Cross-posted Excerpts from The Los Angeles Times
Written by CHRIS WOOLSTON, Special to the Los Angeles Times | June 7, 2010
When a woman stops making estrogen, her body notices. Hot flashes, night sweats, moodiness, foggy thinking — all can be part of the menopausal package.
At first blush, the solution seems obvious: Take extra hormones, and the symptoms of menopause should vanish. Over the decades, millions of women have taken some form of hormone therapy to relieve symptoms of menopause or to prevent the bone-thinning disease osteoporosis. The treatment typically included Premarin, estrogen isolated from the urine of pregnant mares, combined with Provera, a synthetic version of the hormone progesterone.
But when a six-year study of more than 16,600 postmenopausal women that was part of the Women’s Health Initiative found that the combination of Premarin and Provera seemed to increase the risk of breast cancer, stroke and heart disease, doctors and patients suddenly had to consider other options.
Soon after the WHI made headlines, some pharmacies, alternative health clinics and a few outspoken doctors started heavily promoting so-called “bioidentical hormones” for the treatment of menopausal symptoms. Unlike Premarin or Provera, bioidentical hormones — which are produced in laboratories using yam and soy phytoestrogens as a starting point — exactly match the hormone made by human ovaries.
The Food and Drug Administration has approved several prescription-only drugs that contain bioidentical hormones, including Estrace pills, Estrasorb topical cream and the Alora patch. But many health clinics and pharmacies also sell non-approved creams that contain bioidentical estrogen and/or progesterone. These creams are often custom-made — or “compounded” — for each patient, sometimes based on the results of a saliva test that measures a woman’s hormone levels.
The Bottom Line
Bioidentical hormones have an obvious appeal to women seeking relief for menopausal symptoms, says Dr. Nanette Santoro, chair of the department of obstetrics and gynecology at the University of Colorado Health Sciences Center in Denver and vice president of clinical science for the Endocrine Society. After all, it just seems to make sense that anything that exactly mimics a woman’s own hormones must be better than mare’s urine or a man-made compound that doesn’t exist in nature.
But Santoro says there is no proof that bioidentical hormones are any safer or more effective than traditional treatments. “All of the evidence that we have suggests that all of these hormones should be painted with the same brush,” she says.
She has many concerns about bioidentical hormones that don’t have FDA approval. For one thing, she says, it’s impossible to know if unapproved creams have the promised amounts of hormones. “I’ve seen patients on these compounds actually losing bone mass because they were getting an insufficient dosage,” she says. “Why take that chance?”
Dr. Cynthia Stuenkel, clinical professor of medicine at UC San Diego and president of the North American Menopause Society, shares this concern. “Some progesterone creams may contain little or no progesterone, while others contain so much that they definitely should be available only with a prescription,” she says.
Taking hormones without the careful guidance of a doctor is risky business, Stuenkel says. Among other things, too many hormones can potentially cause blood clots and endometrial hyperplasia, a precursor to uterine cancer. Read full article >>
