Bio-identical Hormone Replacement Therapy Part 2

Bio-identical Hormone Replacement Therapy Part 2

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Last week we talked about the Women’s Health Initiative Study from 2002 and Bio-identical Hormone Replacement therapy. This week we will talk about the WHI results from March 2004, depot provera and saliva tests for hormones.

On March 1, 2004 the National Institutes of Health (NIH) in the US informed study participants that they should stop study medications in the trial of conjugated equine estrogens (Premarin) versus placebo in the Women’s Health Initiative (WHI).

NIH informed participants, who now have an average age of almost 70 years and have been followed for approximately 7 years, that the current results show that estrogen alone does not appear to affect (either increase or decrease) coronary heart disease. At the same time, estrogen alone appears to increase the risk of stroke and decrease the risk of hip fracture, and does not increase the risk of breast cancer during the time period of this study. The current results indicate that the increased risk of stroke is similar to the found in the trial of Premarin and Provera (remember from last week that was an extra 8 women in 10,000 got strokes).

So why was the trial stopped early? This study was a primary prevention trial which means that they took otherwise healthy women and gave them premarin in the hope that they could find out how much improvement premarin could produce on things like heart disease. So, since after 7 years there was no improvement in heart disease and there was a slight increase in stroke, NIH believed the increase in stroke was not acceptable in a prevention trial.

If you remember the chart from last week, that there were small increases in risk of breast cancer, heart disease, and blood clots in the premarin and provera trial, but these reports of the premarin alone trial don’t show those increased risks. Is provera the real bad guy? Is there something else going on? The jury is still out.

To add further fuel to the fire that provera might be the bad guy, there was a Health Canada warning about the injectable form of provera (medroxyprogesterone acetate) recently. Depo-Provera is most often used as an injectable form of birth control. In November 2004 a warning was released that Depo-Provera may reduce women’s bone mineral density and thus increase their chance of broken bones due to osteoporosis. It is not proven, but it make you wonder about using medroxyprosterone acetate in older women for menopausal symptoms if the injection weakens bones of younger women.

Saliva testing for hormone levels is controversial. Not all doctors think they are worthwhile or give any useful information. Manitoba Health doesn’t pay for them. A five hormone test will cost about $200 if a woman wants to spit an special test tube and send it to Calgary based Rocky Mountain Analytical labs.

There are blood test for hormone levels that family doctors have access to, but some experts argue the levels that you get don’t co-relate very well with the symptoms very well. So, for example, a woman may have swollen and tender breasts – usually a sign of too much estrogen, but the blood hormone level is normal.

A bio-chemist, David Zava, in the US was using saliva testing to test for different herbal products and found saliva was a better fluid to check for hormone levels than blood. A medical doctor and bio-chemist, George Gillson, worked with Dr. Zava and then opened his own lab in Calgary, Rocky Mountain Analytical. He is the main promoter of saliva testing in Canada. The people who believe in saliva hormone testing are also usually quite pro bio-identical hormone replacement. The idea is that BHRT can be customized to just boost the hormones you need.

Where Can I Find Out More Information About Bio-identical Hormone Replacement?
To find out more about bio-identical hormone replacement therapy and the products that are available, talk to your family doctor or speak to one of the pharmacists at the Dauphin Clinic Pharmacy. One of the pharmacists can arrange an appointment with you (which we will charge for) to discuss your hormone questions.

Some places for more information:
http://www.sogc.medical.org/ The Society of Obstetricians and Gynaecologists of Canada
http://www.whi.org/ The Women’s Health Initiative
http://www.menopause.org/ The North American Menopause Society
http://www.rmalab.com/ Rocky Mountain Analytical Labs

As always if you have any questions or concerns about these or other products, ask your pharmacist.