Andy Myers, CEO of HealthDay
According to recent reports, there is a shortage in the supply of hormone replacement drugs. The deficiency appears to be particularly acute for estrogen patches.
Joining us today is Dr. Stephanie Fabian, director of the Mayo Center for Women’s Health and medical director of the Menopause Society.
Thank you so much for joining us today.
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director of the Menopause Society
Glad to be here. Thanks for having me.
Andy Myers, CEO of HealthDay
So we hear about some of the downsides to HRT in general. Tell me you are definitely at the forefront of this. Do you hear some examples and some talk about it?
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director of the Menopause Society
We hear some, although I must say that this is a phenomenon and it is some doses, not other doses.
So it is ineffective. It can be a little hit or miss. And usually, if we rewrite the prescription, if they can’t get the once-a-week patch, we’ll do the twice-a-week patch, or we’ll do it a little differently by combining two lower-dose patches.
So we can usually do it together. But I think it’s kind of happening because we have more women asking about hormone therapy than in the past.
We still don’t know how many women use it. And I’ll give you a preview of an abstract that we published more than a year ago, but the paper is about to be published, which says that the rate of hormone therapy use in this country is still at a low 1.7%.
It was until the end of 2023. So we don’t have the data over the last year, two years to say that there’s been an upward trend, but it looks like that.
But we do know that the rate of use of hormone therapy was actually very low.
Andy Myers, CEO of HealthDay
interesting So some people have said that this recent surge in use, or shortage, however you want to look at it, is the result of the FDA requiring manufacturers to change the labeling on the hormone replacement therapy package. Do you think there is any truth to this? Or do you think there are some other important factors that actually cause it?
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director of the Menopause Society
I’m not sure I can connect it to this particular one. While this may help more women using hormone therapy, most of the women in my office don’t actually know that any boxed warnings have been removed. So I think it’s more than that.
I think women and doctors and people in general are talking about menopause more than in the past, which is a good thing.
So I think women are asking questions like are all these symptoms related and is there any treatment and what about hormone therapy and can I use it? Is it safe for me?
So I think there’s more discussion about menopause in general.
It’s another generation of baby boomers who didn’t really talk about things like menopause in public.
So we have another generation, the Gen Xers and the first millennials are now at an age where they are experiencing the symptoms. And hearing that there is nothing that can be done about their symptoms is unacceptable to this generation and you have to love that.
So they don’t just ask for answers, they crowdsource the answers and use social media to do it.
They are educated. Most of them have their own money and jobs and have unmet needs. And just like the sound of sucking, that vacuum cleaner has now spawned an industry around menopause that didn’t exist before.
Andy Myers, CEO of HealthDay
So I want to go back for a second and talk about how you feel about people’s perception of the safety of hormone replacement.
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director of the Menopause Society
So back up, we don’t call it hormone replacement therapy anymore. We call it hormone therapy.
And the reason we don’t use a replacement part is because we’re not really trying to replace what the ovaries were making before menopause.
We are trying to manage the symptoms, and the dose needed to manage the symptoms is much lower than the dose needed to completely replace the ovaries if the ovaries were absent or not functioning.
So, the Women’s Health Initiative, an important key study. The first results were published on July 9, 2002, a date anyone in the menopause world remembers because it was something impressive. And it was also reported in a way that was very scary.
And they said, you know, hormone therapy is not as safe as we thought. And not only does it not prevent chronic disease, it can increase the risk of cardiovascular disease. So, heart attack, stroke, blood clot, etc. There was a secondary outcome of breast cancer, which also increased in this group. Now, all of these risks were relatively small in young women.
Finally, they broke down the data by age…and what we found is for those women in their 50s…hormone therapy was actually very safe. And for those women, the risk of heart attack and stroke is very low anyway, because these are younger women.
Now, does this mean that all women should be on hormone therapy? Absolutely not. It does not. And I just want to make this clear.
Andy Myers, CEO of HealthDay
Because one of the things that we’re always most concerned about is delivering news that you can use, what are the factors. for women, should it be encouraged to use it or not to use it?
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director of the Menopause Society
Yes, let’s break it down on who should get it and who shouldn’t.
If you are younger than 60 or within 10 years of menopause and have troubling symptoms like hot flashes, night sweats, sleep disturbances, mood swings, anything that really affects your life. Not just a little, but to the point where you say, yes, I would do something about it if I could. This is the woman we want to talk about.
Another thing we look at when you’re in the office is what is your risk of heart disease? We look at cardiovascular risk factors. If you have, for example, diabetes or high blood pressure, this does not mean that you are not a candidate for hormone therapy, but it may affect the type of hormone therapy and the route of delivery that we give you.
But who shouldn’t take it? Women with a history of breast cancer, women with a history of heart attack, history of stroke, history of blood clots, severe liver disease.
