Do Doctors Use Hormones More Often Than They Prescribe Them?

  • According to a study of German gynecologists,  physicians may be more willing to use hormone replacement therapy (HRT), or recommend it to their wives, than to prescribe it to their patients.

Nearly all were willing to recommend HRT for hot flashes, a typical menopause problem, whether to a spouse, partner or a patient. But when it came to other potential uses, there was some hesitation.

For example, 59 percent of the doctors said they would take hormones to ward off osteoporosis, or recommend it to their partners. But of that group, only three-quarters had suggested the same thing to at least some patients.

That’s not surprising, given the issues still burdening HRT, according to Dr. Michele Curtis of the University of Texas Medical School at Houston, who was not involved in the study.

The survey, which includes responses from more than 2,500 doctors, was done in 2010, eight years after the Women’s Health Initiative hit the news.  The WHI was a large trial set to exploit all of the benefits of hormone replacement therapy, yet was discontinued early  due to slight increases in blood clots, heart attacks, stroke and breast cancer in the the synthetic estrogen-progesterone group.   The study was inherently flawed and representative of the onset menopausal age female, 51, medium age in the study was 64, and did not include the use of bio-identical hormones.

Up to that point, HRT had commonly been prescribed to prevent heart disease, which is generally not  the case today.

However, hormone therapy is still the most effective way to ease menopausal hot flashes and vaginal dryness, and it is still an option for those symptoms. Similarly, since estrogen protects bone mass, it’s an option for treating the bone-thinning disease osteoporosis — though it’s considered a “second-line” option after other treatments by many in the medical community.

Many women are afraid of hormone therapy because of the risks reported in the WHI, Curtis said.  This is especially true when the words breast cancer appear anywhere even though there has never been a study that definitively states estrogen causes breast cancer.

But she said she’s not surprised that doctors would have a more favorable opinion of HRT, and be more willing to use the drugs themselves than prescribe it. “I think this would be applicable to doctors in the U.S., too,” Curtis said.  They have read the reports and know the risks and most believe that bio-identical offers newer options.

Studies since the WHI have, for example, found that HRT seems safer for women who use it at a younger age (soon after menopause begins), and that those women may even have a lower risk of heart disease.  As stated previously, women in the WHI  study were older, in their 60s on average.

And in the U.S., Curtis said, doctors’ fear of lawsuits could keep them from recommending HRT to patients even if they’d use it themselves. “I don’t know about Germany,” she said, “but in the U.S. that absolutely is an issue.”

DIFFERENT KNOWLEDGE?

Dr. Kai J. Buhling, the lead researcher on the study, said that when it comes to osteoporosis, gynecologists may have a more favorable opinion toward HRT for themselves because they are aware of the side effects of bisphosphonates – the “first-line” medications for the bone disease.

Drugs like Fosamax and Boniva, bisphosphonates,   can cause heartburn, upset stomach and muscle or joint pain. They’ve also been linked to two rare but serious effects: breakdown in the bones of the jaw and thighbone fractures.

Unfortunately, since guidelines suggest HRT as only a second option for osteoporosis, doctors may not be as eager to prescribe it for patients, according to Buhling, a gynecologist at the University Hospital Hamburg-Eppendorf.

However, the study, also found that doctors often had favorable views on HRT for uses beyond hot flashes and bone health.

 

You can read more in the current issue of Menopause .

 

What are the symptoms of menopause:

hot flashes

night sweats

cognitive  issues

incontinence

insomnia

irritability

mood swings

osteoporosis, osteopenia

vaginal dryness

 

 

 

Similarly, 42 percent were in favor of using HRT for “overall well-being” for themselves or their partner. When it came to suggesting that to their patients, though, only 59 percent of those doctors were in favor.

HRT has not been proven to ward off memory decline or boost general health. But Buhling and Curtis both pointed out that there are studies suggesting that HRT users have less memory decline.

That’s does not prove that HRT is the reason. But, Buhling said, doctors may be aware of the research and open to using HRT for any potential mental benefits, even if they wouldn’t suggest it to patients.

Curtis did, however, point out that the average age of doctors in this survey was 51.

“If this survey were done again in 10 years, the results might be different,” she said. That’s because younger doctors being trained in the post-WHI years are unlikely to have the same favorable views on HRT as their predecessors. “Now it’s just assumed that HRT is bad,” Curtis said.

Male vs. female doctors
The new study also shows that male doctors were generally keener on prescribing HRT for their female partners than women doctors were on taking the hormones themselves.

For instance, 43 percent of male doctors would put their partner on HRT if she had “reduced libido,” while only 31 percent of the female doctors thought that was a good option for themselves.

The same pattern was found when it came to incontinence, osteoporosis, vaginal problems and other issues that face many women as they get older.

So what can women do with the conflicting messages about HRT?

Curtis suggested taking your time to talk with your doctor and gather information on HRT risks and benefits. “If you’re a woman in your 40s, start now,” she said.

That way, she noted, if you do develop severe hot flashes or vaginal symptoms, you’re less likely to feel rushed into a decision on therapy.

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Doctors to women: Ask us about hormones