Hormone therapy

Hormone therapy

By Susan Block
MD

Symptoms associated with menopause have been treated with estrogen and progesterone for many years. When I went into private practice in 1986, we had been taught that hormones given to postmenopausal women were protective. We prescribed them widely, like they were vitamins. If menses stopped, the next thing to do was to take hormone replacement therapy. We asked patients to let us know when their menses stopped so that we could administer hormone therapy promptly.

Today we have concerns about hormone therapy. The Women’s Health Initiative was a large study that collected data on the incidence of heart disease, stroke, cancer and bone fracture in women taking hormones as compared with women who did not take hormones in menopause. In 2002, a large portion of the study was discontinued because it appeared that women taking estrogen and progesterone were at increased risk for heart disease, stroke and breast cancer.

In 2002 many women went off of hormone therapy and many physicians stopped prescribing it. In the months that followed, many women found that they had symptoms of menopause that interfered with their lives. The consumer media began reporting on natural and bio-identical hormones. Claims surfaced of superior safety.

What are natural hormones?

“Natural” refers to the source of hormones. Natural hormones may not be bio-identical. Phyto-estrogens are naturally occurring estrogens found in soy products; they are plant derived. They are not structurally similar to human hormones and have weaker effects.

What are bio-identical hormones?

Hormones used in bio-identical products tend to be derived from soy and yam, are commercially processed to become bio-identical and therefore are not completely “natural.” Bio-identical hormone would be something that is very similar or the same as the hormone that the body makes. The term “bio-identical hormone therapy” is used to describe estrogen and progesterone that structurally resemble hormones produced in a woman’s body.

What about compounded hormones?

Compounded hormones are products prepared by a pharmacist specifically for an individual patient. Individual recipes are not FDA approved because they are not FDA tested for absorption, efficacy, purity, potency and consistency. There has not been scientific research lending evidence to the effects of the compounded products. They have not been studied in the same way as pharmaceutical preparations and there is no evidence that they are safer or have fewer side effects. Biochemical structure is similar and would presumably have similar effects and risks. Claims of improved safety are unfounded.

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Hormone use for menopausal symptoms is often warranted; however the risks and benefits need to be weighed and the lowest dose effective for a limited time interval is most appropriate. The concept of a completely “safe” hormone is not valid. Testing of hormone levels for prescription and monitoring of doses does not account for the unique genetic makeup of each woman and the estrogen receptor quantity on target tissue cells. Standard of care is to adjust hormone therapy based on clinical symptoms and response, not testing levels.

In summary, there is misconception that bio-identical hormone compounding offers more safety than standardized FDA approved hormones. Standardized bio-identical hormone therapy is available. There is confusion as to what is natural and whether or not natural means better. Consultation regarding hormone therapy as well as lifestyle alterations to reduce symptoms of menopause takes into account the different remedies available. Bio-identical hormone therapy can be appropriate when careful understanding is given to benefit, risks and side effects.

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