The Truth in Statistics

I am always thrilled to have patients come to my office with studies or books that they have read. Education is the power to individual health and wellness. The internet has opened up the doorway of medical research and information to all. This is a very good thing. But it also pulls the curtains back on the short-comings of much of the research out there today.

Research is not a perfect science. We all bring prejudices, bias’, and incomplete knowledge to the table. As hard as we can try to keep scientific research pure, we cannot. In many ways, statistics is a game to play to prove your point. So, every study should be viewed through the prism of healthy skepticism.

No better example of this was an article that a client of mine brought to my attention recently.

The Study, “Perimenopausal Depression”, was published in the American Journal Of Psychiatry in January 2008. As Journals go, this is a prestigious journal in the field of Psychiatry. The premise of the study was accurate: Perimenopause is associated with an increased incidence of mood disorders, particularly depression. However, there were several glaring errors in the study.

First, there were several incorrect statements made. The author assumes that an elevated FSH is related to a decrease in Estradiol levels in the perimenopausal period. However, this is an inaccurate assumption. While it is true that an elevated FSH is associated with decreased ovarian function; the elevated FSH is actually due to decreased levels of another hormone–inhibin. The elevated FSH and estrogen levels have no direct link. This is well published throughout the medical literature. In fact, one of the earliest hormonal changes in perimenopausal women is a decrease in progesterone levels due to decreasing effective ovulation.

Second, the author makes the statement that progesterone increased the negative effects of depression, while estrogen alone improved depression. However, the study the author cites for support, used medroxyprogesterone acetate. This drug, a synthetic analogue, is commonly known as provera and is well known to increase depression. However, provera is not Progesterone, it is a synthetic progestin. Actually, progesterone has been shown to decrease depression by 60% when compared to the synthetic progestin, medroxyprogesterone acetate (provera). The author of this study is comparing apples to cumquats.

I want to expand on the second point above. The mistake this author makes is epidemic throughout the medical literature today. The author intermixes progesterone and medroxyprogesterone acetate as if they are the same hormone. They are in fact very different. Progesterone is what is called a “bioidentical” hormone. It is the hormone that a women produces in the later 2 weeks of her menstrual cycle. Medroxyprogesterone acetate, also known as provera, is a synthetic (not made by the body) progestin which was designed to protect the lining of the uterus from excessive Premarin stimulation. This followed the increased incidence of uterine cancer following the introduction of premarin back in the 1950s. Provera does protect the lining of the uterus, just like progesterone, but that is where the similarities end. Just compare the chemical structures below and you can tell they are not the same compound.
provera_vs_progesterone

A good friend of mine, Eldred Taylor, MD, says he can make you an honorary gynecologist if you can tell the 2 compounds above apart. As you can see from this article in question, this is a fact that many a physician today could not correctly identify.

Last, is the many unsubstantiated statements made by the author in the article. The author references, “other studies suggest…”, “overall, in the studies…”, and “in the studies that used progesterone replacement in addition to estrogen, the progesterone tended to decrease the beneficial effects of estrogen, and in some patients it exacerbated depressive symptoms…”. The problem is the “studies” are not referenced. An unreferenced statement is an opinion. This is why I heavily reference my posts. Opinion is nice, but when it comes to scientific research, opinion represents a potential bias and compromises data.

The goal of this blog is to not call out the author of the above mentioned article, but to have everyone learn to view all information and research articles with a healthy bit of skepticism.

To your health and wellness and to your hormone balance.

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