Bio-identical Hormone Replacement Therapy Part 1

Bio-identical Hormone Replacement Therapy Part 1

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.

I have been getting a lot of calls lately about Bio-Identical Hormone Replacement Therapy. People are reading books by Dr. John Lee, Dr. Christine Northrup, and Suzanne Sommers all talking about Bio-Identical Hormone Therapy (BHRT). What is it? Does it work? Aren’t all hormones going to kill me? This week we will talk about BHRT, and the Women’s Health Initiative Study from July 2002 that scared everyone about hormones. Next week, we’ll talk about saliva test for hormones and the new revelations from the WHI study.

Let’s go back to July 2002. A bunch of scientists went on TV, newspapers, radio etc and announced that there was a 26% increased risk in breast cancer and a 29% increased risk in heart attack for women on premarin and provera and their study was stopped because of such a terrible result. Women were scared. The media jumped all over this story. Many women threw their hormone replacement therapy (HRT) in the garbage. Now, almost 3 years later, women are having hot flashes, night sweats, and not sleeping, but are too scared and confused to get treated. What can be done?

First, let’s talk about the original study. It only looked at women on one specific kind of HRT. They were on premarin or conjugated equine estrogen (CEE) 0.625 mg and provera or medroxyprogesterone actetate (MPA) 2.5mg once daily. So these results do not apply to other types of HRT. Also, the risk in the media was blown way out of proportion. As you can see in the following table only 8 more women than normal out of 10,000 will develop breast cancer. That isn’t much when you consider that consuming alcohol 2 or more drinks a day or exercising less than 4 hours per week have each been reported to increase the risk of breast cancer by 60%.

Outcomes
If 10,000 women took placebo for 1 year how many would get the outcome?
If 10,000 women took premarin 0.625mg and provera 2.5 mg for 1 year how many would get the outcome?
How many more or less women in 10,000 would get the outcome.
Invasive Breast Cancer
30
38
8 more women with breast cancer
Coronary Heart Disease
30
37
7 more women with heart attacks
Stroke
21
29
8 more women with strokes
Blood Clots
16
34
18 more women with blood clots
Hip Fracture
15
10
5 fewer women with hip fracture
Colorectal Cancer
16
10
6 fewer women with colorectal cancer

So after you and your doctor have a discussion, the two of you may quite logically conclude that an 8 in 10,000 risk of breast cancer is acceptable weighed against the benefit of being able to sleep at night.

One of the alternatives to premarin and provera is called Bio-identical Hormone Replacement or BHRT. The ultimate goal of Bio-identical hormone replacement therapy is to imitate, as close as possible, the hormones that are naturally produced by the human body. Bio-identical hormone replacement uses molecules which are taken from yam or soy plants and are then modified so that their structure matches the hormone(s) which are produced by the human body. Bio-identical hormone replacement therapy has also been referred to as natural hormone replacement therapy or native hormone replacement therapy. This causes some confusion because people often associate different meanings with these different names. Bio-identical hormone replacement therapy does not refer to grinding up leaves and plants to make products, nor does it refer to using herbal/natural products such as soy supplements, black cohosh, or yam isoflavones. Bio-identical hormone replacement therapy products are made using pure chemicals purchased from an FDA approved chemical supplier. There are two major classes of hormones which are used in bio-identical hormone replacement therapy; estrogens and progesterone.
· Bio-identical Estrogens
There are three major estrogens that are produced by the human body namely estrone, estradiol, and estriol. Bio-identical forms of these estrogens can be made into products containing one estrogen alone or a combination of estrogens.
· Bio-identical Progesterone
The human body produces progesterone. Progesterone is used in bio-identical hormone replacement products. Some confusion arises because the words progesterone and progestin have sometimes been used interchangeably, but in fact they are different molecules and have some different effects in the body.

How Do I Get Started Using Bio-identical Hormone Replacement Therapy?
Bio-identical hormone replacement therapy products require consultation and a prescription from your family doctor who will prescribe a dose and combination that is right for you and your particular symptoms. As well, a pharmacist at the Dauphin Clinic Pharmacy can book an appointment with you to discuss bio-identical hormone replacement therapy. During this consultation the pharmacist will discuss a symptom checklist, a health questionnaire, and answer as many questions as possible that you may have about bio-identical hormone replacement therapy. A summary of what was discussed during the consultation, as well as any recommendations that the pharmacist may have regarding therapy, will be sent to your family doctor. Since most bio-identical hormone replacement therapy products are not available as commercial products, a compounding pharmacy must prepare these products. Dauphin Clinic Pharmacy is a compounding pharmacy and can prepare bio-identical hormone replacement products.

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