Blog of the Society for Menstrual Cycle Research

House of (Menopausal) Cards

March 26th, 2013 by David Linton

(Spoiler alert: if you haven’t finished or intend to watch the show discussed here, you might wait to read this post until later.)

The premises of the much-discussed new series House of Cards hosted on Netflix, are that no one in the world of politics can be trusted, that alliances are fragile, and that disaster looms at every moment. Beneath the surface of beautiful buildings, attractive people, glamorous receptions, and rousing rhetoric lie depths of deception and betrayal.

At the heart of the intrigue are the central power couple, US Congressman Frank Underwood and his wife, Claire, who heads a non-profit NGO dedicated to providing clean water to impoverished African villages. They appear to be well matched and unified in their ambitions for both personal power and their pet projects while expressing benign neglect toward each other’s outside sexual pursuits.

All is well in the Underwood cacoon until perimenopause makes its destabilizing entrance. There’s a concept that’s sometimes referred to as “Chekhof’s Gun” that goes something like this, “If you show a shotgun on the wall in an early scene, someone better use it before the play is over.” Well, the menstrual shotgun first appears in an early episode when Claire is seen standing before an open refrigerator door and she’s not looking for a quart of milk. Frank notices, says little, and the moment passes. Four or five episodes later Claire makes a deal to accomplish one of her goals, knowing it will undercut a grand scheme he is working on. When he learns of the betrayal, he employs the deadly menstrual shotgun, “Is it the hot flashes?” Whereupon she throws him out of her office and departs for New York to be with a long-time lover.

But this is only the first season of what promises to be an ongoing saga, so following yet another political crisis, she returns to Washington. But something has changed. She has been having dreams about saving a child who is being choked by vines and, in a final scene, visits an ob/gyn to discuss having a baby, despite the fact that she has had three prior abortions. Perimenopause has suddenly altered her perspective. As viewers have already learned that her husband hates children, the set up for next season’s drama is well established.

Hot Flashes Are Weird

November 12th, 2012 by Paula Derry

I have two pretty contradictory sets of opinions about hot flashes. In a previous blog post, I emphasized one of them. Namely, that flashes are a mind/body phenomenon in which a woman’s interpretation of her physical experiences are central to her being distressed or not, of being able to cope or not, of what an experience is and means. A woman can identify her “real” self with her thoughts or her body, or she can experience her embodied self as a totality. In my first set of attitudes, the diversity of physical experiences is part of the mix: The same term, “hot flash,” is used for a wide family of experiences that range from mild to unbearable, from heat to heart palpitations, from empowerment to anxiety. However, in my second set of opinions, physical experience is front and central, and my thoughts can be summarized as follows: Hot flashes are weird.

In a conventional view, flashes are simply something that happens because of the hormonal changes surrounding menopause. They are often defined as a transient feeling of heat, sometimes accompanied by sweating or the skin turning red, that typically lasts a few minutes but can persist up to an hour. Flashes are most common in the years surrounding menopause but can begin many years before or occur many years after the final menstrual period. One theory is that fluctuating levels of estrogen affect a part of the brain that controls heat regulation. As a result, small changes in temperature are interpreted by the brain as meaning that the body’s temperature is outside the normal range; the hot flash is the body’s attempt to cool the body down. Alternatively, perhaps the hormonal imbalance affects the brain or other endocrine glands in other ways, or perhaps some women are simply more sensitive to these changes.

However, the experience of flashes is complex. A woman who is overheated for other reasons may not feel like a woman having a hot flash. A flashing woman might feel like she is on fire. Or she may feel hot only in an isolated body part, like her back or earlobes. Or the feeling of heat may start in one part of the body (like her head or upper back) and travel. Some women may not realize their feeling of gentle warmth is caused by a flash until later. Further, there are experiences in addition to that of warmth. The experience might feel like anxiety rather than heat. There may be a sharp physical shock or jolt. Some women, for example, may wake up in the middle of the night with a shock of anxiety and wonder what has threatened them. Some women report other associated sensations such as a racing heart, nausea, and breathlessness. Some feel dizzy, anxious, and unable to concentrate. Others experience cognitions and feelings such as empowerment, anxiety, and catastrophic thoughts.

Flashes are basically not understood. Beneath the scientific generalities, there is no specific understanding of what underlies flashes. They do clearly have something to do with estrogen: they increase in frequency in the years surrounding menopause, and treatment with a hormone medication is helpful. However, while fluctuating estrogen levels are assumed to be causal, clear evidence of this has been notably lacking. Further, flashes are found during the menopausal transition and postmenopausally, two very different hormonal situations, but are not a widespread phenomenon during premenstrual hormone fluctuations. For the minority of women with severe symptoms, there is no understanding that would lead to correction of underlying problems beyond symptomatic treatment with medications like estrogen. Why would a brain center regulating body heat be affected in some women but not others or in the same woman only sometimes? There are speculations that estrogen is needed for brain general health and proper neurotransmitter balance or that some women are “more sensitive” to normal changes in hormone levels. It seems that additional factors must also be at play. The large cross-cultural differences in flash frequency and the large placebo effects of medications are not understood, neither is the role of stress or other psychological or situational factors.

So, I think it’s weird. I think it’s weird to have odd physical experiences like a sudden experience of intense heat or a sharp jolt, even though for most women the experience seems to cause no significant or permanent harm. For women who find these experiences unsettling: why wouldn’t they? It’s almost sensible. The idea that we’re told “it’s just menopause” is weird. Personally, I wish more basic research was being done about what hot flashes are. I wish that more basic research was being done to understand women who have serious problems. As an analogy to the idea that there is “normal pregnancy and childbirth” and there are “complications of pregnancy and childbirth,” which discomforts are “just menopause” and which are “complications of menopause”?


Derry, P.S., & Dillaway, H. (2013).  Rethinking menopause.   In M. Spiers, P. Geller, & J. Kloss (Eds.), Women’s Health Psychology, pages 440-463. New York: Wiley.

Make Friends With Hot Flashes

May 28th, 2012 by Paula Derry

One important idea in a holistic approach to health is that symptoms or uncomfortable physical experiences don’t exist separate and apart from the whole person.  For this reason, it is important to know how a unique individual experiences that symptom or experience.  Another important idea is that the whole person consists of a physical body, but also thoughts, feelings, even spirit, and she lives in a social and physical world that affects her. Holistic practitioners say “I am a body,” not “I have a body.”

Photo by Pennstatelive // CC 2.0

What does this mean to a woman bothered by hot flashes?   First, one good starting place for a woman is to look inside herself at her individual experience.  Hot flashes are often said to be the bane of a woman’s existence, creating intense discomfort, mood swings, embarrassment.  However, in reality women differ.  Some women  are greatly bothered by flashes.  Others are not.  Some say flashes are power surges. For some, the flash is purely a feeling of heat; for others, it feels more like anxiety. Very distressed women may have experiences like insomnia, depression, fatigue, fogginess.  It turns out that the frequency of flashes is distinct from how distressing they are. For some women but not others simple remedies like dressing in layers works. In a scientific sense, we know more than we did not long ago, but there is still no fundamental understanding of what a hot flash is, or why some women but not others experience them.

Cultivating an inner observer can be useful to identify personal experience.   Mindfulness is one approach to this. For many women, thoughts are an integral part of the hot flash experience, and these thoughts might contribute to how distressing flashes are.  Expecting the worst might amplify distress, as it does for other experiences like pain.   One example of an expectation is: “I’m going to have hot flashes for the rest of my life.”  The meaning of flashes—natural, an indication of aging, a worrisome sign that something puzzling is going on in your body–might be important.  Embarrassment and self-doubt in social settings are known to sometimes contribute to experiencing flashes as problems.  Coping self-talk—for example, “this is a hot flash, it will pass” –might be helpful.  Relaxing the body and observing a flash rather than tensing the body to resist it might make flashes less distressing.  Paradoxically, distancing ourselves from bodily experience—for example, tensing the body until a flash passes, may be less effective than accepting bodily experience as our own with an attitude of observing it. Other active problem-solving might also be useful, like finding solutions to social problems.  Women who talk with other women about flashes tend to find them less distressing.

Of course, other women just want to be rid of flashes.  They might have very distressing, debilitating symptoms.  They may simply just not want to put up with them.   For some, focusing their attention on flashes might not make things better or even make things worse. Active problem-solving can work here, also.  For example, flashes are often associated with triggers (stress, foods like chocolate, caffeine, etc.) that vary from woman to woman. Triggers, once identified, can be avoided. A woman can make time to take care of herself, doing something pleasurable or rejuvenating, find ways to reduce stress, or otherwise alter her lifestyle. A variety of remedies have been suggested, ranging from herbal remedies, to alternative practices and practitioners, to hormone therapies. Actively deciding that a hormone therapy is needed given her own situation might be a way a woman actively takes charge of her experience.

Hot flashes are not invaders. They are sometimes welcome, often not, but always one’s own bodily experience.  Through gathering information, self-observation, talking with others, or finding helpful practices and practitioners, they can be dealt with.

“A Non-Hormonal ‘Fix-It’ for Women Suffering From a ‘Broken Internal Thermostat’”: Just Wear Athletic Clothing to Bed!

November 15th, 2010 by Heather Dillaway

sleepless.jpgThe title of this blog entry comes straight from a media release about Goodnighties® Recovery Sleepwear. That’s right, now there is finally sleepwear made out of a fabric similar to the fabric worn by “Olympians, Astronauts and Even Racehorses” to wick away the moisture of hot flashes, night sweats, and chills accompanying some women’s perimenopause, menopause, and postmenopause. Using the “power of negative ions,” Goodnighties® sleepwear purportedly offers that rest, relaxation, recovery (and, ultimately, sleep!) that most midlife women are lacking! Some users are quoted on the website as saying that Goodnighties® sleepwear “changed their lives.”

One one hand, this makes complete sense — why didn’t people think of this before? Athletic clothing would help someone deal with hot flashes and night sweats in the middle of the night, if only making it so that one doesn’t have to get up and change their clothes or sheets. And considering we’re currently in a “menoboom” (Barbre, 1998), with the aging and menopause of the Baby Boomers, what a great idea to market moisture-wicking clothing to menopausal women! Talk about a money-maker.

On the other hand, while I think on the whole this is probably a good product for many, I do take issue with some of the language on the site, because of the negative connotations about menopause in particular (e.g., the emphasis on “fixing” “broken thermostats,” “suffering,” and quotes about how 85 percent of women are “known to suffer”). But, this line of clothing is also marketed towards others — those undergoing infertility treatments, “athletes, regular exercisers and weekend warriors with sore muscles,” “people with aches and pains due to injury, surgery, chemotherapy, etc.,” and “[t]hose suffering from painful health issues like fibromyalgia, arthritis and diabetes” — so, it’s not exclusively marketed to menopausal women and not exclusively designed to define menopause as a bad thing.

On another issue, though, the emphasis on relief, recovery, and fixing does make me think that this product is being marketed as something that resolves (negative) symptoms, but I’m not sure how that could be the case? Does anyone have any experience with Goodnighties® sleepwear? Is it actually capable of alleviating the symptoms, or is it just making the public manifestation of the symptom disappear?

Hot Flash—Progesterone is an Effective Alternative to Estrogen

July 19th, 2010 by Elizabeth Kissling

Guest post by Jerilynn Prior, Centre for Menstrual Cycle and Ovulation Research

hot flash hellIt’s been two weeks since Chris Hitchcock and I returned from San Diego’s recent Endocrine Society meetings. We are feeling incredibly happy with the success of our protracted, intense commitments to a controlled trial of oral micronized progesterone (marketed in the USA and Canada as Prometrium®) for night sweats and hot flushes/flashes. At the Endocrine Society we presented the first-ever trial showing that the molecularly identical progesterone by mouth is effective treatment for vasomotor symptoms (VMS = hot flushes/flashes and night sweats)(1). We were also invited to present our data at an Endocrine Society-sponsored press conference.

Why did a scientific study require so much from us? First, this trial started in 2003 as the initial scientific venture of the newly founded Centre for Menstrual Cycle and Ovulation Research–thus CeMCOR’s reputation became tied to this trial. Second, despite concerted efforts, we were never able to obtain peer reviewed funding for this study—we successfully supported it with individual private donations. Finally, because of the “estrogen myth” and its corollary negatives about progesterone, I wanted to gain additional accurate information about how Prometrium® works in women’s cardiovascular system from this same study. For that reason we decided to enroll only very healthy women who were within 1-10 years since their final flow—they had to be non-smokers, without obesity, diabetes, or high blood pressure, and further to have normal measured waist circumference, blood pressure, cholesterol, and fasting blood sugar levels. Therefore many women were interested but few were eligible.

Late last fall when we broke to code on this study, we were ecstatic to discover that our trial was highly successful. After only three months’ therapy with Prometrium® (300 mg at bedtime daily) the 127 (of 133 randomized) women’s vasomotor symptoms score (VMS Score, combination of number of flushes times their intensity during the day and during sleep) was decreased by about 60% on progesterone compared to less than 30% decrease on placebo.

In early June we learned the answer to another important question: Does progesterone effectively treat intense VMS? The answer is yes! Although less than half all the treatment-seeking women in our study met the FDA’s criteria for more than 50 moderate-intense VMS/week, the 30 women who did who were randomized to Prometrium® showed significantly more improvement in hot flushes than did women on placebo.

What were the reactions to this news? Some local doctors said they already knew that progesterone was good for VMS! Others people were curious, or skeptical but many realized the importance of providing women with an effective alternative to estrogen for VMS. Other reactions were predictable—many questions about whether this couldn’t really be explained, somehow, by estrogen (Prometrium® is converted into estrogen—not!). And there were several questions about side effects and alleged serious health risks from progesterone (wrongly attributed because of confusion of progesterone with synthetic progestins). Happily I was able to respond that participants had no serious negative effects—more placebo-treated than Prometrium®-treated women dropped out before completion. And it is likely that in estrogen-treated women progesterone decreases breast cancer risk rather than increasing it as medroxyprogesterone does (2). Because of Prometrium®’s significant sleep benefit (3), some women who entered the trial sleep-deprived experienced short-lived morning drowsiness. But the estrogen myth-related mood, bloating, weight gain, migraine headaches, and breast tenderness did not occur.

An epic journey for me, Chris, and CeMCOR ends in triumph. Now that the dust has settled, I am so grateful that CeMCOR’s many researchers over the last six years dedicated themselves to a world class trial, that local donors made the trial possible, and that the Prometrium® and placebo were provided by Schering Canada (for the first two years) and subsequently by the world-wide manufacturer, Besins Healthcare of Belgium.

Where from here? First, in the fall we will start a new Canadian Institutes of Health Research-funded trial of Progesterone for Perimenopausal Night Sweats using the same design as in this study. Second, I’m tickled to discover what new we can learn about progesterone from analysis of information we have already collected as part of this trial: how women feel through their Daily Menopause Diary® data, and what happens with hot flushes on stopping progesterone and placebo (in particular, do they soar higher than baseline as occurs when estrogen is stopped?). In addition, we will soon know what changes occur in cholesterol and triglyceride levels, thyroid function, blood clot risks, and quality of life in women treated with progesterone rather than placebo. We already know, from a specialized study of blood flow in the forearm, that progesterone does not have negative effects and tends to increase flow like estrogen does (abstract presented at the 2010 Endocrine Society).  Finally, we have solid scientific evidence with which to counter the smirking negatives directed at “bioidentical progesterone.”

Reference List

  1. Prior JC, Hitchcock CL. Progesterone For Vasomotor Symptoms: A 12-Week Randomized, Masked Placebo-Controlled Trial In Healthy, Normal-Weight Women 1-10 Years Since Final Menstrual Flow. Endocrine Society Abstracts . 2010. Ref Type: Abstract
  2. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008; 107(1):103-111.
  3. Schussler P, Kluge M, Yassouridis A, Dresler M, Held K, Zihl J et al. Progesterone reduces wakefulness in sleep EEG and has no effect on cognition in healthy postmenopausal women. Psychoneuroendocr 2008; 33(8):1124-1131.

Hot Flashes: Now Especially for Fat Ladies

July 14th, 2010 by Elizabeth Kissling
Photo of art by Czarnobyl by Flickr user || CC 2.0

Photo of art by Czarnobyl by Flickr user || CC 2.0

Since yesterday, although it seems longer, my RSS reader has been clogged with links to news reports about a UCSF study in which some women who lost weight found that their hot flashes diminished. Of course, that’s not what the headlines say. Here’s a sample of some of the titles of current stories about this study on Google news:

  • Hot Flash Relief: Weight Loss Works, What Doesn’t? (US News & World Report)
  • Bad hot flashes? Try dropping a few pounds (
  • Losing weight may ease menopause symptoms (
  • Symptoms of Menopause Can Be Relieved by Weight Loss (Health News)
  • Weight Loss Helped Overweight And Obese Women Reduce Hot Flushes (Medical News Today)

OK, that’s enough – see the trend? Suddenly weight loss is the cure for hot flashes. But in the actual study – which was about urinary incontinence, not menopause -141 women provided researchers with data about their hot flash symptoms six months after the study began. Sixty-five of the 141 women said they were less bothered by their hot flashes six months after participating in the weight loss program, 53 reported no change, and 23 women reported a worsening of symptoms.

Look at those numbers again, more slowly this time: 65 of 141 women who participated in a weight loss program were less bothered by hot flashes after six months. That’s 46% of the women – less than half – who found relief. Almost as many reported no change in symptoms, so why is this being touted as a successful intervention?

Because the women lost weight. Most of the news reports of this research stop just short of fat-shaming, but I submit that is exactly why this study is getting so much media attention. Even though it is well-established that diets do not work, even if you call them a “lifestyle change” or “a whole new way of eating”, and that the BMI (Body Mass Index) is useless as a gauge of health. In fact, fat is not a measure of health. But why pass up an opportunity to shame women about their bodies?

Of Hot Flushes, Lie Detectors, and Stress

March 7th, 2010 by Elizabeth Kissling

Guest Post by Jerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research

A hot flush causes failure on a lie detector test! The same galvanic skin response (in simple terms—clammy skin) is positive in both. Why? Because—with every flush—there is massive dogs’ breakfast of neurotransmitters and brain stress hormones released. These are the same brain chemicals that are produced as we struggle to create a plausible falsehood. Both arise from a fundamental, brain pathway that mediates both our physical and emotional responses to “threats” (be they nutritional, emotional, physical or some combination of stressors).

Some years ago a psychologist from London Ontario showed that menopausal women’s hot flushes were increased by stressful environment (1). Menopausal women who regularly experienced eight hot flushes a day attended two randomly-ordered 4-hour sessions a week apart. During the sessions they had flushes objectively documented by galvanic skin response. When they were forced to experience a chaotic environment, loud noises, unpleasant videos and bright lights, each of these women experienced more hot flushes; they did not in the alternative calm and pleasant session (1). Likewise, the large Study of Women Across the Nation showed that perimenopausal women who reported “trouble paying for basics” (like food and shelter) had more hot flushes than did those with economic and social security (2).

Given these fundamental relationships between hot flushes and stress, it is no wonder that “paced respiration,” “yoga breathing,” mindfulness meditation, the relaxation response, acupuncture, exercise training and many other techniques that reduce our central reaction to stress will decrease night sweats and hot flushes.

I totally agree with Janet Carpenter that women are eager to find non-pharmaceutical ways to decrease the number and intensity of night sweats and hot flushes (collectively called vasomotor symptoms, or VMS for short).  However, to put into perspective the new research being done by the investigators at the School of Nursing at Indiana University, we need to realize that the first randomized controlled trial of “yoga breathing” for VMS was published in 1984 (3) and followed in 1991 by a similar study using objective VMS measures (4). Subsequently, studies of acupuncture (5-8), relaxation (9) and relaxation plus other therapies (10) all show that they are better than placebo at decreasing VMS. [Editor’s note: As she stated in the Indianapolis Star interview published March 4, 2010, Dr. Carpenter is building upon previous research. She did not claim to invent the concept of managing hot flashes with breathing techniques.]

The research on hot flushes and our central stress response is just beginning. But the average 25-50% improvement in VMS in those taking placebos in trials of soy beverage (11) or hormone therapy (12) are evidence that believing a treatment is therapeutic is pretty effective all by itself.

Reference List

1. Swartzman LC, Edelberg R, Kemmann E. Impact of stress on objectively recorded menopausal hot flushes and on flush report bias. Health Psychology 1990;9:529-45.
2. Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am.J.Epidemiol. 2000;152:463-73.
3. Germaine LM, Freedman RR. Behavioral treatment of menopausal hot flashes: evaluation by objective methods. J Consult Clin Psychol. 1984;52(6):1072-9.
4. Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am.J.Obstet.Gynecol. 1991;167:436-9.
5.  Wyon Y, Lindgren R, Lundeberg T, Hammar M. Effects of acupuncture on climacteric symtpoms, quality of life and urinary excretion of neuropeptides among postmenopausal women. Menopause 1995;2(1):3-12.
6. Hammar M, Frisk J, Grimas O, Hook M, Spetz AC, Wyon Y. Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: a pilot study. J Urol. 1999;161(3):853-6.
7.  Borud EK, Alraek T, White A, Fonnebo V, Eggen AE, Hammar M et al. The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial. Menopause 2009;16(3):484-93.
8.  Zhou J, Qu F, Sang X, Wang X, Nan R. Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial. Evid.Based.Complement Alternat.Med 2009.
9. Wijma K, Melin A, Nedstrand E, Hammar M. Treatment of menopausal symptoms with applied relaxation: a pilot study. J.Behav.Ther.Exp.Psychiatry 1997;28(4):251-61.
10.  Ganz PA, Greendale GA, Petersen L, Zibecchi L, Kahn B, Belin TR. Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Natl.Cancer Inst. 2000;92(13):1054-64.
11.  Van Patten CL, Olivotto IA, Chambers GK, Gelman KA, Hislop TG, Templeton E et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J.Clin.Oncol. 2002;20:1449-55.
12. MacLennan A, Lester S, Moore V. Oral estrogen replacement therapy versus placebo for hot flushes: a systematic review. Climacteric. 2001;4(1):58-74.

New Technique for Management of Hot Flashes

March 4th, 2010 by Elizabeth Kissling

The Indianapolis Star has a short interview today with Professor Janet S. Carpenter of Indiana University’s School of Nursing. Dr. Carpenter is conducting a study of whether menopausal women can control hot flashes through breathing techniques.

She told the Star:

Breathing techniques are something nurses use all the time. After surgery, we teach patients to inhale and take deep breaths to clear the lungs of anesthesia. We also teach patients slow, deep breathing to decrease anxiety. Because the study is blinded, I can’t talk specifically about what the two breathing programs are.

Some research seemed to show that it helped hot flashes. We actually think breathing techniques change a woman’s physiology so she will have fewer hot flashes, and if she has the same number of hot flashes, she will cope with them better.

I’ll look forward to seeing the results of her study (maybe I can talk her into presenting them at the next meeting of the Society for Menstrual Cycle Research!). If her hypothesis is correct, we’ll have an easy, cheap, and medication-free method for helping women cope with the discomfort of hot flashes.

Hot Flushes Relief Needn’t Enter the Bio-Identicals Fray

November 5th, 2009 by Elizabeth Kissling

Guest Post by Jerilynn Prior, Centre for Menstrual Cycle and Ovulation Research

pharmacy_clipAs a clinician scientist with expertise in hormones and women’s health, I sit in Canada and look at the hype and dis-sing going on about “bio-identicals” in the USA and shake my head. If we don’t want estrogen that is not FDA approved to be used to treat hot flushes, the simple answer is to regulate appropriately. The perpetual debate about bio-identical hormones has now hit USA Today with a headline: “Bioidenticals: Estrogen without FDA approval for menopause?

In Canada, all hormonal preparations require a prescription. Full stop.  And the pharmacists who compound estriol or progesterone do so with my prescription for a specific dose and clear purpose. Those compounding pharmacists are also regulated the same way as pharmacists who dispense FDA/Health Canada approved medications. End of story.

What bothers me is that I believe there is an intrinsic advantage to  hormones that are molecularly the same as our bodies produce. They are certainly better, a priori than those that are natural for horses or are “similar-but-different.” When oral micronized progesterone (molecularly identical, Prometrium®) is prescribed with estradiol (there are multiple FDA-approved brands of molecularly identical estrogen), there is no increased breast cancer risk.[1] On the other hand, medroxyprogesterone (a similar synthetic derivative of progesterone) with estradiol increases the risk for breast cancer by 79%.[1] That’s called a nasty surprise.

When a hormone treatment is the same as a native hormone we know exactly how it will act, be metabolized, and be excreted. We can learn, if we don’t know, how it interacts with other important factors like age, weight, kidney function, and in relationship to heart disease or breast cancer. So the fact that Wyeth “suggested” that the FDA take compounding and bio-identical hormones to task for false advertising, was simply an effort to regain market share in a legal drug war. They were reeling from the negative results of the Women’s Health Initiative. That’s why they also planned, wrote and published monthly Premarin-positive or estrogen-positive editorials and reviews in house at Wyeth and had them ghost authored by prominent scientists. A turf war.

As a physician, I believe the best treatment for severe vaginal dryness causing repeated bladder infections in older menopausal women is vaginal estriol in a dose of 0.5 mg twice a week.[2] However, there is no FDA/Health Canada approved estriol product. It’s just not available. So, I can prescribe that estriol—the weakest of the three estrogens our bodies make—and a local compounding pharmacist will make it for my patient. And that is a dose and kind of estrogen hormone that doesn’t cause a risk for endometrial (uterine lining) overgrowth or cancer as Premarin cream can (especially if delivered with that ridiculous vaginal applicator and in the doses that are commonly recommended).

What makes me feel both sad and angry is that this bio-identical “tempest in a teapot” (as my grandmother would say) is ignoring the distress of women with severe hot flushes. They are the reason for the popularity of compounded hormones, of the “experts” like Suzanne Somers and those who publicize and back her exuberant and likely imprudent self-medication. I have been cheering since Dr. Leonetti showed that 20 mg twice a day of progesterone cream significantly improved hot flushes.[3] If compounded hormones are evidence-based, as estriol and progesterone cream are for the conditions mentioned, who would fault women for wanting them? Especially when there is sufficient reason to doubt the hormone promises of Big Pharma?

The reality is that all of us—woman, physician, medical journal reviewer, and reporter—are under the spell of “The Estrogen Myth” so that estrogen glitters and progesterone looks dangerous. In reality both work together in every tissue of our bodies. What women need to know is that progesterone (cream and probably Prometriumâ) are effective for hot flushes. And medroxyprogesterone is as effective (by itself!) as Premarin® for treating severe hot flushes in premenopausal women who’ve just had surgical menopause.[4] However, thanks to Big Pharma, Wyeth and “The Estrogen Myth”, that randomized double blind comparative trial took me 12 years to publish (as I wrote in The Estrogen Errors—Why Progesterone is Better for Women’s Health, Praeger-Greenwood, ABC-CLIO Press, Conn., 2009).

Edited Nov 5, 5:47 PM – Dr. Prior adds the following references for the data cited in her post:

  1. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103-11.
  2. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993;329:753-6.
  3. Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol. 1999;94:225-8.
  4. Prior JC, Nielsen JD, Hitchcock CL, Williams LA, Vigna YM, Dean CB. Medroxyprogesterone and conjugated oestrogen are equivalent for hot flushes: a 1-year randomized double-blind trial following premenopausal ovariectomy. Clin.Sci.(Lond) 2007;112(10):517-25.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.