Bio-identical Hormone Replacement Therapy

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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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.

If Oprah Winfrey says it, then it must be true. The most powerful woman in America sure can generate interest in something. You see I seem to be fielding a lot of questions lately about “Natural Hormones”, or “Bio-Identical Hormones”. I was wondering why until one of our pharmacy staff, Patti McDill, told me these menopause treatments were featured on Oprah’s talk show. So what is Oprah talking about? Follow me back about seven years.

Let’s go back to July 2002. The Women’s Health Initiative Study, or WHI was being released. 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 7 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. The study was very well done and designed. However, it only looked at women on premarin and provera. So these results do not necessarily apply to other types of HRT. Also, the risk in the media was blown way out of proportion. For example only 8 more women than normal out of 10,000 on HRT will develop breast cancer. That isn’t much when you consider that consuming 2 or more alcoholic drinks a day or exercising less than 4 hours per week have each been reported to increase the risk of breast cancer to ~35 out of 10,000 women.

What I’m trying to say is that premarin and provera aren’t necessarily evil. I think women were scared unnecessarily away from a treatment that helped many women. 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. Your doctor will probably also recommend that you stay on the premarin and provera for 5 years or less. This is because the harm risks increase after 5 years. However, some women may decide to stay on premarin and provera longer. The risk of breast cancer only goes up to ~25 out of 10,000 women after 15 years on premarin and provera. That is still lower than the risk from drinking and not exercising.

What are alternatives to premarin and provera? One popular, non-hormone, alternative is anti-depressants. No, I’m not saying all menopausal women are depressed. I’m saying that anti-depressants like effexor do a nice job of controlling hot flashes and night sweats in some women.

Oprah wasn’t talking about premarin, provera, or antidepressants, though. She was talking about Natural or Bio-Identical Hormones compounded at a specialty pharmacy like the Dauphin Clinic Pharmacy. The ultimate goal of Bio-identical hormone replacement is to imitate, as closely as possible, the hormones that are naturally produced by the human body. Bio-identical hormone replacement therapy has also been referred to as natural hormone replacement therapy. The word “Natural” causes some confusion, so I try to avoid it. Bio-identical hormone replacement therapy does not refer to grinding up leaves and plants to make products. It does not refer to using herbal/natural products such as soy supplements, black cohosh, or yam isoflavones. 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. There are three major classes of hormones which are used in bio-identical hormone replacement therapy; estrogens, progesterone, and testosterone.

How Do I Get Started Using Bio-identical Hormone Replacement Therapy?
Bio-identical hormone replacement therapy products require a prescription from your family doctor. If you and your physician wish, a pharmacist at the Dauphin Clinic Pharmacy can book an appointment with you to discuss bio-identical hormone replacement therapy and make treatment recommendations. Your Dauphin Clinic Pharmacy pharmacist can also discuss Saliva Hormone Testing, which is a whole topic unto itself.

One of the nice things about having your hormone therapy compounded is that it will be customized for you. Maybe you prefer a cream to a pill. Maybe you need an “in-between” dose that isn’t commercially available. Those are all things that can be compounded.

The last thing I want to discuss is the safety of compounded hormone treatments. Despite what Oprah, Suzanne Sommers and other celebrities claim, no hormone treatments are 100% safe. We do have some theoretical reasons to think the compounded hormones are safer than premarin and provera, but the studies haven’t been done to prove that. We have to assume all hormone treatments have the same 8 out of 10,000 risk of breast cancer. We have to assume all hormone treatment should be used for 5 years or less because the Women’s Health Initiative study is still the biggest, best study done on the subject. The only reason to choose compounded hormones over commercially available ones is your find them more convenient (e.g. cream over capsules) or the compounded hormones treat your symptoms better. We have no evidence that compounded hormones are safer than commercial ones.

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