Health News / January 2007
Match Making Hormones
Many midlife women go through perimenopause and menopause experiencing an occasional hot flash as a minor annoyance and don’t seek over the counter or prescription remedies. For some, the hot flashes and night sweats are so severe they can’t sleep, resulting in daytime fatigue and anxiety that affects the quality of their lives.
“Natural” or herbal remedies like black cohosh or medically prescribed hormone replacement therapy have been the traditional options for the treatment of menopausal symptoms. But, the release five years ago of a major study linking hormone replacement therapy with increased risk of heart disease, breast cancer and other serious effects created a wave of confusion and concern about the topic.
One option increasingly explored by women is bioidentical replacement therapy. According to Kathy Carroll and Kimberly Holmes, owners and family nurse practitioners at Athena Health Center in Parkersburg, bioidentical hormones derived from plants have the same chemical and molecular structure as hormones produced in the human body and are chemically identical to those hormones already produced by the body.
The compounded bioidenticals are typically formulated and custom made by compounding pharmacies that specialize in such drugs to meet individual patient needs, like Loop Pharmacy in Teays Valley.
Traditional hormone therapy relies on patented estrogen or estrogen-progestin products made by pharmaceutical companies and approved by the FDA. The patentable synthetic hormones like Prempro and Premarin, are often made from equine estrogen.
Kathy says proponents of bioidentical hormone replacement therapy say the benefit of bioidentical hormones is that they are natural, and a woman’s body can metabolize them readily while synthetic hormones are quite strong and often produce undesirable side effects. Bioidentical hormones can be matched individually with a woman’s needs, something that can’t be done with mass produced products.
Erin Rudge, a compounding pharmacist at Loop Pharmacy since 1994 says the popularity of biodenticals has increased since the Women’s Health Initiative results were released. “Many women quit taking their prescribed hormones but their symptoms returned and they needed alternatives.”
She says, “Every woman must weigh the benefits and risks of any hormone replacement before making the decision. I’m not sure there’s a clear cut answer for everyone.” But Erin, who has been compounding bioidenticals for over ten years, says they may have fewer risks than synthetic ones because they can be given in smaller doses. Before prescribing bioidenticals, clients undergo tests to determine which, and how much, hormone they need. A physician’s prescription is still required. “The theory makes sense-replace only what is necessary for the individual patient, in the amount needed, and properly balance all the sex hormones, estrogen, progesterone, DHEA and testosterone.”
Not everyone in the medical community is convinced, saying they haven’t been clinically proved safe and effective since, unlike the rigorous testing performed on Prempro and Premarin, there have been no large-scale studies of their safety or effectiveness. Last year, the American Medical Association called for stricter regulation of the compounds.
At Athena Health Center, saliva and/or blood tests are performed taken to evaluate current hormone status. Each patient is monitored and tests repeated as needed to obtain symptom relief in the lowest possible dosage. Kimberly says, “Even though the word ‘natural’ is often used to describe bioidentical hormones, it is important for women to know they are drugs and must be used cautiously.” She says they don’t support the idea that bioidentical hormone therapy be used indefinitely. “It should be used in the lowest effective dose through the transition period in which a woman needs symptom management. Hormone therapy should only be initiated after a complete risk assessment.” She also recommends that dietary and lifestyle changes, along with medical grade nutritional supplements, be incorporated into each patient’s treatment plan.
Erin says, “Most women do really well with bioidentical hormones. Many of them have tried traditional treatments and had side effects or just gotten scared. It takes more time and patience to get the right dosage, but that is the beauty of BHT. It isn’t expensive, and it can be completely individualized, in pill form or even in a topical cream.”
Everyone agrees more research needs to be done on the effects of hormone replacement and the differences between synthetic hormones and bioidentical hormones need to be contrasted and compared. Still, nurse practitioners Kimberly and Kathy say they have observed bioidentical hormones are often better tolerated.
As a pharmacist, Erin says, “The theory behind it makes sense. But everyone has to weigh their own risks. It will take a while to figure out if bioidenticals truly are better for reducing the risks of hormone therapy.”
For more information, contact Athena Health Center in Parkersburg, 304-422-5600 or Loop Pharmacy in St. Albans, 304-727-2233.
Copyright © 2007 A Woman's View. All rights reserved.
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