Hold the cream � it might HRT you

After the HRT scare, all hormone therapies are on trial. Do creams carry risks as well?

By Katherine Addleman

Since the Women's Health Initiative (WHI) blew the lid off the inherent dangers of hormone replacement therapy (HRT), there's been increasing anxiety about the safety of all hormone use in treating the symptoms of menopause. In the wake of the WHI findings, women and health practitioners have been seeking natural alternatives to progestin (synthetic progesterone) in HRT. Many companies, such as the US company Emerita and Matol Botanical International in Quebec have jumped on the bandwagon and are producing natural progesterone creams. These products are being sold aggressively over the internet and are widely available in the US, Europe and Canada. Once thought to be safer than oral HRT � their absorption was considered minimal � these hormone creams are now coming under closer scrutiny.

Dr Anne Hermann, who conducted a study at Bassett Healthcare in Cooperstown, New York, found that women who used natural progesterone creams had the same level of progesterone in their bodies as those who took the hormone pills. So, these creams could potentially expose users to the same risks as HRT.

Of course, not everyone agrees with this conclusion. Dr Deborah Moskowitz, director of research and development education for Emerita, argues that progestin, as a synthetic mimic of progesterone, is different, and that the WHI risks came from combined estrogen plus progestin, not progesterone alone. However, Susan Cruzan, a spokesperson for the Food and Drug Administration in the US, believes that progesterone should be assumed to carry the same risks as progestin until research shows otherwise. "We're asking manufacturers to do further studies," says Ms Cruzan. "Until we have that information, women who use any of these products should work with their doctors to use the lowest effective dose for the shortest duration of time." Especially worrisome is the fact that some women are slathering the creams on as if they were skin-care lotions.

The WHI warnings and the lack of research into natural progesterone have left many women uncertain and confused. For patients diagnosed with a progesterone-receptor-positive breast tumour, the question of the safety of progesterone cream is particularly important. According to Dr Marisa Weiss, president and founder of breastcancer.org, whether a woman has the progesterone receptors or not, different dosage levels can produce different effects. "Sometimes even a little hormone supplementation can cause problems," she says, "including stimulation of breast tissue, while a higher dose may be therapeutic. In other situations, it's the other way around." She concludes, "I'd err on the side of caution and avoid using them."

According to Dr Fay Weisberg, assistant professor of Obstetrics and Gynecology at the University of Toronto School of Medicine, "These natural progesterone creams are used much more frequently than we think, even though there's no good evidence that they do anything. But safety is a huge question. What worries me is that some women on estrogen may be using them to protect the uterus � rather than taking an oral progesterone. But a cream is not adequate protection."

Canada's Health Protection Branch issued a warning letter about natural progesterone creams in 1999.