Bio-identical Hormones. What’s the Hype?
Every year a larger and larger percentage of the female population is aging through menopause. Symptoms of menopause can seriously affect quality of life and women have many questions about safe therapies to use to help. Hormone therapy is one of the most misunderstood of these therapies and a topic of controversy that we are learning more and more doesn’t need to be.
A brief history of hormone replacement therapy (HRT)
A lot of doctors and women were given ample reason to be fearful of prescription hormones after a large scale study of hundreds of thousands of women called the Women’s Health Initiative (WHI) was prematurely stopped because women were dying from heart attacks, strokes and cancer. This was especially frightening to the medical community because it was initially believed that hormones would prevent all of these things! The WHI turned everything we knew about hormone treatments and their effects upside down and tens of thousands of women stopped using them after the results were published. But then women going through menopause who were suffering from concerns like chronic insomnia, debilitating hot flashes, memory loss, anxiety, depression and a host of other menopause-related symptoms didn’t know what to do because their most effective treatment was now potentially a killer.
Along came Bio-identical hormones (BHRT)
In the wake of the WHI alternatives to the widely used synthetic hormones made from horse urine became increasingly popular. These hormones are made from yams or soy and are structurally identical to the hormones we already have in our bodies hence, bio-identical. Celebrity endorsements of their use mainstreamed the movement for a safer yet just as effective alternative to synthetic HRT. Although there are no studies of the sheer scale of the WHI to compare to, many smaller good quality studies have revealed the safety and efficacy of BHRT. Clinically, doctors see the difference as well with fewer side effects reported and greater benefit. Drug companies have made two forms of BHRT estrogen and progesterone, but many doctors prefer compounding these medications to tailor the dosages to exactly the lowest effective dose for each patient. This is done at compounding pharmacies, which many traditional pharmacies are converting to because of the resurgence of demand in the individualized prescription market. Conventional doctors have trouble with the compounded drugs because studies have shown that concentrations of the medicine can change from batch to batch more frequently than the retail manufactured hormones, but greater standardization of purity and potency and quality control practices are changing this. Even with this potential challenge, many doctors choose to prescribe compounded BHRT because of the magnitude of benefit for most women. A prescription as simple as low dose progesterone cream from yams can resolve PMS or menopausal anxiety.
What have we learned since the Women’s Health Initiative?
Even though the study of giving women hormones ended in the early 2000s, participants were still followed afterwards and continue to be studied to this day. The follow-up study and analysis has put the original findings in context. What we know now is that there are three groups of women who were most negatively affected by hormone therapy in the WHI. Women who were ten years past menopause, in their 70s, or women who had already taken hormones for 5 years were most at risk of heart disease. Most other women benefited from replacement of hormones, which is why we are seeing a resurgence of doctors prescribing them again except this time the bio-identical versions. Doctors are keeping these new limits in mind when recommending BHRT. We use the rule of thumb – Give hormone therapy at the lowest effective dose for the shortest time at the time around a woman’s last period.
What about women who don’t want hormones?
Many women don’t want to take hormones. For them the array of treatment modalities is wide. Acupuncture, chiropractic, botanical medicine, traditional Chinese medicine and nutrition and are all valid and effective means to support women through menopause. They can also be used in conjunction with hormone therapy to help wean off sooner for those women who only find resolution of symptoms by taking BHRT. Whichever treatment method it is important to work closely with a clinician and together decide what is best for you.
Dr. Bobby Parmar ND
