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BMC Women's Health
Published in: BMC Women's Health 1/2017

Open Access 01-12-2017 | Research article

Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making

Authors: Jennifer Jo Thompson, Cheryl Ritenbaugh, Mark Nichter

Published in: BMC Women's Health | Issue 1/2017

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Abstract

Background

In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women.

Methods

We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process.

Results

Although women’s individual motivations varied, two overarching themes emerged: “push motivations” that drove women away from conventional HT and from alternative therapies, and “pull motivations” that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention.

Conclusions

This study finds that women draw upon a range of “push” and “pull” motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.
Footnotes
1
The U.S. Institute of Medicine identified patient-centered care as one of six key aims for improving the U.S. health care system in the twenty-first century [109].
 
2
Although we did not recruit or exclude on the basis of education or profession, women in this study (like many other studies of menopause) were highly educated and a number worked in health-related fields. Thus, as recruitment ended and we sought to ensure greater racial and ethnic diversity in our study, we purposively recruited professional women of color, so not to conflate minority status and education or socio-economic status.
 
3
A pseudonym, as are all other participants names throughout.
 
4
Culturally-specific studies of menopausal women’s attitudes toward HT, such as Jin et al.’s study among Chinese women which finds that although most women had knowledge about menopause few thought menopausal symptoms should be treated and few were aware of HT [110], corroborate cross-cultural variability in attitudes toward menopause and HT [111, 112].
 
Literature
1.
Krieger N, Lowy I, Aronowitz R, Bigby J, Dickersin K, Garner E, Gaudilliere JP, Hinestrosa C, Hubbard R, Johnson PA, et al. Hormone replacement therapy, cancer, controversies, and women's health: historical, epidemiological, biological, clinical, and advocacy perspectives. J Epidemiol Community Health. 2005;59(9):740–8.CrossRefPubMedPubMedCentral
2.
Houck JA: The medicalization of menopause in America. In: Controversies in science and technology: From maize to menopause. Edited by Kleinman D, Kinchy A, Handelson J. Madison, WI: University of Wisconsin Press; 2005: 198–218.
3.
Wilson RA. Feminine forever. New York: M. Evans and Company, Inc.; 1966.
4.
Bush TL, Barrett-Connor E, Cowan LD, Criqui MH, Wallace RB, Suchindran CM, Tyroler HA, Rifkind BM. Cardiovascular mortality and noncontraceptive use of estrogen in women: Results from the Lipid Research Clinics Program Follow-up Study. Circulation. 1987;75(6):1102–9.CrossRefPubMed
5.
Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, Ernster VL, Cummings SR. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117(12):1016–37.CrossRefPubMed
6.
Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH. A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med. 1985;313(17):1044–9.CrossRefPubMed
7.
Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Willett WC, Rosner B, Speizer FE, Hennekens CH. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med. 1996;335(7):453–61.CrossRefPubMed
8.
Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980;303(21):1195–8.CrossRefPubMed
9.
Ziel HK, Finkle WD. Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med. 1975;293(23):1167–70.CrossRefPubMed
10.
Smith DC, Prentice R, Thompson DJ, Herrmann WL. Association of exogenous estrogen and endometrial carcinoma. N Engl J Med. 1975;293(23):1164–7.CrossRefPubMed
11.
Hoover R, Gray LA, Cole P, MacMahon B. Menopausal estrogens and breast cancer. N Engl J Med. 1976;295(8):401–5.CrossRefPubMed
12.
NAMS. A decision tree for the use of estrogen replacement therapy or hormone replacement therapy in postmenopausal women: Consensus opinion of The North American Menopause Society. Menopause. 2000;7(2):76–86.CrossRef
13.
Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy: Annual trends and response to recent evidence. JAMA. 2004;291(1):47–53.CrossRefPubMed
14.
Rossouw JE, Anderson G, Prentice R, LaCroix AZ, Kooperberg C, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.CrossRefPubMed
15.
Anderson G, Limacher M, Assaf A, Bassford T, Beresford S, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women's Health Initiative randomized controlled trial. JAMA. 2004;291:1701–12.CrossRefPubMed
16.
Schonberg MA, Davis RB, Wee CC. After the Women's Health Initiative: Decision making and trust of women taking hormone therapy. Womens Health Issues. 2005;15(4):187–95.CrossRefPubMed
17.
Ettinger B, Wang SM, Leslie RSM, Patel BV, Boulware MJ, Mann ME, McBride M. Evolution of postmenopausal hormone therapy between 2002 and 2009. Menopause. 2012;19(6):610–5.CrossRefPubMed
18.
Gass MLS, Stuenkel CA, Utian WH, LaCroix A, Liu JH, Shifren JL. Use of compounded hormone therapy in the United States: Report of the North American Menopause Society survey. Menopause. 2015;22(12):1276–85.CrossRefPubMed
19.
Pinkerton JV, Santoro N. Compounded bioidentical hormone therapy: identifying use trends and knowledge gaps among U.S. women. Menopause. 2015;22(9):926–36.CrossRefPubMedPubMedCentral
20.
ACOG. Compounded bioidentical menopausal hormone therapy. Fertil Steril. 2012;98(2):308–12.CrossRef
21.
McBane SE, Borgelt LM, Barnes KN, Westberg SM, Lodise NM, Stassinos M. Use of compounded bioidentical hormone therapy in menopausal women: An opinion statement of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy. 2014;34(4):410–23.CrossRefPubMed
22.
Santoro N, Braunstein GD, Butts CL, Martin KA, McDermott M, Pinkerton JV. Compounded bioidentical hormones in endocrinology practice: An Endocrine Society scientific statement. J Clin Endocrinol Metab. 2016;101(4):1318–43.CrossRefPubMed
23.
Cirigliano M. Bioidentical hormone therapy: A review of the evidence. J Womens Health. 2007;16(5):600–31.CrossRef
24.
25.
26.
Holtorf K. The bioidentical hormone debate: Are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009;121(1):73–85.CrossRefPubMed
27.
Sites CK. Bioidentical hormones for menopausal therapy. Women's Health (Lond Engl). 2008;4(2):163–71.CrossRef
28.
29.
30.
Eden JA, Hacker NF, Fortune M. Three cases of endometrial cancer associated with "bioidentical" hormone replacement therapy. Med J Aust. 2007;187(4):244–5.PubMed
31.
32.
Davis R, Batur P, Thacker HL. Risks and effectiveness of compounded bioidentical hormone therapy: A case series. J Womens Health. 2014;23(8):642–8.CrossRef
33.
Pinkerton JV. What are the concerns about custom-compounded “bioidentical” hormone therapy? Menopause. 2014;21(12):1298–300.CrossRefPubMed
34.
35.
Manson JE, Kaunitz AM. Menopause management — Getting clinical care back on track. N Engl J Med. 2016;374(9):803–6.CrossRefPubMed
36.
NAMS. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728–53.CrossRef
37.
Winfrey O: To: Oprah Winfrey; Subject: Hormones. In: O, The Oprah Magazine. vol. February 2009; 2009.
38.
39.
40.
Pinkerton JV, Constantine GD. Compounded non-FDA-approved menopausal hormone therapy prescriptions have increased: Results of a pharmacy survey. Menopause. 2016;23(4):359–67.PubMedPubMedCentral
41.
Velentzis LS, Banks E, Sitas F, Salagame U, Tan EH, Canfell K. Use of menopausal hormone therapy and bioidentical hormone therapy in Australian women 50 to 69 years of age: Results from a national, cross-sectional study. PLoS One. 2016;11(3):e0146494.CrossRefPubMedPubMedCentral
42.
Iftikhar S, Shuster LT, Johnson RE, Jenkins SM, Wahner-Roedler DL. Use of bioidentical compounded hormones for menopausal concerns: Cross-sectional survey in an academic menopause center. J Women's Health. 2011;20(4):559–65.CrossRef
43.
Richardson MK. Bioidentical hormone therapy: A challenge for the menopause clinician. Menopause. 2016;23(4):353–4.PubMed
44.
Durant JR, Evans GA, Thomas GP. The public understanding of science. Nature. 1989;340(6228):11–4.CrossRefPubMed
45.
46.
O’Callaghan FV, Jordan N. Postmodern values, attitudes and the use of complementary medicine. Complement Ther Med. 2003;11(1):28–32.CrossRefPubMed
47.
Sturgis P, Allum N. Science in society: Re-evaluating the deficit model of public attitudes. Public Underst Sci. 2004;13(1):55–74.CrossRef
48.
Wynne B: Misunderstood misunderstanding: Social identities and public uptake of science. Public Understanding of Science 192, 1(3):281–304.
49.
Allum N, Sibley E, Sturgis P, Stoneman P. Religious beliefs, knowledge about science and attitudes towards medical genetics. Public Underst Sci. 2014;23(7):833–49.CrossRefPubMed
50.
Moro D, Young W, Stein R, Isaac W, Goodman D. Menopausal women's access path to bioidentical hormone replacement therapy: An exploratory study. Int J Pharm Compounding. 2010;14(2):165.
51.
Spark MJ, Willis J, Byrne G. Compounded progesterone: Why is it acceptable to Australian women? Maturitas. 2012;73(4):318–24.CrossRefPubMed
52.
Fishman JR, Flatt MA, Settersten Jr RA. Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine. Soc Sci Med. 2015;132:79–87.CrossRefPubMedPubMedCentral
53.
Mulley AG, Trimble C, Elwyn G. Stop the silent misdiagnosis: patients’ preferences matter. Br Med J. 2012;345
54.
Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014;94(3):291–309.CrossRefPubMed
55.
Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. Br Med J. 1995;311(6996):42–5.CrossRef
56.
Bernard HR. Research methods in anthropology: Qualitative and quantitative approaches. 3rd ed. Walnut Creek, CA: Alta Mira; 2002.
57.
Schensul SL, Schensul JJ. LeCompte MD: Essential ethnographic methods. Walnut Creek, CA: Alta Mira; 1999.
58.
Lambert H, McKevitt C. Anthropology in health research: From qualitative methods to multidisciplinarity. Br Med J. 2002;325(7357):210–3.CrossRef
59.
Starks H, Trinidad SB. Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qual Health Res. 2007;17(10):1372–80.CrossRefPubMed
60.
61.
62.
63.
64.
65.
Wathen CN. Health information seeking in context: How women make decisions regarding hormone replacement therapy. J Health Commun. 2006;11(5):477–93.CrossRefPubMed
66.
Brown JB, Carroll J, Boon H, Marmoreo J. Women's decision-making about their health care: views over the life cycle. Patient Educ Couns. 2002;48(3):225–31.CrossRefPubMed
67.
van Manen M. Researching the lived experience. Ontario, Canada: State University of New York Press; 1990.
68.
Britten N. Qualitative research: Qualitative interviews in medical research. Br Med J. 1995;311(6999):251–3.CrossRef
69.
Spradley JP. The ethnographic interview. New York: Holt, Rinehart, and Winston; 1979.
70.
Kitzinger J. Qualitative research. Introducing focus groups. Br Med J. 1995;311(7000):299.CrossRef
71.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
72.
Boyatzis RE: Transforming qualitative information: Thematic analysis and code development: sage; 1998.
73.
Miles MB, Huberman AM: Qualitative data analysis, 2nd ed. Thousand Oaks, Calif.: Sage; 1994.
74.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59.CrossRef
75.
Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. Br Med J. 2000;320(7226):50.CrossRef
76.
Pope C, Ziebland S, Mays N. Qualitative research in health care: Analysing qualitative data. Br Med J. 2000;320(7227):114.CrossRef
77.
Saldaña J: The coding manual for qualitative researchers: Sage; 2015.
78.
Namey E, Guest G, Thairu L, Johnson L: Data reduction techniques for large qualitative data sets. In: Handbook for team-based qualitative research. Edited by Guest G, MacQueen KM. Lanham, MD: AltaMira Press; 2008: 137–161.
79.
Newton KM, Reed SD, LaCroix AZ, Grothaus LC, Ehrlich K, Guiltinan J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med. 2006;145(12):869–79.CrossRefPubMed
80.
Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for vasomotor menopausal symptoms. Cochrane Libr. 2007;
81.
Nichter M, Thompson JJ. For my wellness, not just my illness: North Americans’ use of dietary supplements. Cult Med Psychiatry. 2006;30(2):175–222.CrossRefPubMed
82.
Thompson JJ, Nichter M. The compliance paradox: What we need to know about "real world" dietary supplement use in the United States. Altern Ther Health Med. 2007;13(2):48–55.PubMed
83.
Tao M, Teng Y, Shao H, Wu P, Mills EJ. Knowledge, perceptions and information about hormone therapy (HT) among menopausal women: A systematic review and meta-synthesis. PLoS One. 2011;6(9):e24661.CrossRefPubMedPubMedCentral
84.
Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women’s health initiative randomized trials. JAMA. 2013;310(13):1353–68.CrossRefPubMed
85.
Chlebowski RT, Rohan TE, Manson JE, et al. Breast cancer after use of estrogen plus progestin and estrogen alone: Analyses of data from 2 Women’s Health Initiative randomized clinical trials. JAMA Oncology. 2015;1(3):296–305.CrossRefPubMed
86.
Jones ME, Schoemaker MJ, Wright L, McFadden E, Griffin J, Thomas D, Hemming J, Wright K, Ashworth A, Swerdlow AJ. Menopausal hormone therapy and breast cancer: What is the true size of the increased risk? Br J Cancer. 2016;115(5):607–15.CrossRefPubMedPubMedCentral
87.
Chlebowski RT, Anderson GL, Sarto GE, Haque R, Runowicz CD, Aragaki AK, Thomson CA, Howard BV, Wactawski-Wende J, Chen C, et al. Continuous combined estrogen plus progestin and endometrial cancer: The Women’s Health Initiative randomized trial. J Natl Cancer Inst. 2016;108(3) djv350-djv350
88.
89.
90.
91.
Leysen B. Medicalization of menopause: From 'Feminine Forever' to 'Healthy Forever'. In: Lykke N, Braidotti R, editors. In: Between monsters, goddesses and cyborgs: feminist confrontations with science, medicine and cyberspace. London: Zed Books; 1996.
92.
93.
94.
95.
96.
97.
98.
Shore DA: The trust crisis in healthcare: causes, consequences, and cures: Oxford University Press; 2007.
99.
NAMS. The 2012 Hormone therapy position statement of The North American Menopause Society. Menopause. 2012;19(3):257–71.CrossRef
100.
NIH State-of-the-Science Panel: National Institutes of Health State-of-the-Science conference statement: Management of menopause-related symptoms. Ann Intern Med 2005, 142(12_Part_1):1003–1013.
101.
102.
Kleinman A. The illness narratives: Suffering, healing, and the human condition. New York: Basic Books; 1988.
103.
104.
Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, Kirsch I, Schyner RN, Nam BH, Nguyen LT, et al. Components of placebo effect: Randomised controlled trial in patents with irritable bowel syndrome. BMJ. 2008;336:999–1003.CrossRefPubMedPubMedCentral
105.
Franzel B, Schwiegershausen M, Heusser P, Berger B. Individualised medicine from the perspectives of patients using complementarytherapies: A meta-ethnography approach. BMC Complement Altern Med. 2013;13(1):124.CrossRefPubMedPubMedCentral
106.
107.
Manson JE, Ames JM, Shapiro M, Gass MLS, Shifren JL, Stuenkel CA, Pinkerton JV, Kaunitz AM, Pace DT, Kagan R, et al. Algorithm and mobile app for menopausal symptom management and hormonal/non-hormonal therapy decision making: A clinical decision-support tool from The North American Menopause Society. Menopause. 2015;22(3):247–53.CrossRefPubMed
108.
Berger S, Braehler E, Ernst J. The health professional–patient-relationship in conventional versus complementary and alternative medicine. A qualitative study comparing the perceived use of medical shared decision-making between two different approaches of medicine. Patient Educ Couns. 2012;88(1):129–37.CrossRefPubMed
109.
IOM: Crossing the quality chasm: A new health system for the 21st century. Edited by Committee on Quality of Health Care in America. Washington, DC: National Academy Press; 2001.
110.
Jin F, Tao M, Teng Y, Shao H, Li C, Mills E. Knowledge and Attitude towards Menopause and Hormone Replacement Therapy in Chinese Women. Gynecol Obstet Investig. 2015;79(1):40–5.CrossRef
111.
Lock M. Encounters with aging: mythologies of menopause in Japan and North America. Berkeley: University of California Press; 1993.
112.
Melby MK, Lampl M. Menopause, a biocultural perspective. Annu Rev Anthropol. 2011;40:53–70.CrossRef
Metadata
Title
Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making
Authors
Jennifer Jo Thompson
Cheryl Ritenbaugh
Mark Nichter
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2017
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-017-0449-0

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