BIO-IDENTICAL HORMONE REPLACEMENT THERAPY
DEFINITION: Bio-identical Hormone Replacement Therapy (BHRT), also called Natural Hormone Therapy involves the prescription of hormones which are structurally identical to the hormones produced by the human body.
INTRODUCTION: A recent large scale trial, the Woman's
Health Initiative Study showed that a combination of
chemically modified hormones “Prempro,” increased
the risk of heart attack, stroke, blood clots in the veins,
and breast cancer. In reaction to this study, the
mainstream media churned out dire warnings that all
such hormone therapies are dangerous. The media,
and many mis-informed “experts,” ignored the fact
that these results occurred in women taking SYNTHETIC
HORMONES, which are PATENTED CHEMICAL ALTERATIONS of the body's natural hormone messengers. Television, radio, and newspaper reports made blanket assertions that all forms of hormone replacement therapy are risky. As a result, many women have been taken off of their hormones and are suffering with the symptoms of decreased post-menopausal hormone levels.
However, there is a safe and effective alternative: Natural, or bio-identical hormone therapy. By using natural hormones and following a program of periodic blood testing and careful clinical follow-up care, women can be treated with hormone regimens which are customized for each individual. Natural hormone therapy is effective, and can safely be used to restore the body's hormone balance. Bio-identical hormones are superior to the patented drug hormones because they are exact replicas of the hormones the body produces. They simply work better, with fewer side effects.
PATENTS AND PROFITS: Natural hormones are not patentable: What God made cannot be patented by the pharmaceutical industry. Bio-identical human hormones can easily be made from plant sources, including soy and wild yams. The resulting hormone molecules are structurally identical and indistinguishable from the hormones of the human body.
If a pharmaceutical company expects to make a profit in the development, marketing, and sale of a new drug, a patent is required. Then the company is awarded exclusive rights to produce and sell the product after gaining approval from the FDA (Food and Drug Administration). It's all about the profits.
Since natural, bio-identical hormones are not patentable, no pharmaceutical company will conduct a large controlled clinical trial to determine risks and benefits. Since these trials cost millions of dollars, they have not been done.
However, hundreds of small trials have been done over many years. Clinical experience in the hands of physicians in Canada, Europe and America has been uniformly favorable. All experience points to the conclusion that natural hormone therapy appears to be safe and effective. However, slight increases in risk for breast or uterine cancer, heart attack or stroke, or blood clots in veins remain a possibility.
THE COMPOUNDING PHARMACY: Pharmacies dispense medications. They count pills and put them in containers and dispense them to patients. Compounding pharmacies are different, for they prepare custom made prescriptions using pharmaceutical grade hormones and medicines. It is a return to the practice of collaboration and consultation between the physician and pharmacist.
THE HORMONES: Progesterone: Progesterone is produced
by the ovary after ovulation each month in young women.
As early as the early to mid thirties, ovulation may falter
intermittently. The resulting deficiency of progesterone
often results in premenstrual discomfort, night sweats
or hot flashes, and depression symptoms.
Supplementation with progesterone is often very helpful
in this situation. This hormone is also prescribed for post
menopausal women, as well. There is evidence that
progesterone supplementation may decrease the risk of
uterine fibroids, endometriosis, osteoporosis, and even breast cancer. Appropriate supplementation with progesterone often enhances the libido and even promotes weight loss.
Estriol, the Safest Estrogen: Estriol has been used for many years in Europe and in the United States. It is a very weak form of estrogen, and it seems to buffer or weaken the effect of the stronger estrogens, estradiol and estrone. It has been shown to have a protective effect against breast cancer, for example: In BHRT prescriptions, estriol comprises 50% to 90% of the total estrogen. (Dr. Hogan typically uses it as 80% of the dose). Even though estriol has weaker estrogenic effect than estradiol, it often provides adequate relief from the common menopausal symptoms. Using it allows the total estrogen load to be less than if estradiol was used alone. This would help to decrease the risks of excessive estrogen.
Estradiol: Addition of a small amount of the stronger estrogen, estradiol, to the hormone prescription provides additional relief of some of the most difficult symptoms. Using the 2 estrogens in combination allows us to keep the dose of potent estradiol as low as possible. Many women who have had a hysterectomy have been treated with estradiol alone. However, this is not advisable, as it is very potent at stimulating the breast cells. You also were never just an estrogen woman. To get your balance back we employ several ingredients working together. Many women after menopause actually have symptoms of relative estrogen excess. That is, the estrogen level may be lower than before menopause, but is excessive in relation to the totally absent level of progesterone. Estrogen dominance can cause symptoms that are undesirable.
Testosterone: Women have testosterone, too. The level of testosterone decreases with age, often resulting in decreasing strength and libido. Also, testosterone deficiency contributes to loss of bone mass. A deficiency of testosterone may also promote breast cancer. A study in 2003 found that testosterone inhibits breast cell growth. (About 80% of our BHRT prescriptions have a touch of testosterone).
DHEA (Dehydroepiandrosterone): DHEA is an adrenal hormone. Anti-aging benefit can be realized by the addition of small amounts of DHEA. Blood levels should be determined before prescribing DHEA. If the level is low, and if symptoms suggest a deficiency, addition of DHEA can be beneficial. Adding DHEA to the hormone mix often helps in maintaining and increasing muscle mass, decreasing body fat, improving libido, mood and stamina.
EVALUATION AND FOLLOW-UP: After the decision has been made to prescribe BHRT, we evaluate your blood tests. We recommend that you do your yearly exam here or with your home physician. Careful periodic follow-up evaluations, and periodic blood hormone level testing insures safety and effective treatment. Adjustments in the BHRT prescription can be made easily and customized for each woman. The aging process is difficult enough without having to deal with hot flashes, foggy thinking, dryness, and leaking. When accompanied by optimum nutrition and exercise, natural hormone therapy can be a great benefit for many women.
George Gillson, M.D., PhD., and Tracy Marsden BScPharm.: You've Hit Menopause, Now What?
Christiane Northrup, M.D.: The Wisdom of Menopause
Eldred Taylor, M.D., and Ava Bell Taylor, M.D.: Are Your Hormones Making You Sick?