Why Hormone Optimization is Under Prescribed

During the North American Menopause Society's Annual Meeting in September, an impactful revelation by Dr. Talia Sobel from the Mayo Clinic in Scottsdale, Arizona, left the audience astounded. Dr. Sobel presented a staggering statistic: a mere 4 percent of outpatient healthcare visits for women aged 50 and above involved a new or ongoing prescription for bioidentical hormone replacement therapy (BHRT). 

This data, derived from physician-reported information gathered from six thousand healthcare visits spanning 2018-2019, mirrors the number of HRT prescriptions from 2010 nearly a decade earlier. Surprisingly, despite ongoing research affirming HRT as a safe and effective treatment, and amidst a menopause media frenzy over the past few years, the prescription rates for BHRT have remained stagnant. This trend persists despite an increasing number of women clamoring for relief from vasomotor symptoms.

When we last spoke with Wellcore advisor M. Roxana Cocos, APRN, MSN, FNP-C, we talked at length about how the healthcare industry prioritizes profits over preventive medicine, which BHRT falls squarely into. Beyond addressing the 34 different menopausal symptoms, BHRT is proven to protect against cardiovascular events, Alzheimer’s, osteoporosis, breast cancer, macular degeneration, cataracts, colon cancer and many more age-related health issues. Today, Cocos shares her perspective on the bias and why women should seek healthcare providers who take a proactive approach.

First, tell me about your overall approach to women’s healthcare and how balancing hormones fits in.

Women’s health is a big miss in our healthcare, or rather “sick care” industry. We are highly hormonal beings and imbalances trigger a lot of health issues - mentally, physically, and emotionally. Balancing our sex hormones, such as Estradiol, Progesterone, and Testosterone, but also thyroid and adrenal hormones, as well as Melatonin will improve our overall health, wellbeing, and quality of life, as well as reduce risk of chronic comorbidities and cancer. Also, achieving this balance will exponentially reduce the unnecessary costs associated with treating illnesses.

How does this preference for treatment over prevention manifest in women's healthcare?

There is misinformation and quite frankly bad science to convince us that all hormones are bad for us and replacing them past our prime is going to kill us. In the medical world there is this ongoing debate… should you or should you not replace your hormones if you are a peri or postmenopausal woman? Biased doctors, insurance companies and medical associations seem to blatantly dismiss and ignore the solid evidence-based science literature in support of BHRT while many of them have deep pockets with drug companies. And yet, drug companies are racing to develop drugs which mimic bio-identical hormones and their benefits. Crazy, right? Europe has dismantled their anti-BHRT guidelines, reversing their opinion and advocating for it as a safe, effective treatment..

Researchers can easily manipulate the science and poorly designed studies with significant biases can unfortunately discredit BHRT. For example, studies where women were given oral Estradiol at 0.25 mg daily had shown increased risk of heart disease and cancer. They came to this conclusion because Estradiol at 0.25 mg orally will never achieve a steady optimal serum concentration to provide any benefits. There is not one study to show that oral Estradiol at a 1 mg or higher dose will increase the risk of heart disease and cancer. In fact, this dose will achieve meaningful and protective serum concentration and show benefits in the long term. 

Pharmaceutical companies are now advertising drugs that reduce vasomotor symptoms by positioning them as embarrassing and difficult for women to talk about. There is nothing embarrassing about a woman’s body and the changes we naturally go through. These advertisements underline that these drugs are non-hormonal, playing into unfounded fears and leading women to believe this makes them exceptionally beneficial. Nothing is further from the truth. The small print on the Prescribing Information speaks the truth about these drugs and their lack of benefits and long term adverse effects. Very misleading and confusing to patients, and yet they have big dollar signs attached.

Can you share specific examples?

To this day the smartest doctors confuse progestins (such as oral birth control pills,  hormonal IUDs and implants) with Progesterone. Progestins, the synthetic version of Progesterone, come with a slew of side effects such as depression, weight gain, increased risk for blood clots and cancers, but yet are handed out like candy by lots of ob/gyn doctors who are considered the experts in women’s health. 

Also, doctors often convince women that their postpartum depression is a condition only Wellbutrin, Lexapro or Zoloft can treat. Very few doctors know and understand that there is a huge drop in Progesterone level after childbirth and replacing Progesterone immediately can level and improve mood, sleep, reduce anxiety and depression, and improve mother-baby bonding. I do not deliver babies and I am not an OB/GYN specialist but I have heard these stories a thousand times and more… Not to mention the tremendous benefit of Progesterone in reducing risk of breast, endometrial, and ovarian cancers and also cardiovascular benefits. Bio-identical hormones do not cause cancer - lack of or imbalances in them do, along with lifestyle choices, toxins exposure, stress, trauma, and genetics.

What about mental health?

Women often receive antidepressants rather than addressing hormone imbalances. 

As I mentioned before, Progesterone loss can spark postpartum depression, which is why some psychiatrists even treat anxiety and depression with hormones. In my current practice, my female patients often stop antidepressants within 6 - 12 months of being treated with BHRT when they feel stable, balanced, and content.

How can women find someone who understands their health needs?

Seek practitioners trained through World Link Medical. Their training and knowledge is top notch and evidence-based. And, same as before, I suggest finding a clinician who gets to the root cause of your symptoms and who truly listens to you. Lean on word of mouth, referrals from people you know and trust, and above all, educate yourself and ask them as many questions as you can think of. An educated patient will have better motivation and outcomes in reclaiming their health. 

About M. Roxana Cocos, APRN, MSN, FNP-C

Roxana graduated with honors (cum laude) from the University of Texas in Dallas with a Bachelors in Neuroscience as well as from the Texas Woman’s University with a Bachelors in Nursing. In 2011, she completed her education with a Master of Science in Nursing from Texas Woman’s University. She is board certified as a Family Nurse Practitioner through the American Academy of Nurse Practitioners, a proud alumni of the Academy of Integrative Health and Medicine, and member of the Academy of Preventive and Innovative Medicine.

As a Family Nurse Practitioner, she has worked in Family Practice, in Primary Care, Urgent Care, Endocrinology, and Functional Medicine giving her a well-rounded foundation of experience in treating patients. She has completed with honors the two-year postgraduate fellowship in Integrative Health and Medicine.

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