Some doctors reacted to news published in 2002 that made it sound as if the risks of all menopause-related hormones outweighed the benefits. In fact, the study showed that a particular hormone treatment (a combination of estrogen and a progestin called MPA) had serious health risks, particularly if a woman started taking it after age 60. The media focused a lot of attention on this news. The very same study later released findings some years later about women who had hysterectomies and took estrogen-only hormone treatments. These women displayed important health benefits from estrogen.
Sadly, this part of the study didn’t receive as much media attention.
When the dust settled, many women and many doctors were left with a generalized fear of hormone therapies. Many medical schools started to omit teaching about menopause care, resulting in many health professionals being left marginally informed about the subject.
There are some doctors who refuse to prescribe any medication that has what is known as an FDA “black box,” and menopausal hormones do carry this “black box.” The black box is a general warning that the medication may cause health risks. You may agree with that policy, but you should know that these black boxes are very hard to get removed and may not reflect the latest science. Ultimately, each woman must weigh her own risks versus benefits. Hopefully, your doctor can help you with this process.
Another reason some doctors are reluctant to prescribe hormones is fear of medical malpractice legal action. Your doctor is unlikely to admit to making decisions based on that fear, but you should understand that it is a possibility.
If your doctor is not an obstetrician/gynecologist and if you have a uterus, he or she may feel unable to handle some of the side effects women can experience when using a combined estrogen/progestin therapy – side effects such as recurring spotting or bleeding. If that’s the case, perhaps you should see an ob./gyn. or a nurse practitioner certified for menopause health care. A good source for the names of doctors and nurses who are up-to-date about hormone therapies is the website of the North American Menopause Society (NAMS).
Your doctor may be generally against any hormone therapy or not well-informed, but it’s also possible that he or she may be knowledgeable and up-to-date but thinks that your medical history makes this course of treatment not advisable for you. Just as you want your doctor to listen to you, you owe it to your caregiver to understand exactly why he or she doesn’t want to prescribe hormone therapy
for you.
Once you have heard out the reasons, you’ll have a better idea of how to proceed. If he or she believes that your medical history is the issue but you are not sure you agree, a second opinion is the proper course. If you know someone who is using menopausal hormone therapy, try to see her doctor. If you suspect that your doctor is either not knowledgeable or has a too rigid “no-hormones” policy, you should probably find a new doctor.
Do remember there are nonhormonal options you should also consider that can help control symptoms, as well as some behavioral and lifestyle choices that can help. For a discussion of nonhormonal approaches, there is a good article on this website.
References:
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. 2002. JAMA 288:321-333. http://jama.jamanetwork.com/article.aspx?articleid=195120
Anderson RL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. 2004. JAMA 291:1701-1712. http://jama.jamanetwork.com/article.aspx?articleid=198540
Find A Menopause Practitioner. NAMS. Accessed February 10, 2016. http://www.menopause.org/for-women/find-a-menopause-practitioner
Nonhormonal management of menopause symptoms. EmpowHER. Accessed February 10, 2016. https://www.empowher.com/menopause/content/nonhormonal-management-menopause-symptoms
Reviewed February 12, 2016
By Michele Blacksberg RN