Since the story employed helpful sidebars, we yearned for a sidebar that provided some actual data on the tradeoff in HRT benefits and harms.
And we would have liked to learn more about the International Menopause Society: who’s in it and do they have any conflicts of interest?
We did appreciate the one overview line in the middle of the story:
“the great, universally accepted hot flash cure remains elusive.”
In the nearly 10 years since the publication of results of the Women’s Health Initiative pointed out dangers of prolonged hormone replacement therapy for many women, women and their health care professionals continue to try to balance the recommendations with the problems that some women have with hot flashes as they go through menopause.
There is no mention of the cost of prescription hormone replacement therapy (HRT) or of any of the non-prescription approaches described. Cost information would be valuable for readers because many women who do choose HRT use it for years.
The story focused on the analysis of non-prescription approaches to hot flashes and the conclusion that “failed to show any benefit of over-the-counter therapies compared to placebo for (hot flashes).”
And it briefly mentioned that “hormone therapy (estrogen, often combined with progestin)…reduces hot flashes by about 90%.”
The piece does not include balanced information regarding both the risks and benefits of using HRT. While the author does state that “Hormones are not for every woman…” the quotes from Dr. Michelle Warren, medical director of the women’s health center at Columbia College of Physicians and Surgeons in New York, and from Margery Gass, executive director of the North American Menopause Society, support using HRT.
Dr. Warren states that “it’s actually very safe, but that’s not getting across to the public’.”
Gass believes that the risks of HRT are “…low for women who use them for a short time around menopause.”
Readers would be better informed by a more balanced approach that included actual data about possible adverse side effects from using HRT. Most studies show that there is a small increase in risk of breast cancer after 3 or more years of use.
The author refers to the hormone replacement therapy treatment review published by the International Menopause Society (IMS) but no information is provided about the objectivity of the IMS nor is there any information about studies that formed the basis for the treatment recommendations.
Use of hormone replacement therapy has been especially controversial since 2002 and readers deserve to know about the objectivity of the IMS, the organization that published the treatment review. Readers should also be given information about any recent studies about the risks of HRT. Margery Gass, executive director of the North American Menopause Society, states that studies since 2002 have “given us a lot of reassurances that risks are low for women who use them {HRT} for a short time around menopause.” Readers should be given more information about the studies Gass refers to.
As already noted, most studies show that there is a small increase in risk of breast cancer after 3 or more years of use. The nice sidebars on “What doesn’t work” and “hot flash faq” could have also provided some of the actual data on potential harms.
The story does not commit disease-mongering. Stating that 20-25% of women are really bothered by hot flashes helps put this in perspective.
Readers aren’t told anything about who is in the International Menopause Society and whether any conflicts of interest exist.
The woman profiled in the piece tried alternatives to HRT but eventually decided to try using a hormone patch to relieve her hot flashes. It was helpful for readers to learn that she decided to use a lower dose of HRT because the lower dose didn’t make her feel as bloated. Other alternatives such as exercise are mentioned but are all termed ineffective.
The author notes that the treatment review is “bluntly dismissive of non-prescription remedies.”
Readers who are dealing with hot flashes would benefit from more balanced information about HRT and from advice to talk with their healthcare professional to reach a shared decision about HRT after discussing the risks and benefits.
The story didn’t explicitly address the availability of the various HRT approaches, but we didn’t think this was absolutely necessary in this case.
No claims of novelty were made – not about the approaches nor about the analysis by the International Menopause Society.
Quotes are included from one of the contributors to the treatment review and from two others who work in women’s health. There is also a profile of a woman who decided to use HRT after four years of side effects from hot flashes.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
Comments (3)
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Liz Scherer
February 1, 2012 at 1:46 pmAs someone who has been firmly entrenched in and writing about this subject since 2008, I respectfully disagree that the USA Today piece adequately quantified the benefits of alternatives to HRT. I’ve repeatedly examined well-designed, placebo-controlled studies that actually demonstrate significant benefit. However, the Menopause Industrial Complex, including many health reporters, would have you believe otherwise. Until we stop cherrypicking the data, women will continue to be confused. Your overall rating of the story is too high IMHO.
Liz Scherer
February 1, 2012 at 5:05 pmGary, I am happy to point your readers to certain links as it only helps to make my point that it’s easy to cherry pick data.
Soy (S-Equol) : http://jn.nutrition.org/content/140/7/1386S.full?gca=140%252F7%252F1350S&gca=140%252F7%252F1355S&gca=140%252F7%252F1363S&gca=140%252F7%252F1369S&gca=140%252F7%252F1373S&gca=140%252F7%252F1377S&gca=140%252F7%252F1380S&gca=140%252F7%252F1386S&gca=140%252F7%252F1390S&sendit=Get%20All%20Checked%20Abstract%2528s%2529
Acupuncture: http://www.biomedcentral.com/1472-6882/7/6
Mindfulness training: http://journals.lww.com/menopausejournal/Abstract/2011/06000/Mindfulness_training_for_coping_with_hot_flashes_.6.aspx
I have more if you’d like.
Best.
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