Menopause Society Certified Practitioner-affiliated clinics likely to adhere to guidelines
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Key takeaways:
- Overall, 13% of clinics had a Menopause Society Certified Practitioner (MSCP).
- Clinics with vs. without an MSCP were less likely to advertise hormone testing and compounded or bioidentical hormones.
Clinics with vs. without Menopause Society Certified Practitioners were more likely to adhere to guidelines and not advertise compounded or bioidentical hormones, hormones for youthful appearance or weight loss or recommend hormone testing.
“The lack of training and thus treatment of menopausal symptoms combined with public concern over safety of hormone therapy has created an opportunity for alternative treatment options. This includes an increase in compounded [or] bioidentical hormones that are often marketed as safer and more natural with less side effects despite lack of research to support those claims,” Jean M. Marino, APRN-CNP, MSCP, IF, women’s health nurse practitioner in the department of OB/GYN and Urology Institute at the University Hospitals Cleveland Medical Center, and colleagues wrote. “Because providers with varying degrees and specialties may take care of midlife women, and there is no specific certification required to offer menopause treatment, The Menopause Society offers a certification exam with mandatory continuing medical education for providers who strive to become Menopause Society Certified Practitioners (MSCP).”
Marino and colleagues conducted a pilot study, published in Menopause, identifying 174 clinics in Ohio (41%), Michigan (31%) and Pennsylvania (28%) advertising menopause treatment on their websites. Researchers checked clinic personnel against The Menopause Society directory of practitioners to assess whether the clinic was affiliated with an MSCP.
Overall, 13% of clinics were affiliated with an MSCP. Of all clinics, 52% advertised hormone testing, 37% advertised compounded hormone therapy, 61% advertised bioidentical hormone therapy, 15% advertised using hormone therapy to maintain a youthful appearance and 21% advertised using hormone therapy for weight loss, the researchers wrote.
Compared with clinics without an MSCP, MSCP-affiliated clinics were significantly less likely to advertise hormone testing (OR = 0.11; 95% CI, 0.02-0.39), compounded hormone therapy (OR = 0.06; 95% CI, 0.001-0.41) and bioidentical hormone therapy (OR = 0.07; 95% CI, 0.001-0.26).
In addition, MSCP-affiliated clinics were also less likely to advertise using hormone therapy to maintain a youthful appearance or aid with weight loss, but these associations were not statistically significant, the researchers wrote.
“Providers engaging with midlife women are encouraged to pursue MSCP certification, ensuring they stay abreast of evidence-based practices,” they wrote. “This not only enhances their commitment to current guidelines, but also facilitates patient access to providers who consistently uphold the most recent standards in menopause care.”
Perspective
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The study asks a very straightforward question: Do clinics associated with MSCPs adhere more closely to Menopause Society guidelines than those that are not? The answer is that they indeed do.
The Menopause Society has always opposed the use of compounded hormone therapies for spurious reasons — they have always advocated their use for women who have allergies to components of standard brands, and for those who need a dosage which is not available in commercial products. The authors of this article clearly point out the origins of the use of these compounded products; namely, in the wake of the Women’s Health Initiative, women assumed that standard commercially available hormones were dangerous and likely to give them breast cancer, whereas compounded products were much safer. The origin of this needs to be understood. Compounding pharmacies are not required by the FDA to place a package insert with a black box warning to accompany their estrogen products, whereas standard pharmacies have to insert such warnings.
What also surprised me in this study was that the states studied in this paper were not among such hotbed states, primarily in the South, where pellet therapy is quite widespread. The authors cite a well-known paper by Dr. Jiang (Jiang X, et al. Menopause. 2021;doi:10.GME.000000000001782.), which demonstrates that pellet users — because of the significant overdosing often seen in pellet therapies leading to very high and irregular blood levels of hormones, particularly estrogen and testosterone — are associated with significantly higher levels of bleeding and women treated with hysterectomies as a result.
Fortunately, as documented in this paper, the clinics associated with members of The Menopause Society are much less likely to promote compounded products with many spurious claims, such as youthful appearances and weight loss. When asked to recommend menopause providers in other areas of the country, I have always suggested that women go to the website Menopause.org, the website of The Menopause Society, to find members of the society who practice scientifically based menopause care. There are many FDA-approved estrogen and progesterone products that contain the same molecules of 17-beta estradiol and progesterone that these providers are much more likely to prescribe.
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