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Bio-Identical Hormones: FAQ
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Bio-Identical Hormones: FAQ
There has been a lot of buzz in the news recently about bio-identical hormone replacement therapy (BHRT). Women, prompted by great media hype and celebrity endorsement, are using BHRT in place of conventional therapy. The following Q & A discussion is presented in a effort to provide balanced information.
What are bio-identical hormones?
Why use bio-identical hormones?
Are bio-identical hormones "natural"?
Are bio-identical hormones safer?
Is bio-identical progesterone safe?
Do drug companies make bio-identical hormones?
What are bio-identical hormones?
Bio-identical hormones are hormones that have exactly the same chemical structure as those produced by the human body. Compounding pharmacies, upon receipt of prescriptions from doctors willing to use BHRT, formulate BHRT using three estrogens, progesterone and sometimes testosterone. The three estrogens incorporated into BHRT formulas are estrone (E1), estradiol (E2), and estriol (E3). Estrone is about 1/3 as potent as Estradiol; estriol is about 1/5 as potent. Typically, bio-identical estrogen formulations are at least 80% estriol.
Why use bio-identical hormone replacement therapy?
The concept behind bio-identical hormone replacement is logical and based upon copying nature. The type, dose, route, and timing of hormone administration is designed to mimic a woman's body before menopause. Dosages are lower than conventional HRT, and are targeted to produce blood levels that mimic the lower end of the range typically found in young, healthy pre-menopausal women. Doctors who prescribe bio-identical HRT typically watch blood or urine levels carefully so as not to overshoot targets. Careful monitoring, flexibility in dosages and lower dosages are advantages of bio-identical HRT.
Are bio-identical hormones "natural hormones"?
No, they are not "natural" - rather they are made in laboratories by synthetic methods.
Are bio-identical hormones safer?
There is no good evidence to believe that bio-identical hormones are safer. Doctors with years of experience using BHRT believe they are safer, but there are no large, well designed clinical trials to verify the claim. Women who decide to use bio-identical hormone therapy should do so with their eyes open. Regular checkups, mammograms, self examination are as important as ever. Do not be lulled into complacency. If you are using progesterone and/or testosterone, in addition to estrogen, keep tabs on your blood pressure and cholesterol levels.
Observational studies of women that look at the number of years a woman mestruates and relate the data to breast cancer risk shed light on the issue of safety. Women who begin menstruation earlier in life and/or go through menopause later than the norm have a higher risk for breast cancer. In other words, women who have more menstrual cycles in their lifetime and therefore experience a longer time exposed to their own, bio-identical estrogen are at greater risk for breast cancer than those who had fewer menstrual cycles during their lifetime. Based on this information, it is prudent to assume that all types of HRT carry breast cancer risk.
Is bio-identical progesterone safe?
Bio-identical progesterone is a better choice than progestin, which is chemically altered progesterone. Progestins, such as medroxyprogesterone, cause fluid retention and may interfere with the metabolism of other steroid hormones, especially cortisol.
In the Women's Health Initiative Trial, the arm that took Prempro (a combination of medroxyprogesterone and conjugated equine estrogen) had a higher risk of breast cancer compared to placebo. The arm that took Premarin alone (no progestin) did not show an increased risk of breast cancer. The Premarin alone arm showed a slighter lower risk than placebo. Scientists surmise that progestin increases the blood supply to small, microscopic cancer tumors, allowing them to grow. Bio-identical progesterone has the same effect on breast tissue, so there is no reason to assume it is safer than progestins in regard to breast cancer.
Exposure to daily doses of medroxyprogesterone in the Prempro arm of the Women's Health Initiative study may be the reason why there was an increase in breast cancer. In pre-menopausal women, maximum progesterone exposure occurs for about 10 days out of the month.
Do drug companies provide bio-identical hormones?
Yes, drug companies provide bio-identical hormones and have done so for decades. Estrace® is a brand name for bio-identical estradiol (E2) and is available as oral, vaginal and topical products. The "patch" is estradiol and made in a variety of strengths under various brand names. The newer, ultra-low dose patch (0.014 mg/da) was recently shown to increase bone density in older women without any adverse effects on cognition. Estradiol is also available as a vaginal cream and a vaginal ring.
Resources:
1) Study Challenges Tie of Estrogen Use to Breast Cancer, WSJ, April 12, 2006
2) Drug Topics, May 2, 2005; What is bio-identical HRT and is there evidence to support its use?
3) Rethinking Hormones, Again; NYT January 31, 2006
4) Hormones and Cancer: NYT December 26, 2006
5) Jonathan Wright, MD Bio-Identical Steroid Hormone Replacement - Selected Observations from 23 Years of Clinical and Laboratory Practice. Ann NY Acad Sci 1057: 506 - 524 Dec. 2005
6) Effects of Ultra-Low-Dose Transdermal Estradiol on Cognition and Health Related Quality of Life Arch Neurol 2006; 63: 945 - 950
7) Breast cancer risk factors and second primary malignancies among women with breast cancer. Breast Cancer Res Treat Dec 21, 2006
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+These have not been evaluated by the Food and Drug Administration. They are not intended to diagnose, treat, cure or prevent any disease. This newsletter is for information purposes only, and is not medical advise or prescription. Consult your physician if you are having a health problem.
