Menopause - the price of having the good luck to grow older and wiser. But getting through it, ah, there's the rub. Young women skeptical about the pharma monopoly only have to look at what their older sisters went through when the medical establishment handed out hormone replacement therapy at every hot flash and then were forced to backtrack when the rates of HRT-related cancer, heart disease and strokes started climbing.
Nowadays we hear a lot about "natural" or "bioidentical" hormones derived from plant sources, available by prescription and compounded by pharmacists. Many tout these as much safer than drug company concoctions. Witness the TV appearances of Suzanne Somers, of 70s bimbo fame, who has written two books on the subject.
But beware - there's little agreement over the evidence that natural hormones are what the body wants.
What the experts say
"[In natural HRT], the three sex hormones, estrogen, progesterone and testosterone, are extracted from wild yams and soya beans. We do a saliva test to determine which are in an imbalanced state. Mostly we use creams. Creams are absorbed more quickly than pills, so you can use smaller doses. One would assume this would mean fewer side effects. Sales reps for drug companies tell doctors that bioidentical hormone therapy does not have evidence-based medicine to support it. But studies using Premarin, for example, are often paid for by the Ayerst company. Don't get me wrong - I'm not anti-drug-company. I'm a pharmacist. I have concerns, though, about the way women are treated. I use a bioidentical approach because I think it's safer."
RAY BANNISTER, pharmacist consultant, Saskatoon
"[The hormone formula promoted by Somers] is not something in my armamentarium because there have been no studies showing that the amount of progesterone prescribed in the formulation is safe to prevent uterine cancer. The philosophy behind bioidentical hormones is good, but the safety data does not exist. Also, these can vary between batches because they are a compounded medication [mixed for a particular customer] and there is no standardization. Pharmaceutial companies use the same so-called natural source of estradiol, a soy product, that naturopaths use. The data on whether the progesterone cream is adequate to prevent endometrial growth is limited."
WENDY WOLFMAN, director, menopause unit, Mt. Sinai Hospital, Toronto
"Bioidenticals are God's own natural plan for women. Conventional therapies do not belong in the body. They're synthetic, and the body knows they're foreign. A synthetic progestin is not identical to the body's own progesterone. It will be too powerful. Bioidenticals are not available over the counter in Canada. If I give a prescription for 1 per cent of progesterone, the compounding pharmacist must make that exactly to the prescription. It is more accurate than taking a pill. How can you possibly imagine that one pill would fit a person who weighs 100 pounds and a person who weighs 200? With cream, you can change the dose according to the patient's needs. But pharmacists have to be trained in compounding."
ALVIN PETTLE, MD obstetrics and gynecology, integrative medicine, Toronto
"A compounding pharmacy can make a product not available commercially and not regulated by Health Canada or the FDA. People market these products as safer than regulated products, but there is no proof that is the case. There's an evil triangle: physicians who say they know about special HRT, compounding pharmacists who make it and the poor women facing licensed professionals promoting a product not shown to be safe. Some products advertised as bioidentical hormones are the same as some regulated products. These are at least as dangerous as and sometimes more so than regulated hormones. There are also questions about the quality of the material. This stuff is probably coming from outside North America, from unregulated facilities."
LARRY SASICH, chair, department of pharmacy practice, Lake Erie College of Osteopathic Medicine School of Pharmacy, consultant for Public Citizen, Erie, Pennsylvania
"The naturopathic approach would be to try to supply something that mimics the role of the body's hormones. The number-one herb for menopause is black cohosh. Then you have red clover. A gentler approach is to use ground flax seeds, which have weaker phyto-estrogenic properties. Soy isoflavins can also be taken. Though dong quai is well respected for its phyto-estrogenic properties, I don't usually use it because there has been some discussion about its safety. Acupuncture also works."
OREST SZCZURKO, naturopath, Mississauga