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Bioidentical hormones for menopausal symptoms

Rating

3 Star

Bioidentical hormones for menopausal symptoms

Our Review Summary

Bio-identical hormone therapy is a poorly-defined term for using a set of hormones that are molecularly identical to natural hormones in the body. Proponents of this treatment claim that bio-identical hormones are safer and more effective than conventional hormone therapy for treating the symptoms of menopause, however there is no evidence to support these claims. Furthermore, hormones are expected to have the same risk and benefits as approved drugs for which there is an evidence base as well as extensive research and regulation. Many medical organizations, both in the US and internationally, have issued statements raising concerns about the claims made about bio-identical hormones.

This story does a good job of raising awareness about this issue, although it should have noted that many women don’t experience symptoms in the same way and that treatment with bio-identical hormones or traditional hormones should only be used by women who are bothered by their symptoms and not if they are trying to prevent heart disease.

The story could have been greatly improved by coming down harder on the proponents of bio-identical hormones. While the story includes a debate on whether there is evidence to support the use of bio-identical hormones, in doing so, it gives the impression that there really is a debate. Bio-identical hormone supporters claim that there have been dozens of clinical trials showing a benefit. However, a 2007 systematic review found "a dearth of scientific evidence to support these claims". The story should have been more critical of the evidence base to support the use of bio-identical hormones.

 

Why This Matters

This is a subject sure to attract attention, given the wide range of troublesome symptoms experienced by many women during the menopausal transition.  It is important for women to be aware of the potential risks of uNPRoven therapies, including bioidentical hormone preparations, that may be "prescribed" by alternative health clinics.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story describes the cost of two bio-identical hormone products. There are many products available so costs may vary widely.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not quantify the potential benefits of either bio-identical or conventional hormones. There was much talk about efficacy by the Holtorf Medical Clinic Director, all about patient perception.  At the least, the story could have pointed out that patients who self-refer to such alternative care clinics (and often pay out of pocket for these services) may be  more likely to report benefit from the treatment.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story does not quantify the potential harms of bio-identical or conventional hormones. The story does rightly point out that there is no real reason to assume that bio-identical hormones are any safer than conventional hormones. There was some mention of blood clots and uterine issues, but this was not clearly delineated.  Harm is one of the major concerns about any estrogen or estrogen-like compounds, and the health risks could be more serious than with other supplements.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story includes a debate on whether there is evidence to support the use of bio-identical hormones. However, in doing so, it gives the impression that there really is a debate. Bio-identical hormone supporters claim that there have been dozens of clinical trials showing a benefit. However, a 2007 systematic review found "a dearth of scientific evidence to support these claims". The story should have been more critical of the evidence base to support the use of bio-identical hormones. This is the biggest drawback to this article, which was otherwise pretty good.  The story really didn’t get at the problem of shaky to absent scientific evidence of efficacy. 

Does the story commit disease-mongering?

Not Satisfactory

The story doesn’t exaggerate the seriousness or prevalence of menopause. However, it should have noted that many women don’t experience symptoms in the same way and that treatment with bio-identical hormones or traditional hormones should only be used by women who are bothered by their symptoms and not if they are trying to prevent heart disease.  The story also could have countered some of the suggested symptoms of menopause –  such as "fuzzy thinking" – which are not clearly associated with menopause in epidemiologic studies.  For these two reasons, we lean toward an unsatisfactory score on this criterion.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes two independent experts who provide valuable, differing opinions on the value of bio-identical hormones. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story does compare bio-identical hormones with its most important alternative, conventional hormones.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Bio-identical hormones are clearly available in many formulations.

Does the story establish the true novelty of the approach?

Satisfactory

Bio-identical hormones have been around for some time, although they grew in popularity within the past 10 years, particularly after the publication of the results of the Women’s Health Initiative. The story didn’t make any inappropriate claims of novelty.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Because the story quotes two independent experts, the reader can assume the story does not rely solely on a press release.

Total Score: 6 of 10 Satisfactory

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