations that are exactly the same as the hormones made by the body are available and will work superbly well for almost everyone.
My goal is to treat you and have your symptoms get better or go away completely. I have an entire toolbox of treatments—there are more than 100 FDA-approved compounds that have potential to alleviate common menopause symptoms—and I will use the best tool I’ve got for you to do the job when prescription medications are indicated.
My point? There is very good reason to beware the inflated promises made by the bioidentical industry and to take better care of yourself during your menopause transition by going to the real experts—licensed medical professionals who have knowledge of the process of menopause and its treatment. Be leery of websites and experts who provide only their own product and recommend only their own tests. If it sounds too good to be true—it probably is. There are better and safer ways to cope with this important life transition, and most women will not require treatment for more than a few years, when risks remain very low.
So choose science.
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Mood swings, short-term memory loss, and difficulty thinking straight are common complaints from midlife women. However, while many of these symptoms are attributed to menopause, there are other contributing factors to consider as well.
Hormones: During reproductive years, most women become accustomed to their own hormonal rhythm. When this rhythm is disrupted during perimenopause, mood changes may result.
Timing: The timing of menopause may coincide with a multitude of midlife stresses like relationship issues, divorce or widowhood, care of young children, struggles with adolescents, return of grown children to the home, being childless, concerns about aging parents and caregiving responsibilities, as well as career and education issues...
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