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.

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 and click on “Learn how to take charge of your health.”

Go to the Ask Dr. Marie Home Page | Dr. Marie's Home Page

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  10. Renee Olson Says:

    I have been on Estratest since 1990 due to removal of uterus and overies in 1986. I am now 60 yrs old. In Sept. of 06 I was dx with DCIS Stage 0. After much consideration I had a left breast mastectomy (no lymph note removal) and immediate recon with right breast augmentation from an A cup to a D cup. I actually wanted to have larger breasts anyway. Then I saw my oncologist and they ripped my hormones away. I said ok, no problem I will give it a try. Within one year, my joints degenerated so badly I was taken in for spine surgery. My hands and feet deformed and swelled so bad they thought I had RA. My vagina and labia were so dry I asked my dr. to cut my labia off. I had no feeling in my clitoris, could not orgasm, and trying to get a penis in my vagina was like someone turning on a blow torch in there not to mention I was repulsed with the idea of sex and men. It was horrible. I had boyfriends always younger guys from the gym and was multi orgasmic. I had no energy and laid in bed all day and cried over the dispair I was in. My face wrinkled and I turned ugly, my nose grew and my long curly hair went brittle and thin. I had continuous dry eye infections and eczema grew all over my legs. Each time I went to my oncologist they said you will get use to the changes, but my life only got worse and I contemplated ending my life because I had nothing of what I was or what I lived for. I couldn’t return to my job in law enforcement because of my spine surgery and mental dysfunction. …..- Going back to two months of who I was before dx of breast cancer: At 58 I was turning competative body builder. I loved lifting weights and I was pretty and looked 15 yrs younger than I am. I had an 18 percent body fat and would squat 100 reps with 80 lbs. After a year without my hormones, I lost all my muscle, fat emploded within my belly, on my hips, on my thighs and my hands were so disjointed and swollen I couldn’t hold my car keys. I didn’t care if my garden died, yelled at and hated people and had violent rages of anger. I went to dr. after dr. asking for help saying look at me what can you do?? Tried alot of drugs, antidepressents, anti inflammatories, sleeping pills, vaginal supportories, you name it. Nothing worked. About a year and half later my estrogen levels were below 10 (which is low) and I thought the only difference between me right now and me being dead is that I’m not in a coffin. I rolled myself out of bed went to my medicine cabinet and pulled out my bottle of Estratest. I started taking my hormones again and within three days I realized I could never go back into that black hole ever again. Fortunately one of the doctor’s who knew me before was fine with prescribing me hormones. He said, Renee you are only a shell of a woman I once knew. Hormones don’t cause breast cancer. When you walked into a room you use to have presence about you, an essence that people loved. Now you are slumped over, there is no light in you eyes. I told him all I had been through especially with the immediate advancement of degenerative disc disease that came on so rapidly from being thrown into immediate menopause. My disc degeneration and deformed hands and feet can never be returned to how they were before, but I have been on HRT now again for about 6 months and I don’t have the pain in them, my hair has started growing again, the ezcema is completely gone, so are the eye infections, bladder and vaginal infections, I have energy enough to start training. I will never go off again. I had the best and strongest weight lifting session yesterday since before the breast cancer. Do I fear getting another one cancer? There is no history on either side of my family, I have never been overweight, ate organic, maybe had a drink on special occasions. But I had a lot of stress in my life. The way I see it, is since I see an oncologist quite often, have an MRI once a year, if there is something there, it will be caught early as was the other brease cancer. I know I am a lucky woman having been deligent since I was forty getting mamograms… or was it the mamogram that caused the cancer. No one knows. Even though I AM trying to keep my hormone replacement as low as possible, I will never go off them again!! Can’t wait to meet another younger man and get back to my life! That’s my hormone story and I am sure Ileft out half of the symptoms I had since I don’t have them anymore and don’t need to. :)

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