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Promotion of Risky Menopause Hormones Sway Doctors Judgment


Promotion of menopause hormone prescriptions by the pharmaceutical industry through publications may be a powerful influence on a doctor's decision to prescribe them. This finding could help explain why, despite the known dangers of menopause hormone therapy, more than half of all gynecologists in the US still believe they are beneficial to a woman’s health and prescribe them anyways

Hormone Therapy and Menopause

Menopause typically affects a woman between the ages of 45 to 55 and causes a decrease in the production of progesterone and estrogen hormones. This decline in hormone levels causes the uncomfortable symptoms of menopause which include hot flashes, flushing, insomnia, decreased libido, headaches, and heart pounding. Prescribing hormone replacement therapy has been a method frequently used by gynecologists and other doctors to try and help relive some of these discomforts in patients. In addition it was previously believed that hormone replacement therapy also decreased the patient's risk for other diseases which were associated with low progesterone and estrogen levels including cardiovascular disease, osteoporosis and cancer.

WHI Study Finds Menopause Hormones Dangerous

However, back in 2004 the Women's Health Initiative (WHI) study, which included 26,000 women, found that hormone therapy actually had numerous heath risks. Researchers identified that women who were prescribed these meditations had more strokes, deep vein thrombosis, dementia, incontinence, and even breast cancer. In addition the hormones were not found to have any protective effect against cardiovascular disease. These findings were so alarming that several portions of the study were discontinued in order to prevent further harm among the participants. Researchers concluded that the risks of hormone therapy outweighed the benefits in most, if not all, cases.

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Despite the findings of the WHI study and similar results found in follow-up studies, surveys show that nearly half of all gynecologists still do not agree with the dangers of menopause hormone therapy. Many reported that they thought the results of the WHI study were not convincing and they disagreed with the decision to stop the trial early. This is surprising as clinical research is typically the foundation of of how doctors choose to prescribe and treat their patients. The fact that so many doctors distrust the results of the largest placebo-controlled study on hormone replacement therapy has been cause for inquiry among researchers.

Researchers Examine Industry Promotion of Hormones

Researchers at Georgetown University looked at the possibility of promotion by the pharmaceutical industry through publications as an influence on doctors' perception of hormone therapy. This study identified 340 relevant opinion articles written after the publication of the WHI findings. They found that 90% of the articles which were identified as promotional of hormone therapy were authored by people with a conflict of interest. The researchers also identified several themes among these articles which included attacks on the WHI study method, suggestions that clinical trial results should not guide treatment, and arguments that observational studies are jut as good, if not better, than randomized clinical trials for guiding clinical treatment.

Senior author on the study Adriane Fugh-Berman wrote in the study's report “Industry-funded reviews and commentaries may be designed to convey specific, but subtle, marketing messages. As a possible explanation for why so many physicians continue to support the use of menopausal hormone therapy in asymptomatic women, we investigated whether...articles identified as promotional were more likely to have been authored by those with conflicts of interest as determined by declared payments from hormone manufacturers....We found that articles with a promotional tone were more likely to have been written by authors who had disclosed financial conflicts of interest than by authors without such disclosures.”

Doctors Should Exercise Caution

Doctors and other health care providers are the primary audience for the above mentioned articles thus can have a very influential affect on their opinions and clinical practice. Fugh-Berman warns that “Health care providers should exercise caution” when reading articles with an opinion tone related to menopause hormone therapy.

The U.S. Food and Drug Administration (FDA) recommends that only women with moderate to severe menopausal symptoms should be given hormone replacement therapy. Furthermore, only the lowest prescribed dose should be given for the shortest amount of time. It is not recommended that these medications be given for the prevention of osteoporosis or any other disease.