• Glaucoma, which is when the optic nerve is damaged. One of the causes is increased pressure within the eye. Normal, healthy eyes create a clear fluid called aqueous humor. When drainage of this fluid is hindered, this causes an increase in pressure. While the risk for glaucoma increases with age, this is a correlation, not a direct cause.¹


• Increasing need for vision correction (reading glasses) which can be caused by presbyopia, an age-related condition characterized by a gradual loss of ability of the eyes to focus for near work (activities like reading, where your eyes have to focus on near objects).


• Increase in dry eye which manifests in the form of irritation and the occasional blurring of vision when you stare at an object like the television for a long time. This is caused by a loss of tear production in the eye, often as a result of changes in hormonal balance as people age.


• Cataracts, or clouding in the lens of the eye, is usually common after age 65 but can occur earlier. Cataracts are most commonly associated with aging. Other risk factors are diabetes, smoking, exposure to ultraviolet light, nutrition and genetic factors. (more...)

• Glaucoma, which is when the optic nerve is damaged. One of the causes is increased pressure within the eye. Normal, healthy eyes create a clear fluid called aqueous humor. When drainage of this fluid is hindered, this causes an increase in pressure. While the risk for glaucoma increases with age, this is a correlation, not a direct cause.¹


• Increasing need for vision correction (reading glasses) which can be caused by presbyopia, an age-related condition characterized by a gradual loss of ability of the eyes to focus for near work (activities like reading, where your eyes have to focus on near objects).


• Increase in dry eye which manifests in the form of irritation and the occasional blurring of vision when you stare at an object like the television for a long time. This is caused by a loss of tear production in the eye, often as a result of changes in hormonal balance as people age.


• Cataracts, or clouding in the lens of the eye, is usually common after age 65 but can occur earlier. Cataracts are most commonly associated with aging. Other risk factors are diabetes, smoking, exposure to ultraviolet light, nutrition and genetic factors.

Our most trusted medical source answers your most commonly asked health question.

• What is the difference between bio-identical hormones and non-bio-identical hormones?
  
  
  
  • Bio-identical hormones are chemically identical to the hormones a woman naturally produces in her body. They are synthesized by chemically extracting diosgenin (a precursor) from yams and other similar plant products.
  
  
  • Non-bio-identical hormones (also called synthetic hormones) are derived from other sources, for example the urine of a pregnant mare. They do not have the identical chemical structure as hormones that are naturally produced in the female body.
  
  
  • There are bioidentical and non-bioidentical versions of estrogen and progestogen, which are the two hormones we use most often to treat menopausal symptoms.
  
  
  
  


• Is one better than the other?
  
  
  
  • It really depends on a woman’s individual needs. For example, some women are allergic to certain formulations of bioidentical hormones, so we opt for the non-bioidentical versions. Prometrium, for example, is a bioidentical hormone that is micronized in peanut oil, which women can have allergies to. We try to tailor hormone treatment individually to a woman and her needs.
  
  
  
  


• Is one more “natural”?-- I often hear bioidentical referred to as “natural.”
  
  
  
  • “Natural” is a marketing term--not a scientific term. The only “natural” hormones are the ones found in your body. Both bioidentical and non-bioidentical hormones are man-made.
  
  
  
  


• Why is there so much confusion around this issue?
  
  
  
  • I think the big confusion is between compounded hormone therapy (CHT) and bioidentical hormone therapy. And there is a huge difference between those two. Compounding hormone therapy claims to be “bioidentical,” and “natural,” but it can claim anything because it’s not regulated by the FDA.
  
  
  
  


• What exactly is compounding hormone therapy?
  
  
  
  • Compounding pharmacies mix together different formulations of hormones in different quantities, as directed. These hormones are bio-dientical, but they are not FDA approved. That means there is no regulation on the quality, grade or consistency of the medications that are produced. Patients also have to pay out of pocket because insurance will not cover it.
  
  
  
  


• Why do people choose the compounding pharmacies?
  
  
  
  • Practitioners of compounding therapy advertise the fact that they’re creating a “natural” cocktail of hormones just for you. They use techniques such as salivary testing to determine your hormone levels, and then they concoct a mixture of hormones to try to regulate that level. These techniques haven’t been well-proven and we don’t believe salivary testing is very accurate.....But, a lot of people are turning on their TV and getting information from celebrities. People come to us and say, “I want bio-identical. I want what Suzanne Sommers had.” [Editor’s note: Suzanne Sommers is the most well-known celebrity proponent of compounding hormone therapy.] And they can have bio-identical, but we recommend they take the FDA-approved version that we prescribe. That way we know exactly what's in it.
  
  
  
  


• Are there any serious risks to using the compounding hormone therapy?
  
  
  
  • Yes. Compounding pharmacists prescribe progesterone creams, and we’re very against that. If you are on estrogen and you have a uterus, you need to be on a progestogen as well to protect against endometrial cancer. But progesterone cream isn’t enough--you need to be on a systemic progestogen to balance the estrogen. We’ve actually seen women come into our clinic with endometrial cancer because they’ve been taking estrogen for years and only using a progesterone cream.
  
  
  
  


• Is there any time you recommend someone use a compounding pharmacist?
  
  
  
  • Sometimes, if there's a hormone that's not available yet in an FDA-approved form. For example, testosterone is a hormone that is available in Europe right now, but for some reason--I’m not sure why--it hasn’t been approved in the US to treat female sexual dysfunction. It’s available to men, but not to women. So some physicians work with a compounding pharmacist to prescribe off-label testosterone to help libido and sexual function. You’d want to talk to your provider about that and she would have to make it clear that there are risks associated with taking anything that’s not FDA approved.
  
  
  
  


• The Women’s Health Initiativestudy famously found a link between hormone replacement therapy and breast cancer. It scared a lot of women away from using hormones. Did that study use bio-identical or non-bio-identical hormones?
  
  
  
  • That was non-bio-identical--a combined conjugated equine estrogen (in part made from horse urine) plus progestin. In women without a uterus, treated with estrogen only, there was actually a decreased risk of breast cancer seen. This decreased risk persisted, even after stopping estrogen.
  
  
  
  


• Is it fair to say, then, that the risks found in the Women’s Health Initiative study may not be the same for bio-identical hormones?
  
  
  
  • The risks are still there. Any hormone therapy--which includes birth control--comes with an increased risk of blood clot or stroke. Also, if you use combined hormone therapy--estrogen and progestogen--for more than five years, there’s a slight increased risk of breast cancer. The estrogen and progestogen are still stimulating the same organs, whether they’re bio-identical or non-bio-identical.
  
  
  • It’s important to note that the WHI study was done with patients who were, on average, at least 10 years past menopause--much older than the average age that we would start people on hormone therapy. When they looked at the data by age, the risks were not as high. But that hasn’t been as widely publicized as the first study.
  
  
  
  


• Have there been any similar long-term studies done with bio-identical hormones?
  
  
  
  • No. There have been long-term studies comparing the bio-dientical patch to the oral hormone therapy, but that was more about the method (patch vs. oral) than about the type of estrogen. People tend to have lower risk of blood clot and stroke on the patch than they do on the oral medication.
  
  
  
  


• So despite the risks, you still recommend hormone therapy?
  
  
  
  • Yes! We would never say hormones are a fountain of youth--no matter what form you take--but there is a place for hormone therapy in patients who are low risk and who have severe-enough symptoms that they need it. There’s no reason to suffer hot flashes, sexual dysfunction, etc. As long as a woman is being monitored by a good doctor, her quality of life can be drastically improved with hormone therapy. So, for many women with menopausal symptoms, the benefits of hormone therapy outweigh the risk.
  
  
  
  


• With so many people calling themselves “women’s health experts,” how do you know if you have a “good doctor”? How do you know who to trust?
  
  
  
  • Well, if your doctor is trying to sell you something--especially if it’s something you have to pay for out of pocket--that’s a red flag. We would advise to stay away from compounding pharmacies that promote progesterone cream and salivary testing. There are many physicians in North America who are certified menopause experts and can be found online.
  
  
  
  

Author
	Dr. Lynn Pattimakiel Physician at the Cleveland Clinic Center for Women's HealthDr. Lynn Pattimakiel, MD, is a physician at the Cleveland Clinic's Center for Women's Health. Her specialty is hormone replacement therapy and bio-identical hormones.

Our most trusted medical source answers your most commonly asked health question.

• What is the difference between bio-identical hormones and non-bio-identical hormones?
  
  
  
  • Bio-identical hormones are chemically identical to the hormones a woman naturally produces in her body. They are synthesized by chemically extracting diosgenin (a precursor) from yams and other similar plant products.
  
  
  • Non-bio-identical hormones (also called synthetic hormones) are derived from other sources, for example the urine of a pregnant mare. They do not have the identical chemical structure as hormones that are naturally produced in the female body.
  
  
  • There are bioidentical and non-bioidentical versions of estrogen and progestogen, which are the two hormones we use most often to treat menopausal symptoms.
  
  
  
  


• Is one better than the other?
  
  
  
  • It really depends on a woman’s individual needs. For example, some women are allergic to certain formulations of bioidentical hormones, so we opt for the non-bioidentical versions. Prometrium, for example, is a bioidentical hormone that is micronized in peanut oil, which women can have allergies to. We try to tailor hormone treatment individually to a woman and her needs.
  
  
  
  


• Is one more “natural”?-- I often hear bioidentical referred to as “natural.”
  
  
  
  • “Natural” is a marketing term--not a scientific term. The only “natural” hormones are the ones found in your body. Both bioidentical and non-bioidentical hormones are man-made.
  
  
  
  


• Why is there so much confusion around this issue?
  
  
  
  • I think the big confusion is between compounded hormone therapy (CHT) and bioidentical hormone therapy. And there is a huge difference between those two. Compounding hormone therapy claims to be “bioidentical,” and “natural,” but it can claim anything because it’s not regulated by the FDA.
  
  
  
  


• What exactly is compounding hormone therapy?
  
  
  
  • Compounding pharmacies mix together different formulations of hormones in different quantities, as directed. These hormones are bio-dientical, but they are not FDA approved. That means there is no regulation on the quality, grade or consistency of the medications that are produced. Patients also have to pay out of pocket because insurance will not cover it.
  
  
  
  


• Why do people choose the compounding pharmacies?
  
  
  
  • Practitioners of compounding therapy advertise the fact that they’re creating a “natural” cocktail of hormones just for you. They use techniques such as salivary testing to determine your hormone levels, and then they concoct a mixture of hormones to try to regulate that level. These techniques haven’t been well-proven and we don’t believe salivary testing is very accurate.....But, a lot of people are turning on their TV and getting information from celebrities. People come to us and say, “I want bio-identical. I want what Suzanne Sommers had.” [Editor’s note: Suzanne Sommers is the most well-known celebrity proponent of compounding hormone therapy.] And they can have bio-identical, but we recommend they take the FDA-approved version that we prescribe. That way we know exactly what's in it.
  
  
  
  


• Are there any serious risks to using the compounding hormone therapy?
  
  
  
  • Yes. Compounding pharmacists prescribe progesterone creams, and we’re very against that. If you are on estrogen and you have a uterus, you need to be on a progestogen as well to protect against endometrial cancer. But progesterone cream isn’t enough--you need to be on a systemic progestogen to balance the estrogen. We’ve actually seen women come into our clinic with endometrial cancer because they’ve been taking estrogen for years and only using a progesterone cream.
  
  
  
  


• Is there any time you recommend someone use a compounding pharmacist?
  
  
  
  • Sometimes, if there's a hormone that's not available yet in an FDA-approved form. For example, testosterone is a hormone that is available in Europe right now, but for some reason--I’m not sure why--it hasn’t been approved in the US to treat female sexual dysfunction. It’s available to men, but not to women. So some physicians work with a compounding pharmacist to prescribe off-label testosterone to help libido and sexual function. You’d want to talk to your provider about that and she would have to make it clear that there are risks associated with taking anything that’s not FDA approved.
  
  
  
  


• The Women’s Health Initiativestudy famously found a link between hormone replacement therapy and breast cancer. It scared a lot of women away from using hormones. Did that study use bio-identical or non-bio-identical hormones?
  
  
  
  • That was non-bio-identical--a combined conjugated equine estrogen (in part made from horse urine) plus progestin. In women without a uterus, treated with estrogen only, there was actually a decreased risk of breast cancer seen. This decreased risk persisted, even after stopping estrogen.
  
  
  
  


• Is it fair to say, then, that the risks found in the Women’s Health Initiative study may not be the same for bio-identical hormones?
  
  
  
  • The risks are still there. Any hormone therapy--which includes birth control--comes with an increased risk of blood clot or stroke. Also, if you use combined hormone therapy--estrogen and progestogen--for more than five years, there’s a slight increased risk of breast cancer. The estrogen and progestogen are still stimulating the same organs, whether they’re bio-identical or non-bio-identical.
  
  
  • It’s important to note that the WHI study was done with patients who were, on average, at least 10 years past menopause--much older than the average age that we would start people on hormone therapy. When they looked at the data by age, the risks were not as high. But that hasn’t been as widely publicized as the first study.
  
  
  
  


• Have there been any similar long-term studies done with bio-identical hormones?
  
  
  
  • No. There have been long-term studies comparing the bio-dientical patch to the oral hormone therapy, but that was more about the method (patch vs. oral) than about the type of estrogen. People tend to have lower risk of blood clot and stroke on the patch than they do on the oral medication.
  
  
  
  


• So despite the risks, you still recommend hormone therapy?
  
  
  
  • Yes! We would never say hormones are a fountain of youth--no matter what form you take--but there is a place for hormone therapy in patients who are low risk and who have severe-enough symptoms that they need it. There’s no reason to suffer hot flashes, sexual dysfunction, etc. As long as a woman is being monitored by a good doctor, her quality of life can be drastically improved with hormone therapy. So, for many women with menopausal symptoms, the benefits of hormone therapy outweigh the risk.
  
  
  
  


• With so many people calling themselves “women’s health experts,” how do you know if you have a “good doctor”? How do you know who to trust?
  
  
  
  • Well, if your doctor is trying to sell you something--especially if it’s something you have to pay for out of pocket--that’s a red flag. We would advise to stay away from compounding pharmacies that promote progesterone cream and salivary testing. There are many physicians in North America who are certified menopause experts and can be found online.
  
  
  
  

Author
	Dr. Lynn Pattimakiel Physician at the Cleveland Clinic Center for Women's HealthDr. Lynn Pattimakiel, MD, is a physician at the Cleveland Clinic's Center for Women's Health. Her specialty is hormone replacement therapy and bio-identical hormones.

With her new documentary about menopause, Hot Flash Havoc, Heidi Houston wants to change the way this country looks at the ‘change of life.’

• FOF: First, tell me about your own menopause experience. Was it that awful?
  
  
  
  • Houston: I had major mood swings. I mean, rageful moments when I would actually fire people. I had joint pain every morning to the point where I could barely move; hot flashes every 20 minutes; major weight gain. My quality of life stunk—my kids hated me. Probably everybody did at that point.
  
  
  • I went from doctor to doctor and took everything from herbs to prescriptions, but no two ever gave me the same information, and half the time they contradicted each other! When I saw Dr. Vliet speak about menopause and hormones, everything made sense. I thought, “That’s my doctor!”
  
  
  
  


• FOF: Did she help you?
  
  
  
  • Houston: She did a series of tests, because she wanted to confirm that there wasn’t anything else wrong with me, but she said, ‘I can almost guarantee you this is all menopausal symptoms from hormone withdrawal.’ She treated me with hormone replacement, and in the first 24 hours my hot flashes went away. Within 72 hours I felt like the woman I’d been 10 years before. Within 2 weeks my joint pain was completely gone and my mood swings stopped.
  
  
  
  


• FOF: So is this movie advocating hormone use?
  
  
  
  • Houston: It’s not about ‘hormones good or hormones bad’—it’s about ‘know the true facts about what happens to our bodies after our reproductive years’--from 33 onward. What do we need to know so we can be vital, vertical, alert and sexual into our 80s? Women should walk away saying, ‘I now know enough to talk to my doctor and get my questions answered.’
  
  
  
  


• FOF: Can you give us some surprising facts that women will learn from your movie?
  
  
  
  • Houston: Of course…
  
  
  • You may be treating your menopause with drugs and not even know it.
    
    
    
    • About 20-25% of women won’t have any outward symptoms of menopause—hot flashes, etc.--but inside the body, they are affected. Without estrogen, you may find that you’re developing osteoporosis, heart palpitations or high cholesterol. If that happens, your doctor may put you on Boniva or a statin. Women need to look at their overall body and say, ‘What’s my best option, so I don’t get put on 10 medications with 50 different side effects.’ We have to start getting our doctors to treat our bodies as a whole, and not treat each individual symptom.
    
    
    
    
  
  
  • We’re the first generation to live long enough for menopause to become a real issue.
    
    
    
    • Menopause is a not a disease, it’s a natural part of life. But here’s how things have changed: During the dark ages, a woman’s life expectancy was 35. A lot of women died in childbirth and never reached menopausal age. If they did, they were often drowned or hung for being witches. Over 400,000 women met this fate in the dark ages.In the 1700s, we were still only living on average into our 40s. In the 1800s, the upper middle class started to live into older age because they had better healthcare, but it wasn’t until their 1960s and that women started regularly living into their 60s. Our average age is now 83 years old and many of us will live to be 100. This is the largest population ever of aging people--60% of America.
      
      When our hormones quit producing, it causes a lot of things in our bodies to crumble. That was all well and good when our average age was 60 to 65, because we’d die before we really had to worry about osteoporosis or had heart disease. That’s why our generation really has to re-examine the way we approach menopause.
    
    
    
    
  
  
  • Most ob/gyns have no more than 1 to 2 hours of schooling on menopause during their training.
    
    
    
    • Many doctors are simply uncomfortable talking about sex and aging because they don’t know anything about it. There are only 1000 certified menopause specialists in this country for a population of 105 million women. I hope this movie will make doctors go get certified.
    
    
    
    
  
  
  • We’re the only free country in the world that doesn’t have women’s testosterone.
    
    
    
    • Testosterone is different in a woman’s body than a man’s body. In Europe, where they started giving women hormones thirty years before we did, they’ve had ‘women’s testosterone’ for twenty years. Here we can only get men’s testosterone, because the FDA hasn’t approved the women’s version. And yet, Viagra was passed in 6 months.
    
    
    
    
  
  
  • Menopause is not the end of great sex. 
    
    
    
    • When a woman no longer has estrogen, her vagina becomes dry and hard and shrinks and it’s no fun to have sex—it hurts. Many women think, ‘I guess it’s just that time of life and I have to put up with it.’ It’s not true! We are sexual creatures and there are things that fix it. That’s where you really see the difference between Europeans and us. They see their women as sexual into their 80s and 90s and they always have.
    
    
    
    
  
  
  
  

Author
	Heidi Houston Executive ProducerHeidi Houston is the executive producer of Hot Flash Havoc, an award-winning documentary about menopause in America.

With her new documentary about menopause, Hot Flash Havoc, Heidi Houston wants to change the way this country looks at the ‘change of life.’

• FOF: First, tell me about your own menopause experience. Was it that awful?
  
  
  
  • Houston: I had major mood swings. I mean, rageful moments when I would actually fire people. I had joint pain every morning to the point where I could barely move; hot flashes every 20 minutes; major weight gain. My quality of life stunk—my kids hated me. Probably everybody did at that point.
  
  
  • I went from doctor to doctor and took everything from herbs to prescriptions, but no two ever gave me the same information, and half the time they contradicted each other! When I saw Dr. Vliet speak about menopause and hormones, everything made sense. I thought, “That’s my doctor!”
  
  
  
  


• FOF: Did she help you?
  
  
  
  • Houston: She did a series of tests, because she wanted to confirm that there wasn’t anything else wrong with me, but she said, ‘I can almost guarantee you this is all menopausal symptoms from hormone withdrawal.’ She treated me with hormone replacement, and in the first 24 hours my hot flashes went away. Within 72 hours I felt like the woman I’d been 10 years before. Within 2 weeks my joint pain was completely gone and my mood swings stopped.
  
  
  
  


• FOF: So is this movie advocating hormone use?
  
  
  
  • Houston: It’s not about ‘hormones good or hormones bad’—it’s about ‘know the true facts about what happens to our bodies after our reproductive years’--from 33 onward. What do we need to know so we can be vital, vertical, alert and sexual into our 80s? Women should walk away saying, ‘I now know enough to talk to my doctor and get my questions answered.’
  
  
  
  


• FOF: Can you give us some surprising facts that women will learn from your movie?
  
  
  
  • Houston: Of course…
  
  
  • You may be treating your menopause with drugs and not even know it.
    
    
    
    • About 20-25% of women won’t have any outward symptoms of menopause—hot flashes, etc.--but inside the body, they are affected. Without estrogen, you may find that you’re developing osteoporosis, heart palpitations or high cholesterol. If that happens, your doctor may put you on Boniva or a statin. Women need to look at their overall body and say, ‘What’s my best option, so I don’t get put on 10 medications with 50 different side effects.’ We have to start getting our doctors to treat our bodies as a whole, and not treat each individual symptom.
    
    
    
    
  
  
  • We’re the first generation to live long enough for menopause to become a real issue.
    
    
    
    • Menopause is a not a disease, it’s a natural part of life. But here’s how things have changed: During the dark ages, a woman’s life expectancy was 35. A lot of women died in childbirth and never reached menopausal age. If they did, they were often drowned or hung for being witches. Over 400,000 women met this fate in the dark ages.In the 1700s, we were still only living on average into our 40s. In the 1800s, the upper middle class started to live into older age because they had better healthcare, but it wasn’t until their 1960s and that women started regularly living into their 60s. Our average age is now 83 years old and many of us will live to be 100. This is the largest population ever of aging people--60% of America.
      
      When our hormones quit producing, it causes a lot of things in our bodies to crumble. That was all well and good when our average age was 60 to 65, because we’d die before we really had to worry about osteoporosis or had heart disease. That’s why our generation really has to re-examine the way we approach menopause.
    
    
    
    
  
  
  • Most ob/gyns have no more than 1 to 2 hours of schooling on menopause during their training.
    
    
    
    • Many doctors are simply uncomfortable talking about sex and aging because they don’t know anything about it. There are only 1000 certified menopause specialists in this country for a population of 105 million women. I hope this movie will make doctors go get certified.
    
    
    
    
  
  
  • We’re the only free country in the world that doesn’t have women’s testosterone.
    
    
    
    • Testosterone is different in a woman’s body than a man’s body. In Europe, where they started giving women hormones thirty years before we did, they’ve had ‘women’s testosterone’ for twenty years. Here we can only get men’s testosterone, because the FDA hasn’t approved the women’s version. And yet, Viagra was passed in 6 months.
    
    
    
    
  
  
  • Menopause is not the end of great sex. 
    
    
    
    • When a woman no longer has estrogen, her vagina becomes dry and hard and shrinks and it’s no fun to have sex—it hurts. Many women think, ‘I guess it’s just that time of life and I have to put up with it.’ It’s not true! We are sexual creatures and there are things that fix it. That’s where you really see the difference between Europeans and us. They see their women as sexual into their 80s and 90s and they always have.
    
    
    
    
  
  
  
  

Author
	Heidi Houston Executive ProducerHeidi Houston is the executive producer of Hot Flash Havoc, an award-winning documentary about menopause in America.

A recent report raises concerns once again about the link between hormone replacement therapy and breast cancer. Our FOF experts weigh in.

Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly, a study finds. Women who took hormones and developed breast cancer were more likely to have cancerous lymph nodes, a sign of more advanced disease, and were more likely to die from the disease than were breast cancer patients who had never taken hormones.

The new information comes from the continuing follow-ups with 12,788 women who were in the Women’s Health Initiative, a major federally financed study that compared women taking hormones with a group taking placebos. The study was halted in 2002, three years ahead of schedule, because researchers found that the hormones were causing small but significant increases in the risk of breast cancer, heart disease, strokes and blood clots in the lungs.

• Alan M. Altman MD, Perimenopause, post menopause, natural hormonal therapy and women's sexual function and dysfunction specialist.
  
  
  
  • “This is mostly already published data from 2004. The only change is a very small increase in mortality from breast cancer in the women taking Prempro. This increase amounts to ONE WOMAN per 10,000 women per year! There is minimal statistical significance to this and no clinical significance whatsoever, hence, too much is being made about such a minimal increase. Additionally, when you talk about the specific small increase in risk, you also have to talk about the potential benefits that may accrue while being exposed to the potential risk. These benefits have been previously reported in the Women’s Health Initiative (WHI) study http://www.nhlbi.nih.gov/whi/ as well as numerous other studies.
  
  
  • It's also important to remember that they only studied one estrogen product (oral Prempro) and only one dose for everyone. None of the other estrogen products were studied. Second, you can’t make a statement about what a woman should or shouldn't take by looking at a single study. You have to look at all the potential risks AND benefits. They need to be placed in the appropriate context. Remember, every study is a piece of a puzzle and sometimes it takes 50 pieces or more to complete this puzzle and obtain the truth. Unfortunately the media treats each puzzle piece as a completed puzzle and that confuses the public causing unnecessary hysteria and mass fear.”
  
  
  
  


• Heidi Houston, Executive Producer, Hot Flash Havoc
  
  
  
  • "This is 'déjà vu' all over again. The WHI has presented a rehash of data on breast cancer first presented six years ago with a few small additions. There is no mention of the long term benefits of hormone therapy that help decrease the risk of death in order to balance these risks and put them in context. There is no mention of the WHI's own data showing decreased heart attack, osteoporotic fracture, diabetes and colon cancer in women who start the appropriate hormones at the appropriate time--within 10 years of their final menstrual period. The WHI researchers are once again overstating the risks and thereby frightening women into throwing their hormones down the toilet.”
  
  
  
  


• Staness Jonekos, co-author of The Menopause Makeover
  
  
  
  • "The study found the increased risk translates into 2.6 vs. 1.3 deaths from breast cancer each year for every 10,000 women taking hormones. There was no increase in breast cancer risk with estrogen alone (without progestin) among women with hysterectomy over an average of 7 years of randomized treatment. The current new lower doses of hormone and natural progesterone as opposed to synthetic progestin are not included in this study.
  
  
  • HT has always carried risk. Making the choice to use HT is very individualized. Bottom line: Anyone taking HT must consider their risk factors -- stroke, deep vein thrombosis, heart disease, breast cancer, uterine cancer, history of blood clotting.
  
  
  • The current HT recommendation is the lowest dose for the shortest amount of time taken around the time of menopause. We are all different. We must work closely with our healthcare providers to determine whether hormone therapy is an acceptable choice.
  
  
  
  


• Dr. Judith Volkar, MD, Center for Specialized Women’s Health, the Cleveland Clinic
  
  
  
  • “This is not a huge increase in breast cancer. If you look at the data one way, you think, “oh my, it’s double the risk of beast cancer!” But if you look at the overall risk, it went from 1.9 to 2.9, an increase of just one woman out of every 10,000.
  
  
  • We do so many other things in our lives that put us at risk, you have to put it in perspective. It’s also worth noting that many of the women in that study started taking hormones in their 70s. It didn’t separate out women who are newly menopausal from women who were far from menopause. The typical woman who seeks hormonal treatment is within 10 years of menopause. Data from those women show a 30% decrease in mortality overall with the use of hormones.
  
  
  • The bottom line: You don’t have to panic. You need to go and have a talk with your physician or seek counsel from a menopause expert and find a plan that works for you.”
  
  
  
  

Author
	FOF Health Experts

A recent report raises concerns once again about the link between hormone replacement therapy and breast cancer. Our FOF experts weigh in.

Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly, a study finds. Women who took hormones and developed breast cancer were more likely to have cancerous lymph nodes, a sign of more advanced disease, and were more likely to die from the disease than were breast cancer patients who had never taken hormones.

The new information comes from the continuing follow-ups with 12,788 women who were in the Women’s Health Initiative, a major federally financed study that compared women taking hormones with a group taking placebos. The study was halted in 2002, three years ahead of schedule, because researchers found that the hormones were causing small but significant increases in the risk of breast cancer, heart disease, strokes and blood clots in the lungs.

• Alan M. Altman MD, Perimenopause, post menopause, natural hormonal therapy and women's sexual function and dysfunction specialist.
  
  
  
  • “This is mostly already published data from 2004. The only change is a very small increase in mortality from breast cancer in the women taking Prempro. This increase amounts to ONE WOMAN per 10,000 women per year! There is minimal statistical significance to this and no clinical significance whatsoever, hence, too much is being made about such a minimal increase. Additionally, when you talk about the specific small increase in risk, you also have to talk about the potential benefits that may accrue while being exposed to the potential risk. These benefits have been previously reported in the Women’s Health Initiative (WHI) study http://www.nhlbi.nih.gov/whi/ as well as numerous other studies.
  
  
  • It's also important to remember that they only studied one estrogen product (oral Prempro) and only one dose for everyone. None of the other estrogen products were studied. Second, you can’t make a statement about what a woman should or shouldn't take by looking at a single study. You have to look at all the potential risks AND benefits. They need to be placed in the appropriate context. Remember, every study is a piece of a puzzle and sometimes it takes 50 pieces or more to complete this puzzle and obtain the truth. Unfortunately the media treats each puzzle piece as a completed puzzle and that confuses the public causing unnecessary hysteria and mass fear.”
  
  
  
  


• Heidi Houston, Executive Producer, Hot Flash Havoc
  
  
  
  • "This is 'déjà vu' all over again. The WHI has presented a rehash of data on breast cancer first presented six years ago with a few small additions. There is no mention of the long term benefits of hormone therapy that help decrease the risk of death in order to balance these risks and put them in context. There is no mention of the WHI's own data showing decreased heart attack, osteoporotic fracture, diabetes and colon cancer in women who start the appropriate hormones at the appropriate time--within 10 years of their final menstrual period. The WHI researchers are once again overstating the risks and thereby frightening women into throwing their hormones down the toilet.”
  
  
  
  


• Staness Jonekos, co-author of The Menopause Makeover
  
  
  
  • "The study found the increased risk translates into 2.6 vs. 1.3 deaths from breast cancer each year for every 10,000 women taking hormones. There was no increase in breast cancer risk with estrogen alone (without progestin) among women with hysterectomy over an average of 7 years of randomized treatment. The current new lower doses of hormone and natural progesterone as opposed to synthetic progestin are not included in this study.
  
  
  • HT has always carried risk. Making the choice to use HT is very individualized. Bottom line: Anyone taking HT must consider their risk factors -- stroke, deep vein thrombosis, heart disease, breast cancer, uterine cancer, history of blood clotting.
  
  
  • The current HT recommendation is the lowest dose for the shortest amount of time taken around the time of menopause. We are all different. We must work closely with our healthcare providers to determine whether hormone therapy is an acceptable choice.
  
  
  
  


• Dr. Judith Volkar, MD, Center for Specialized Women’s Health, the Cleveland Clinic
  
  
  
  • “This is not a huge increase in breast cancer. If you look at the data one way, you think, “oh my, it’s double the risk of beast cancer!” But if you look at the overall risk, it went from 1.9 to 2.9, an increase of just one woman out of every 10,000.
  
  
  • We do so many other things in our lives that put us at risk, you have to put it in perspective. It’s also worth noting that many of the women in that study started taking hormones in their 70s. It didn’t separate out women who are newly menopausal from women who were far from menopause. The typical woman who seeks hormonal treatment is within 10 years of menopause. Data from those women show a 30% decrease in mortality overall with the use of hormones.
  
  
  • The bottom line: You don’t have to panic. You need to go and have a talk with your physician or seek counsel from a menopause expert and find a plan that works for you.”
  
  
  
  

Author
	FOF Health Experts

Staness Jonekos went through menopause and ended up in better shape than she was “in her twenties.” You can, too, she says, if you’re willing to do the work.

• Tell me about your own menopause experience. Why was it so terrible?
  
  
  
  • I’d been on birth control for almost thirty years to manage endometriosis and ovarian cysts. When I got engaged, I went off the pill to have my fertility checked. (I wanted my younger husband to know I wasn’t going to be a babymaking machine at 47!) Once I went off the pill, I immediately slammed into menopause.
  
  
  
  


• What were your symptoms like?
  
  
  
  • Miserable: hot flashes; I gained 25 pounds in six months; I was depressed, had itchy skin and was irritable. Also, the stress caused me to eat more. I was desperate to lose the weight for my wedding.
  
  
  
  


• What did you do?
  
  
  
  • There are tons of books that have opinions on how to manage your menopause, but I was striking out right and left. I tried all the diet plans—Jenny Craig, Nutri-System, The Zone—and none of them worked. I did research and talked to lots of doctors, and eventually I decided to create my own plan. I used my wedding-planning book as a template.
  
  
  
  


• Why do you think menopause treatment is so confusing?
  
  
  
  • We’re all different. There’s no one magic pill. You really have to look at your personal history, your family history, and your symptoms to find a formula that works for you.
  
  
  
  


• So how is your book different?
  
  
  
  • 
    

    

    
    The Menopause Makeover supports all alternative, complementary and medical management options supported by science. How I treat my menopause is different than how you treat yours. If you have moderate symptoms, lifestyle changes such as diet and exercise combined with alternative herbal remedies like black cohosh might be all you need. Women with more severe symptoms may need to look at medical (hormonal and non-hormonal) options to manage their menopause.
  
  
  
  


• Which of course brings us to hormone therapy. Why is HRT so controversial?
  
  
  
  • Again, there’s no one easy answer. Almost ten years ago, it became very confusing, because the Women's Health Initiative (WHI) 2002 results basically said, “hormone therapy may increase heart attacks, strokes and breast cancer,” scaring many women away from hormone therapy. Many people have since disputed those results, and research continues. There are indeed risk factors to consider. You must work closely with your healthcare provider. For some women, hormone therapy is a good option, but for others it may not be. Today the North American Menopause Society (NAMS) says, "the benefit-risk ratio for menopausal hormone therapy is favorable for women who initiate HT close to menopause but decreases in older women with time.
  
  
  
  


• Did you opt for hormones?
  
  
  
  • Hormone therapy was a good fit for me because I had miserable symptoms. The first step in my book is to track and manage your symptoms. In order to get on top of night sweats, hot flashes and itchy skin, I use a bio-identical estrogen spray. I also take a bio-identical progesterone pill. They are both FDA-approved, and that’s the important word here.
  
  
  
  


• There are a lot of buzzwords—bio-identical, natural—what do women need to know?
  
  
  
  • I spent weeks and weeks trying to simplify the process, working closely with menopause expert Dr. Wendy Klein, and I’ve plotted it all out on pages 22 to 24 of my book. I’d rather you reprint those pages, because it’s so easy to misinterpret.
    
    
    click on each page to enlarge
  
  
  
  


• Done! But, can you explain: are there “natural” hormones that are better for you?
  
  
  
  •  “Natural” is a marketing term. The only “natural” hormones on this planet are made in your body. End of story. The reason people hear “natural” is that there are two places where you can purchase hormone therapy, ‘compounding pharmacies’—which are state regulated—and FDA-regulated manufacturers. A manufacturer that is regulated by the FDA can’t use the word “natural” because the FDA strictly regulates that language. A compounding pharmacy using the same ingredients can say “natural,” because it’s not regulated by the FDA, but by the state. There is no scientific evidence that custom compounded hormone therapy is safer or more effective than standard, FDA-approved hormone therapy prescriptions.
  
  
  
  


• It sounds like you’re not a fan of the compounding pharmacies.
  
  
  
  • For a lot of women who have allergies or for some other reason can’t get their dose from an FDA approved product, compounding pharmacies are a wonderful alternative. But wouldn’t you rather have a product that’s been tested on thousands of people, rather than one that has been individually mixed in a pharmacy and not tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue?
  
  
  
  


• You mentioned that there’s “a lot of riffraff” out there trying to sell different menopause cures. How do you find a doctor you can trust to help treat your menopause?
  
  
  
  • The North American Menopause Society (NAMS) has a listing at menopause.org of doctors who are certified in menopause management.
  
  
  
  


• Your book talks about all aspects of treatment—no just hormones. You have chapters on diet, exercise, skincare, etc.
  
  
  
  • Yes. Menopause is a lot more than just fluctuating hormones. It’s about taking control of your health for the next 50 years. During our reproductive years, we’re busy with kids and jobs and our health often suffers. Menopause is a fork in the road with two arrows: One says, ‘I promise you a path of joy and health but you have to do a little work,’ and the other path says, ‘You don’t have to do any work and you may have poorer health.’
  
  
  
  


• Speaking of “work,” tell me about the diet that helped you lose this weight.
  
  
  
  • It really isn’t a diet….it’s a lifestyle change. As you hit menopause, your metabolism slows, and you can’t eat the same way. That’s why women get all big around the middle—the 'menopot.' I started eating lean protein, low-glycemic carbs and healthy fats every four hours. That sped up my metabolism and I lost the weight. The trick is keeping your blood sugar level constant, so you don’t have cravings.
  
  
  
  


• That sounds like a healthy diet no matter what age you are.
  
  
  
  • It is.
  
  
  
  

•  So you're saying that menopause is an opportunity to assess your health and make the life changes you should have made a long time ago.
  
  
  
  • Menopause is the ultimate women’s liberation. You’re not being defined as a babymaker anymore. So you have the freedom to reinvent yourself and live your dreams. Think about all the women who get in to politics, philanthropy or start businesses after their kids leave home. Taking control of my health and beauty during menopause has me feeling like I’m 12 years old again. That was when I felt total freedom. I've never been happier!
  
  
  
  

Author

Staness Jonekos Staness Jonekos was one of the original executive producers to launch Oprah Winfrey’s television network, Oxygen Media, where she produced multiple shows and events focused on women’s issues. Her own production company, Krystal Productions, has earned a total of 12 Telly Awards for corporate clients. Since writing The Menopause Makeover, she has become a full-time crusader for women’s health. Read more at: www.menopausemakeover.com

Staness Jonekos went through menopause and ended up in better shape than she was “in her twenties.” You can, too, she says, if you’re willing to do the work.

• Tell me about your own menopause experience. Why was it so terrible?
  
  
  
  • I’d been on birth control for almost thirty years to manage endometriosis and ovarian cysts. When I got engaged, I went off the pill to have my fertility checked. (I wanted my younger husband to know I wasn’t going to be a babymaking machine at 47!) Once I went off the pill, I immediately slammed into menopause.
  
  
  
  


• What were your symptoms like?
  
  
  
  • Miserable: hot flashes; I gained 25 pounds in six months; I was depressed, had itchy skin and was irritable. Also, the stress caused me to eat more. I was desperate to lose the weight for my wedding.
  
  
  
  


• What did you do?
  
  
  
  • There are tons of books that have opinions on how to manage your menopause, but I was striking out right and left. I tried all the diet plans—Jenny Craig, Nutri-System, The Zone—and none of them worked. I did research and talked to lots of doctors, and eventually I decided to create my own plan. I used my wedding-planning book as a template.
  
  
  
  


• Why do you think menopause treatment is so confusing?
  
  
  
  • We’re all different. There’s no one magic pill. You really have to look at your personal history, your family history, and your symptoms to find a formula that works for you.
  
  
  
  


• So how is your book different?
  
  
  
  • 
    

    

    
    The Menopause Makeover supports all alternative, complementary and medical management options supported by science. How I treat my menopause is different than how you treat yours. If you have moderate symptoms, lifestyle changes such as diet and exercise combined with alternative herbal remedies like black cohosh might be all you need. Women with more severe symptoms may need to look at medical (hormonal and non-hormonal) options to manage their menopause.
  
  
  
  


• Which of course brings us to hormone therapy. Why is HRT so controversial?
  
  
  
  • Again, there’s no one easy answer. Almost ten years ago, it became very confusing, because the Women's Health Initiative (WHI) 2002 results basically said, “hormone therapy may increase heart attacks, strokes and breast cancer,” scaring many women away from hormone therapy. Many people have since disputed those results, and research continues. There are indeed risk factors to consider. You must work closely with your healthcare provider. For some women, hormone therapy is a good option, but for others it may not be. Today the North American Menopause Society (NAMS) says, "the benefit-risk ratio for menopausal hormone therapy is favorable for women who initiate HT close to menopause but decreases in older women with time.
  
  
  
  


• Did you opt for hormones?
  
  
  
  • Hormone therapy was a good fit for me because I had miserable symptoms. The first step in my book is to track and manage your symptoms. In order to get on top of night sweats, hot flashes and itchy skin, I use a bio-identical estrogen spray. I also take a bio-identical progesterone pill. They are both FDA-approved, and that’s the important word here.
  
  
  
  


• There are a lot of buzzwords—bio-identical, natural—what do women need to know?
  
  
  
  • I spent weeks and weeks trying to simplify the process, working closely with menopause expert Dr. Wendy Klein, and I’ve plotted it all out on pages 22 to 24 of my book. I’d rather you reprint those pages, because it’s so easy to misinterpret.
    
    
    click on each page to enlarge
  
  
  
  


• Done! But, can you explain: are there “natural” hormones that are better for you?
  
  
  
  •  “Natural” is a marketing term. The only “natural” hormones on this planet are made in your body. End of story. The reason people hear “natural” is that there are two places where you can purchase hormone therapy, ‘compounding pharmacies’—which are state regulated—and FDA-regulated manufacturers. A manufacturer that is regulated by the FDA can’t use the word “natural” because the FDA strictly regulates that language. A compounding pharmacy using the same ingredients can say “natural,” because it’s not regulated by the FDA, but by the state. There is no scientific evidence that custom compounded hormone therapy is safer or more effective than standard, FDA-approved hormone therapy prescriptions.
  
  
  
  


• It sounds like you’re not a fan of the compounding pharmacies.
  
  
  
  • For a lot of women who have allergies or for some other reason can’t get their dose from an FDA approved product, compounding pharmacies are a wonderful alternative. But wouldn’t you rather have a product that’s been tested on thousands of people, rather than one that has been individually mixed in a pharmacy and not tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue?
  
  
  
  


• You mentioned that there’s “a lot of riffraff” out there trying to sell different menopause cures. How do you find a doctor you can trust to help treat your menopause?
  
  
  
  • The North American Menopause Society (NAMS) has a listing at menopause.org of doctors who are certified in menopause management.
  
  
  
  


• Your book talks about all aspects of treatment—no just hormones. You have chapters on diet, exercise, skincare, etc.
  
  
  
  • Yes. Menopause is a lot more than just fluctuating hormones. It’s about taking control of your health for the next 50 years. During our reproductive years, we’re busy with kids and jobs and our health often suffers. Menopause is a fork in the road with two arrows: One says, ‘I promise you a path of joy and health but you have to do a little work,’ and the other path says, ‘You don’t have to do any work and you may have poorer health.’
  
  
  
  


• Speaking of “work,” tell me about the diet that helped you lose this weight.
  
  
  
  • It really isn’t a diet….it’s a lifestyle change. As you hit menopause, your metabolism slows, and you can’t eat the same way. That’s why women get all big around the middle—the 'menopot.' I started eating lean protein, low-glycemic carbs and healthy fats every four hours. That sped up my metabolism and I lost the weight. The trick is keeping your blood sugar level constant, so you don’t have cravings.
  
  
  
  


• That sounds like a healthy diet no matter what age you are.
  
  
  
  • It is.
  
  
  
  

•  So you're saying that menopause is an opportunity to assess your health and make the life changes you should have made a long time ago.
  
  
  
  • Menopause is the ultimate women’s liberation. You’re not being defined as a babymaker anymore. So you have the freedom to reinvent yourself and live your dreams. Think about all the women who get in to politics, philanthropy or start businesses after their kids leave home. Taking control of my health and beauty during menopause has me feeling like I’m 12 years old again. That was when I felt total freedom. I've never been happier!
  
  
  
  

Author

Staness Jonekos Staness Jonekos was one of the original executive producers to launch Oprah Winfrey’s television network, Oxygen Media, where she produced multiple shows and events focused on women’s issues. Her own production company, Krystal Productions, has earned a total of 12 Telly Awards for corporate clients. Since writing The Menopause Makeover, she has become a full-time crusader for women’s health. Read more at: www.menopausemakeover.com