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

Breast cancer is perhaps the greatest fear of women when deciding whether to take hormones. The women in the WHI study who took estrogen alone in the form of Premarin (they had hysterectomies so didn't need the progesterone) did not have an increased risk of breast cancer.

Women taking the combination of estrogen and the synthetic progestin medroxyprogesterone (commonly called Provera) did have a small increased risk of breast cancer after five years of use. It may be that when it comes to breast cancer, the type of progesterone product and whether you take it in a cyclic or continuous way may be the most important factors. Research suggests that natural micronized progesterone (called Prometrium) is better for your health than synthetic progestin's (such as Provera) and best used cyclically (taking progesterone 10 days each month) rather than continuously (taking progesterone daily) to protect the uterus.

Most women who have had breast cancer should avoid hormones altogether, although occasionally their doctors agree they can try a small amount of vaginal estrogen cream or a tablet.

HRT May Help Some -- but It's No Cure-All

On the plus side, there is no question that estrogen is the most effective treatment for severe hot flashes, sleep disturbances and an annoyingly dry vagina. In an attempt to be fully transparent, I admit that I take a small dose of FDA-approved hormones in the form of a skin patch of natural estrogens changed twice a week and 10 days of natural micronized progesterone each month. Based on the evidence, I believe that I am protecting my heart, my bones and maybe even my brain, colon and eyes.

Unfortunately if libido is a problem, there is no good prescription testosterone for women. I would avoid taking any oral testosterone because of the risk of side effects -- and would prefer a cream or gel much like what the men already have available to them. I do think the proponents of bio-identical hormones prepared by a compounding pharmacy have it right that small amounts of natural testosterone (usually mixed in a cream and applied to the skin) for some women can be useful.

If you want to try some natural remedies for hot flashes, consider soy foods, such as fresh or frozen soybeans, soy milk and tofu (never soy supplements) and black cohosh, a traditional herbal remedy for hormonal problems.

What has been your experience with hormones? Have you tried both bio-identicals and the more traditionally pharmaceutical brands? What were the results?

I know there is so much more to say about hormones. I promise to write much more about hormones, the latest research and the continuing controversy in the weeks to come. As always, I welcome your questions and comments.

Dr. Marie Savard is an ABC News medical contributor. To learn more about Savard's health management system, download free forms and a sample letter to your doctor, visit http://www.drsavard.com and click on "Learn how to take charge of your health."

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