Lisa Jarvis: Why can’t we get hormone therapy right?

If you re a woman of a certain age your social media feed is likely filled with advice on what hormones you should take The promises made by menopause influencers about hormone therapy are expansive easing hot flashes and night sweats for starters but also promoting better brain and heart soundness improving muscle mass and bone strength boosting force and even enhancing your sex life What bone-tired middle-aged woman balancing childcare elder care and a job while also trying to maintain particular semblance of a healthy long-term partnership wouldn t want all that And yet as women s soundness influencers participants on menopause message boards and now the head of the U S Food and Drug Administration will tell you doctors have for too long been gatekeeping hormone therapy Millions of women the narrative goes are being deprived of something that could help them live longer and feel better If only the evidence supporting those indicates about hormones were as strong as their conviction in them Hormone therapy can help countless women but it s not the panacea various advocates are promising And while women s medical has indeed suffered from neglect it does women a terrible disservice to overpromise on what any single therapy can do for their fitness FDA Commissioner Marty Makary has long been a proponent of expanding access to hormone therapy so that more perimenopausal and menopausal women can benefit from it He devotes a chapter to the topic in his most of newest book Blind Spots Earlier this month he directed the FDA to remove the black box warning labels from several forms of hormone therapy theoretically making it easier for women in midlife and beyond to access these treatments A pall was cast over such treatments in when a large long-term evaluation the Women s Medical Initiative ended abruptly after researchers ascertained hormones increased the pitfall of heart infection strokes and breast cancer Over time it became clear that those warnings were not only overblown but also wrong Hormone therapy did not increase the likelihood of a heart attack and short-term use didn t increase women s chances of evolving breast cancer Moreover new and safer products have emerged that minimize those already small risks Yet certain doctors spent decades reluctant or even refusing to prescribe hormones to alleviate women s indicators In a podcast discussion about the strategy change Makary described the pullback as maybe one of the greatest screw-ups of modern medicine By getting rid of the black box warnings he declared we are getting rid of that fear machine As I ve written a corrective to that frustrating period is overdue And yet by making these changes without nuance Makary is ushering in a new equally frustrating era one where the pendulum swings too far toward healing for all regardless of their markers or the material and where expectations for what the therapy can deliver are overstated Let s start with the good in this month s decision The FDA removed the so-called black box warning on topical estrogen Doctors have long argued that this warning mistakenly conflated the risks of systemic medicines with those of a locally applied low-dose formulation that clinical studies have shown to be very safe That label has discouraged its use even though it can help prevent and treat a number of menopause-related conditions Doctors are less in agreement on the FDA s decision to remove the black box warning from other forms of hormone therapy which deliver estrogen systemically and may carry longer-term risks for various women While it s true that a large number of physicians might have been overly cautious and that the field has needed to do better by women patients still deserve all the pertinent information when considering a new remedy But Makary didn t stop at removing the labels During a press conference announcing the labeling change he and several menopause doctors who have built vast social media followings and lucrative private practices by promoting hormones significantly overstated the benefits of hormone therapy while minimizing its expected risks Research shows that hormone therapy can help relieve multiple of the markers of menopause including hot flashes night sweats and vaginal dryness and can help protect against bone loss and lower the liability of advancing diabetes Yet Makary claimed it has profound long-term robustness benefits that limited people even physicians know about Those purported benefits he explained include cutting their exposure of heart ailment by as much as half and Alzheimer s ailment by and even extending the lives of breast cancer patients Menopause researchers who have spent years studying the effects of hormone use were stunned by certain of the unfounded suggests They re making menopause and hormone therapy synonymous says Monica Christmas associate anatomical director of the Menopause Society They re suggesting that hormone therapy is this magic antidote to aging and it s not she says Related Articles Cory Franklin What will AI automation of wellness care mean for patients Mary Ellen Klas The property tax fight is a power grab in Texas and Florida F D Flam AI thinks it s smart Chimps may beg to differ Mark Z Barabak Why ballot fraud still matters F D Flam How women could be the key to unlocking longer life The hype was enough to draw Pauline Maki director of the University of Illinois College of Medicine s Women s Mental Wellbeing Research Project off the social media sidelines In an Instagram video one of only six posts she s ever made Maki walks through the results of a randomized investigation she conducted comparing brain function and memory in women taking hormones with those receiving a placebo She unveiled no difference between the groups and neither did three larger studies conducted by other researchers in her field Not one of them revealed an improvement in cognition she says Zero zip zero In subsequent research Maki detected that hormone therapy may improve cognition but only in women experiencing the majority severe markers They re having these hot flashes and waking up in the middle of the night she says You don t need me and all my decades of research to tell you that if you re not sleeping well your cognition is bad A more open conversation about menopause and greater access to therapies for women who might truly benefit from them should be welcomed But women also deserve accurate evidence-based information so they can make informed decisions about their fitness Anything short of that isn t progress it s more paternalism Lisa Jarvis is a Bloomberg Opinion columnist covering biotech wellness care and the pharmaceutical industry Previously she was executive editor of Chemical Engineering News