Sex and the City Part 3- The “Risky” Kind


My dear husband asked me to be the guest writer this week. His choice of subject matter was interesting as typically men complain about hormonal changes in others far more than they embrace hormonal changes as an avenue to wellness for both genders. I suppose I should count myself lucky!

When women present to my office to discuss hormone replacement therapy they typically fall into one of two camps. Most women complain of roughly the same symptoms and they usually include fatigue, lack of concentration, decreased libido, depression and the ever-present night sweats. Their approach to treatment varies widely and usually there is not a lot of middle ground. The first group has tried multiple over the counter remedies and strongly desires to avoid hormones of any kind because of their fear of the associated risks. The second group feels that hormones are the answer to the problem whatever the risk. Both groups are tired of living like they currently do and want help. My job today is not to dissuade you from the camp you choose but to help you think about risks in a way that can allow you to obtain treatment without fear.

First – most of the misgivings that people have regarding hormones stem from the Women’s Health Initiative study. The arm of the study that evaluated hormone therapy’s impact on cardiovascular disease and breast cancer contained approximately 65,000 women who were placed on oral conjugated equine estrogen and medroxyprogesterone acetate. Neither of those were bio-identical, but at the time of the study they were the most commonly used medications. When discussing results and studies and thinking about our own health, most times the popular media does not give us the tools we need. For example, this study did show an increased risk in heart disease and breast cancer in women using ONE of many types of available hormone regimens. Does that mean all hormones cause an increase in these risks? Not likely. Multiple studies of bio-identical hormones done after this study have shown no increased risk. What does this mean to you? When you hear something in the media that you think is applicable to you, ask your doctor about it. Don’t jump to conclusions. The study group may not contain patients of your age, ethnicity or with your underlying health conditions.

Second – we must compare apples to apples. I see patients all the time who want to compare the risk of treatment to the risk of no treatment. Realistically, we should compare the risks of treatment to the risks of the untreated condition. Consider birth control pills – yes, there is a very small risk of deep vein thrombosis and pulmonary embolism while using birth control pills. Yes, there is no increased risk if you don’t take birth control pills but what is the risk of deep vein thrombosis in pregnancy? 0.05-0.2% depending on the study you read. The rate in birth control pill users? 0.03-0.09%. Let me go ahead and put a media spin on it to prove the point. “Did you know that pregnant women are 22 times more likely to have a deep vein thrombosis than birth control pill users?!” I bet the FDA wouldn’t approve pregnancy! The better point is that the risk is low in either group but the risks of an unplanned pregnancy don’t stop at DVT. Consider the impact on women’s and children’s lives. Compare apples to apples.

Hormone replacement therapy may not be risk free but neither is walking through life in a fog of exhausted depression. Talk to you doctor and get the real story. Don’t trust the media scare.

Disclaimer: Dr Keri Rath, MD, FACOG is a board certified OB/Gyn practicing in Ruidoso, NM. She lives in our beautiful mountain town with her devoted husband and two darling children. Her opinions don’t always agree with his but he loves her anyway. Comments or questions? The email address is: