Bioidentical Hormones

As a woman, unless you undergo the ‘instant menopause’ of a total hysterectomy, anticipate your own menopause transition in one of three ways. First, there’s “Menopause Heaven.” Your periods will lighten, become erratic, then stop altogether. A year goes by, and you’ll say, “Oh, so that was menopause. I wonder what everyone is complaining about.”

Then, there’s “Menopause ‘Pretty Typical’” same change in periods, with an occasional hot flash, a rare night sweat. No big deal. Herbs, like Gaia’s Black Cohosh or an herbal combination like Xymogen’s Menofem work nicely for this.

Lastly, you might cross the Styx and enter “Menopause Hell,” a veritable smorgasbord of physical and emotional misery. Heat waves course through your body all day and through the night, (you grab anything in sight to fan yourself), perspiration drips down the back of your neck and forehead, night sweats wake you despite having set your bedroom thermostat at “meat locker,” PMS mood swings disrupt your usual ebullience into chaos, and libido is a distant memory. 

Life in “Menopause Hell” is definitely unnecessary. Time to give serious thought to bio-identical hormone replacement therapy (BHRT).

Remember, we replace other hormones when we need them. Thyroid, adrenal, insulin are all hormones. Billboards encourage men to stay young with testosterone.

So what’s the problem with replacing your sex hormones, estrogen and progesterone?

Doubts about hormone replacement surfaced years ago after a study called the Women’s Health Initiative, concluded that hormones increased risks for breast cancer. A few years later, the conclusions were challenged because it turned out many women may have entered the study with undiagnosed breast cancer invalidating the numbers. Now, just about all doctors agree that hormones are safe when used appropriately, namely for relief of menopausal symptoms. In fact, a more recent study, which I wrote about several weeks ago, added that many women would benefit remaining on hormones their entire lives.

However, an increasing number of physicians, myself included, believe one of the overlooked risks of hormone replacement therapy relates to the source of the hormones themselves. The estrogen of Premarin and Prempro, number one prescribed hormone products, is extracted from the urine of a pregnant horse which Big Pharma deviously renames “conjugated equine estrogen,” ‘equine’ is, of course, Latin for horse. It’s not human estrogen, it’s horse piss, definitely not the same as human estrogen. 

If you’re going to restore sex hormone levels in a woman, common sense dictates to use hormones that are identical with hers, hence the term bioidentical hormones (‘biologically identical’). These are also called ‘natural’ hormones, since they are derived from plants such as soybean and wild yam, but ‘bio-identical’ is really a more exact description.

To the surprise of many women, ‘Premarin’ stands for ‘pregnant mare urine.’ And by the way, there is probably no product manufactured on Earth involving greater cruelty to animals than Premarin. Animal rights activists like PETA have been petitioning its manufacturer to come up with something more humane than impregnating and collecting the urine of 750,000 mares every year. But why should they bother?  Profits from Premarin and generic variations are in the billions.

Here’s why horse estrogen isn’t right for you. The human female estrogen consists of three separate molecules: estrone (10-20%), estradiol (10-20%) and estriol (60-80%). Premarin on the other hand, is mainly estrone (75%) and equilin (25%), the latter found only in horses. And considering the pharmaceutical company gets it from horse urine, and urine is a way to get rid of body wastes, then even the horse doesn’t want it! Although Premarin may ‘act’ like a replacement for human estrogen, just that fact that the estrone content is three times that found in women means the match is far from perfect. And equilin is a totally foreign molecule altogether.

In response to the increasing resistance of women to Premarin and Prempro, Big Pharma did introduce an “almost but not quite” bioidentical hormone in the form of a twice weekly skin patch, the Vivelle Dot, now available as a generic. This contains estradiol but no estriol or progesterone. Gynecologists will tell you the estriol isn’t needed but the progesterone is a “must” and will write you a prescription for progesterone capsules to be taken daily.

The current most common treatment for menopause being written both by gynecologists and primary care physicians are two separate prescriptions: one for  an estradiol patch and a second for progesterone capsules.  

Bioidentical hormone replacement therapy tries to replicate the hormonal milieu of “you” at about age 33 and in the process effectively relieve menopause symptoms a couple of weeks after starting them. Dose adjustment is easy: if the dose is too low, you’ll be reporting hot flashes; if too high, you’ll complain of breast tenderness; if just right, you’ll feel great.

Doctors like myself who prescribe bio-identical hormone therapy (BHRT) usually recommend  “Bi-Est”, estradiol + estriol (dropping the weakest one, estrone) and adding progesterone. Doctors may suggest a small amount of the male hormone testosterone to the mix. This can enhance the effect of the estrogen (without needing to increase the amount of estrogen) and have some beneficial effects on a faltering libido. BHRT is available either as capsules or as creams, applied to the forearm or thigh.

You can’t get BHRTs from Walgreen’s or CVS. They’re made expressly for you by any of the hundreds of compounding pharmacies throughout the United States and mailed to your home. The one sticking point is BHRTs are not covered by your health insurance although you can use your HSA (Health Savings Account) if you’ve got one. Most compounding pharmacies discount when you buy a three month supply.

Women frequently ask how long should they take BHRTs. My answer is that you can determine it for yourself. After two or three years, stop the hormones and see if your symptoms are gone. Remember, menopause is a transition, and for most women symptoms do eventually come to an end. If, after stopping your hormones, symptoms come surging back, restart your BHRT. Researchers do know that untreated hot flashes and night sweats at any age do increase a woman’s risks for heart attacks, strokes and dementia. Moreover, women who remain on their hormones have stronger bones, smoother skin, and overall “feel better.” I have many patients in their mid to late seventies who have no intention of ever stopping their BHRT. 

BHRT Ground Rules: you’ll need regular mammograms, you can’t have a history of either breast cancer or blood clots. I personally don’t prescribe BHRT for women who smoke cigarettes (smoking + hormones increases blood clot risks).We have been prescribing bioidentical hormones for thousands of women since we first opened in 1994. Just call and schedule an appointment with any of our practitioners. We’ll also give you an rx for a mammogram if you’re overdue.

We have been prescribing bioidentical hormones for thousands of women since we first opened in 1994. Just call and schedule an appointment with any of our practitioners. We’ll also give you an rx for a mammogram if you’re overdue.

Be well,

David Edelberg, MD

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