Compounded bioidentical hormones are prepared,mixed and assembled by a pharmacist under aprescriber’s orders. Most compounded products
have not undergone rigorous testing for safety,effectiveness, purity, potency and quality. There isno scientific evidence to support the claims madeof increased safety with use of these products.
There are many bioidentical hormones that areFDA-approved, including various patches, creams
Is it in Here?
and gels that are manufactured using the same plant-derived hormones as compounded products.
However, FDA-approved bioidentical hormonesmust pass stringent quality control standards andtherefore lack the intrinsic risk of compounded
products. I recommend the FDA-approved“patch” for estrogen replacement because it is
about Hormone Therapy
bioidentical to the estrogen produced by thehuman ovary, it maintains very steady delivery of
estrogen, preventing highs and lows in symptoms,
and is very friendly to cholesterols – lowering thebad, raising the good – and does not increase
This seems to be a mantra of some women in
There is one FDA-approved bioidentical hormone
their 40s and 50s. Hot flashes and night sweats
patch that contains both estrogen and progestin in
are just some of the symptoms women experience
when their ovaries begin producing less estrogen
weekly). There’s also a vaginal ring that delivers
and may occur for months or even years before a
systemic estrogen levels and is changed every
three months. Some oral estrogen products arebioidentical; some are not. The estrogen used in
The exact cause of hot flashes (or flushes) is
the WHI was Premarin, the first estrogen for
unclear. What is clear is that diminishing
hormone therapy in the United States (derived
estrogen levels causes a deregulation of the
Physicians still find that HT is the most effective
from pregnant mares’ urine). Many of the
therapy for menopausal symptoms and that it is
compounds in Premarin are not utilized in the
allowing an increase in peripheral and core body
human female and are simply excreted in the
temperature. Hence, hot flashes are a result of an
urine. Today, although still frequently prescribed,
Is it necessary
Premarin has for the most part been replaced bythe newer estrogen formulations.
Night and daytime hot flashes can interrupt sleep
to test for menopause?
and cause other quality of life issues, such as
Laboratory testing for hormone levels is generally
not helpful due to the normally wide fluctuations
in female hormones, and there is no scientific
progestogen increases the risk of endometrial
Many women seek “non-hormonal” remedies for
evidence that “saliva testing” for female hormone
cancer four to five fold. Natural micronized
hot flashes such as soy, black cohash, red clover
levels is biologically meaningful. (Millions of
progesterone is available in an FDA-approved
and other supplements. Although some women
dollars are spent every year for saliva testing and
product called Prometrium. Other synthetic
find relief with these products, there is little
compounded hormones. These are advertised as
scientific evidence to support their effectiveness.
being more natural and safer. This is actually not
Certain antidepressant drugs have proven helpful
true and could even be more dangerous.) In
addition, centers that offer saliva testing advertise
Also, “compounded” topical progesterones lack
symptoms, specifically women who cannot take
“customizing hormones” for individual women.
absorption so they are not adequate to protect the
Hormone therapy (estrogen and progesterone)
does not need this individualized dosing since
Hormone Therapy –
there is a wide range in therapeutic levels and
toxic concentrations are extremely unlikely.
what you need to know
menopausal (natural or surgical) with symptoms
Therefore, testing isn’t only unnecessary; it’s
associated with menopause, the benefits of
The most effective therapy currently available to
unreliable. I prefer to treat patients based on
hormone therapy most likely outweigh the risks.
treat hot flashes is hormone therapy (HT). In
symptoms of estrogen deficiency, which include
recent years, the practice of hormone therapy has
hot flashes, night sweats, mood swings and
concerned about possible risks, can be assured
gotten negative publicity due to the 2002 release
that the women enrolled in the WHI were on
of the Women’s Health Initiative (WHI), a study
average 15-20 years postmenopausal and not the
that showed an increased risk for heart disease
While hormone replacement is the safest and
typical symptomatic menopausal women seen in
among HT users. The results of this study led to a
clinical practice today. Talk to your healthcare
media frenzy and, based on pharmacy records,
symptoms, it’s important to know what your
provider or a specialist in gynecology/women’s
hundreds of thousands of women stopped using
health regarding the right kind of therapy for you. Bioidentical Hormones
However, in the final analysis as well as in spin-
off studies, it was found that women who started
North American Menopause Society: www.menopause.org
hormones have the exact molecular structure as
The Endocrine Society: www.endo-society.org
HT early in menopause (as opposed to the women
those made in the human body. All hormones
American College of Obstetricians and Gynecologists:
outside the human body have to be made in a
postmenopausal) actually tended to have a
Red Hot Mammas: http:///www.redhotmamas.org
laboratory/pharmaceutical setting (there are no
reduced risk of heart disease. The increased breast
natural occurring sources of estrogen or proges-
cancer risk was only 1:10,000 higher than that of
Jane B. Thiel, APRN, WHNP-BC is a nurse practi-
terone outside the human body) and are formu-
the placebo group and not considered statistically
tioner at Grand Rapids Women’s Health and has
lated to be metabolized exactly as the body would
been in practice for 33 years. She enjoys working
metabolize estrogen or progesterone from the
decreased risk of colon/rectal cancer, hip fracture
with women of all ages and many seek her out for
and new-onset diabetes among HT users. her experience in menopausal issues.
“More than most men am I dependent on sympathy to bring out the best that is in me.” Keeping One’s Own Counsel: Authorship, Literary Advice and New Grub Street In George Gissing’s 1891 novel New Grub Street, Whelpdale is a failed novelist who, in order to earn some money, begins giving advice to novice writers in London. His advertisement runs in The Study each week and rea
Prof. Dr. V. Mall Publikationsliste in print 1. Jung NH, Delvendahl I, Pechmann A, Gleich B, Gattinger N, Siebner HR, Mall V . Transcranial magnetic stimulation with a half-sine wave pulse elicits direction-specific effects in human motor cortex. BMC Neuroscience 2. Jung NH, Janzarik WG, Delvendahl I, Münchau A, Biscaldi M, Mainberger F, Bäumer T, Rauh R, Mall V . Impaired in