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Bio identical hormonesBioidentical hormones
by Marcelle Pick, OB/GYN NP
Suzanne Somers has brought bioidentical hormones onto center stage. In her books, Ageless and The Sexy Years, and in media appearances to promote them, she describes how bioidentical hormones relieved her menopause symptoms. She also makes it clear that she intends to stay on them for the rest of her life. As a result, we’re now deluged with calls about bioidentical hormones. The basic question women ask is, “Are they for me?” Let’s explore what we’ve learned about bioidentical hormone replacement therapy (BHRT) in the 15 years we’ve used it in our clinical practice, and help you answer that basic question for yourself. Just what are “bioidentical hormones”?
Bioidentical hormones are manufactured in the lab to have the same molecular structure as the hormones made by your own body. By contrast, synthetic hormones are intentionally different. Drug companies can’t patent a bioidentical structure, so they invent synthetic hormones that are patentable (Premarin, Prempro and Provera being the most widely used examples). Though bioidentical hormones have been around for years, most practitioners are unfamiliar with them. There are several branded versions now available for use in the kind of hormone replacement therapy (“HRT”) typical of synthetic hormones. This is generally a one-size-fits-all dosage regime. In our practice, we have had the greatest success with an individualized approach. We begin with laboratory tests of hormone levels (a so-called “hormone panel”). When warranted, we then prescribe a precise dosage of bioidentical estrogen, testosterone or DHEA that is made up at a compounding pharmacy. Each patient is then monitored carefully through regular follow-up hormone panels to ensure we get symptom relief at the lowest possible dosage. In the initial stages, we will do a hormone panel every three months. Once balance is restored, we’ll do one panel a year at the time of the annual exam. Are bioidentical hormones better than synthetic hormones?
We long ago concluded that the answer to this question is yes. But that doesn’t
mean bioidentical hormones are perfect.
The great appeal of bioidentical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing side effects. Synthetic hormones are quite strong and often produce intolerable side effects. Moreover, the compounded bioidentical hormones can be matched individually to each woman’s needs — something that’s just impossible with mass-produced products. Are bioidentical hormones safer than synthetics?
European medical studies suggest that yes, bioidentical hormones are safer than
synthetic versions. This makes perfect sense. But we must be cautious here,
because they have not been well-studied, especially for long-term use. And in
any case, we never recommend that a woman think of any drug as completely
Let us note here that the WHI studies on the effectiveness and health risks of HRT were based on synthetic/equine-based hormones. Read our article on the risks of HRT for our perspective on these studies. The great majority of women can rebalance their hormones without the use of drugs. We have found that about 85% can find relief through an approach that combines medical-grade nutritional supplements, gentle endocrine support, and dietary and lifestyle changes. We recommend that every woman start with this combination approach as a foundation of health. For a guided version of this approach, see our Personal Program. We’ve developed a three-pronged approach that supports a woman’s hormonal pathways upstream of where problems arise and develop into full-blown symptoms requiring stronger hormonal replacement therapy. (Our dietary guidelines are based on Dr. Diana Schwarzbein’s work — the same endocrinologist who introduced Suzanne Somers to bioidentical hormones.) Our Essential Nutrients fill in the nutritional gaps so common in our modern diet. And our Herbal Equilibrium offers phytocrine support to rebalance all three of the major sex hormones most prone to disharmony in perimenopause and menopause: estrogen, progesterone, and testosterone. Even with this foundation, a minority of women will need to add prescription-strength hormone supplements to get complete relief, at least through a transition period. We recommend they use bioidentical hormones, preferably in a compounded form personalized to their needs by an experienced practitioner. It’s important that the hormones be used in addition to the combination approach outlined above. (Note that Suzanne Somers is among this minority — she began with a healthy diet and lifestyle that supported her endocrine system, but still experienced intractable symptoms.) We don’t recommend that any hormones be used long-term unless essential for symptom relief, and then only with a complete risk assessment. We also don’t support the idea that bioidentical hormone therapy should be used indefinitely as some kind of fountain of youth. What about bioidentical hormones for breast cancer patients?
The pendulum has swung so far that today, very few doctors will prescribe any type of HRT — synthetic or bioidentical — for women who have had breast cancer or even a family history of breast cancer. In fact, many such women are given anti-estrogen drugs. Dr. Dixie Mills, who co-developed Women to Women’s Personal Program, feels that we just do not have enough data to rule out HRT in every case, and prefers to look at each woman’s particular situation, history, pathology and blood work. Dr. Mills has breast cancer patients who, like Suzanne Somers, use low-dose bioidentical hormones by choice. These women have researched the issues, discussed them with their doctor, and made a well-informed decision for themselves. (For more insight on this topic, see Dixie’s articles on estrogen and breast cancer and progestins and breast cancer. ) Janet was a 54-year-old woman who came to us with severe menopausal symptoms. We changed her diet to increase her protein and vegetables and reduce carbohydrates, added a pharmaceutical-grade nutritional supplement, and did a complete blood hormone panel. At her first follow-up visit six weeks later, Janet definitely felt better, but she still suffered too many hot flashes and sleepless nights. Our next step would have been to increase her soy intake, but Janet wanted immediate relief and chose to try bioidentical hormone replacement therapy. After reviewing her hormone panel we placed Janet on a combination of bioidentical estradiol (one of the three forms of estrogen), testosterone, DHEA and progesterone, all in cream form. Six weeks later Janet came back for another follow-up. “I feel fabulous,” she said, explaining she hadn’t felt this good since her early 30’s. A year later Janet still feels great. She’s carefully compliant with her diet and exercise regime, and takes her bioidentical hormones faithfully. Her latest hormone panel shows she’s still in balance and there is no need to adjust her dosages. Not every patient is as easy to help as Janet. Sometimes we have to adjust the formulas three to five times to get it right. But it’s a very effective solution. So — are bioidentical hormones for you?
At Women to Women, our goal is to help inform women about their options so that they can make the choice that’s best for them. A woman’s hormonal balance is a dynamic equilibrium that shifts from day to day, week to week, and through the years. When you give your body the support it needs it can reset itself, because it’s equipped and programmed for balance and wellness. So we recommend beginning with the gentlest form of support possible to allay your discomfort and tweaking it as you go. We’ll support you in any way we can, each step of the way. The good news is that women can feel incredibly well right through menopause. Bioidentical hormones: Are they safer?
Mayo Clinic breast-health specialist Sandhya Pruthi, M.D., and colleagues answer select questions
There's a lot of interest in bioidentical — or so-called "natural" — hormone therapy for menopause
symptoms. However, there's no evidence that bioidentical hormones are safer or more effective than
standard hormone replacement therapy.
Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body. These prescription and over-the-counter products are marketed as being tailored to a woman's individual hormone needs, typically determined through saliva hormone testing. Manufacturers claim that bioidentical hormones are safer than standard, FDA-approved hormone therapy. According to the North American Menopause Society (NAMS), custom compounds may provide certain benefits, such as individualized doses and mixtures of products and forms that aren't available commercially. However, they may also pose risks to consumers. These compounds haven't been approved by the Food and Drug Administration (FDA) and as a result haven't been tested for purity, potency, efficacy or safety. These products may even contain unknown contaminants. For this reason, NAMS does not recommend these custom-mixed products over well-tested, government-approved commercial products for the majority of women. Also, bioidentical estrogen and progesterone are available in FDA-approved hormone therapy products, including: Estradiol, such as Estrace, Climara patch and Vivelle-Dot patch These products come in many different doses and forms. So, you don't need to turn to unregulated, individually compounded products as your only source of "natural" hormones.
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