Ask Dr. Marie: The Skinny on Bio-Identical Hormones

The results of the Women's Health Initiative study in 2002 suggesting that the risks of hormones may outweigh the benefits had millions of women stopping their hormones overnight. And just as quickly, hot flashes returned, thermostat settings were lowered, and bedcovers were thrown off in homes everywhere.

Yet two recent segments on "The Oprah Winfrey Show" touting the benefits of hormones have women scrambling to get prescriptions again from their doctors. The hormones Oprah's guests were applauding, called bio-identicals, are shelved under "natural" menopausal hormones and are often made to order and compounded at a pharmacy.

So can the body tell the difference? Are some hormones safe and others not?

Getting to the Bottom of Bio-Identicals

I am intrigued by the interest in bio-identicals, and I find myself asking if there is something special about hormones that are made in the laboratory from plants and compounded by a pharmacy. Or is it the laying on of the pharmacist's hands, by personally mixing the hormone mixture, that makes the difference, much like physicians did less than a century ago?

Or is it the good feeling that comes from believing the cream is being made "just for you" to match your hormones precisely that maybe makes a difference?

Doctors who prescribe bio-identicals often rely on a sample of saliva to estimate the amount of hormone needed -- but in truth, saliva levels and even blood tests for hormones are notoriously unreliable. Not to mention that the quality and dose of a product that is not regulated in any way and made by each individual pharmacy may differ tremendously.

I suspect that women who get great results from bio-identicals are probably benefiting from the transdermal route (any cream applied to the skin is transdermal). I believe this route may be safer than pills because the medicine bypasses the liver.

Their popularity may also be helped by the addition of testosterone to the mixture. After all, most doctor prescribed regimens of hormone replacement therapy do not include testosterone, whereas the bio-identical hormones usually do. Who wouldn't feel better after menopause -- when testosterone levels fall -- with a little testosterone, the hormone of better energy, well-being and heightened sexual desire?

The Truth About HRT

The headlines about HRT have been confusing, but the most recent evidence shows that there can be great benefit from hormones -- at least in the short term -- and that the risks vary significantly for women in different situations. In other words, there isn't a one-size-fits-all answer. A number of studies looking at timing of hormones, dose and method of delivery helps us get a handle on what is best.

Bear in mind that the WHI study examined women who were, on average, 63 years old when they began taking hormones and were mostly overweight or obese -- and therefore likely already had the beginnings of heart disease. They were also not experiencing severe symptoms of menopause, such as hot flashes, and they had not taken hormones in the past 10 years or more; indeed, many had never taken hormones at all.

So the research that led so many women to stop taking estrogen overnight probably did not apply to many younger, healthy women who were taking hormones to treat their sleep disturbance, hot flashes and dry vaginas. But they didn't hear that message from their doctors -- and certainly not from the media at first.

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