bio-identical hormones
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Mon Jul 20, 2009 6:01 am

Is anyone using bio-identical hormones? If so what is your experience with them and what do you use?

free skin care · Mon Jul 20, 2009 6:41 am

Hello,
I don't use "bio-identical" hormones but I thought I'd chip in (since I feel quite strongly about the subject!).

"Bio-identical" is a marketing term really with no scientific support behind it and in fact the FDA has been warning compounding pharmacies over and over to stop using the term since it's misleading.

There is no conclusive evidence showing the safety of these compounds and in fact, there's nothing that points out to the fact that they would do anything different than conventional HRT.

Given the disastrous results of the WHI trial which revealed that women taking HRT had a higher incidence of stroke, heart attack and breast cancer, I would never, ever ever take any product containing any form of estrogen.

This is, btw, just my humble opinion!

free skin care · Mon Jul 20, 2009 6:55 am

If supplementing with any form of estrogen (even topically?) carries serious health risks, what are the current recommendations for countering the ill effects of perimenopause and menopause ? - or - is each symptom treated differently?

Thanks, BF

free skin care · Mon Jul 20, 2009 7:29 am

Barefootgirl wrote:

If supplementing with any form of estrogen (even topically?) carries serious health risks, what are the current recommendations for countering the ill effects of perimenopause and menopause ? - or - is each symptom treated differently?

Thanks, BF

Yeah, each symptom is treated separately.

Every woman should be given guidelines for osteoporosis prevention before menopause. Also you would do a risk assessment (many doctors are using FRAX for that) and base the treatment (or prevention) on that. You would do something similar with cardiovascular risk factors.

The rest, you really work based on what the woman is experiencing, and provide treatment on a case-by-case basis.

HTH!

free skin care · Mon Jul 20, 2009 8:02 am

arym - Antonia is using bioidentical hormones and is in great favor. I have been researching this option myself - Suzanne Somers endorses these in her books as an alternative to other types of menopausal options.
You need to find a compounding pharmacist who is knowledgable and a doc who is on top of things.
Antonia is taking estriol which is extrememly low level estrogen as part of her program.

As for osteoporosis - there are some risk factors you cannot change. Small frame, caucasian...
I had a dex scan (full body bone scan) and found out my weak spots. I exercise daily, do not smoke and eat well but still know that my hips are vulnerable. For me the best option is taking care of myself and being aware of potential risks for hip breaks and monitoring my bone structure. Many will break a hip and then fall VS the other way around.
If doing a mild course of bio-identical hormones will help me, then I'm all for it.

I believe the reason they are known as bio-identical is because they are closer to the persons regular body chemistry Vs taking horse urine, etc. (premarin).

free skin care · Tue Jul 21, 2009 5:22 am

I use the vivelle dot which is a transdermal patch...it's about the size of a stamp and I really like it...it bypasses the liver...I tried giving up all hormones after a complete hysterectomy but felt about 85 years old...it's a regular formulary drug which I hope becomes available in a generic soon ...HTH

Mary

Tue Jul 21, 2009 6:38 am

Josee- Thank you for your reply. Have you done any reading on bio-identical hormones? Your opinion sounds like maybe you haven't. Check out Women's Health Connection atwww.womenshealthconnection.com. They sent me allot of info. You said that the term bio- identical was a marketing term, that's wrong. Bio-identical hormones are identical in chemical structure as the hormones we produce naturally. Of course they are still hormones and must be used cautiously, but from what I've read they are safer than synthectic hormones produce in a lab and controlled by a drug company for profit which does not match up to the molecular structure of the hormones Mother Nature has given me.

My doctor has recently put me on Tri-est along with progesterone and testosterone cream to balance my hormones and to treat osteoporosis.

The dosages are low and he will be monitoring my levels. My gyn wanted to put me on vivelle dot and a progestrone pill but I was concerned about future liver problems and I wanted dosages to be low. Creams do not pass the blood barrier so therefore side effects are low.

I want to know if anyone has been taking bio-identical hormones for years and their experiences with them good or bad. Also, what method used-oral, cream or patch?

It makes sense to me that we should replace what has been lost so that we can we can avoid some of the negative health issues women accept as natural as we get older. This will not turn back the clock but if I can do anything within reason to look and feel good than I'm willing to try it. Of course I will do my research first before I make a decision.

I hope you look into this and keep an open mind.

I'm still learning and always searching for answers and I don't accept the first answer.

Again, thanks for your reply and I hope that many women respond with opinions and experiences in this controversial subject which effects all of us.

free skin care · Tue Jul 21, 2009 9:09 am

arym wrote:

Josee- Thank you for your reply. Have you done any reading on bio-identical hormones? Your opinion sounds like maybe you haven't. Check out Women's Health Connection atwww.womenshealthconnection.com. They sent me allot of info. You said that the term bio- identical was a marketing term, that's wrong. Bio-identical hormones are identical in chemical structure as the hormones we produce naturally

Hello arym,
I actually have read quite a big about them. I am an OBGYN and although now I'm working on high-risk obstetrics, I did a Menopause fellowship at Mass. General and was actually involved in the secondary analysis of WHI. So I would say that I know more about menopause and HRT than the average OBYGYN.

What I meant by "marketing strategy" was not something that I said, but the FDA has said. I did not mean that they're not identical in structure, but what I mean is that the term "bioidentical hormones" is used to imply that this hormones are "natural" and hence safer and that is simply not true.

There is absolutely no proper research done on the long-term safety of "bioidentical hormones" and there is no indication of why they should be any safer than nonbioidentical hormones. Non-bioidential hormones are not safe not due to them being "non-bioidentical" but simply due to their estrogenic effect, which is the same thing that the "bioidential hormones" do.
In fact this was pointed out in a press release of the ACOG (The American College of Obstetricians and Gynecologists, the association that groups all the OBGYNs in North America). You can check the press release here:
http://www.acog.org/from_home/publications/press_releases/nr02-03-09.cfm

The ACOG states:

"More recently, the US Food and Drug Administration (FDA) issued warning letters in 2008 to several pharmacies in the US that make compounded bioidentical hormones. Some of these pharmacies claimed that compounded hormones were superior to FDA-approved hormone therapies and that they also prevented or treated serious diseases, such as Alzheimer's disease, stroke, and various cancers. The FDA stated that the pharmacies' claims of safety and effectiveness were false, misleading, and a violation of federal law."

"Despite celebrity testimonials touting scientifically unfounded benefits of compounded bioidentical hormones, the bottom line is that most have not undergone rigorous clinical testing for safety or efficacy, nor are they approved by the FDA."

The only advantage that "bioidentical hormones" do is that you can monitor the hormone levels more precisely but in reality no one knows what level is the adequate one.

WHI was a large, multi-center RCT that evaluated the effects of HRT on different outcomes. The results of the WHI trial were so clear that the trial was stopped before its time because it was not considered ethical or safe for women to still be randomized to HRT when there was an increase in breast cancer, heart disease, and stroke (among others).

After the results of WHI, the ACOG (the american college of obstetricians and gynecologists) changed their recommendations on HRT.

These recommendations called for physicians to VERY carefully weight the risks vs. benefits of using HRT (be it bioidentical or not). Right now the ACOG guidelines do not recommend giving hormones for osteoporosis prevention since the risks do not outweight the benefits. This is in light of the fact that there are a lot of non-hormonal treatments for osteoporosis that have proven effective and safe. Only in certain risk groups it might be considered.

The major recommendation for HRT nowadays is for women that have hot flushes and night sweats that have not responded to other therapies and are severe enough to significantly alter the patient's quality of life. In that case the ACOG recommends the minimum dose and for the shortest possible time. The FDA has also recommended that HRT be given only to women with SEVERE symptoms (e.g. severe hot flushes) and for a very short time.

The other recommendation is also for vaginal dryness, although most patients do well with just a regular lubricant.

arym wrote:

Creams do not pass the blood barrier so therefore side effects are low.

Hormones given in a cream vehicle DO make it to the blood stream. Usually though since the dosage is low they do not reach enough concentration to cause systemic effects.

arym wrote:

It makes sense to me that we should replace what has been lost so that we can we can avoid some of the negative health issues women accept as natural as we get older.

Yes, it would make sense if it had no adverse effects. I have women that have come to me and asked me to put them on HRT because their friend is on HRT and "her skin looks so nice!".
Personally, I don't prescribe HRT so that the patient can have a nicer skin and most of my colleagues won't either. The risks just do not outweight the benefits. It is usually doctors who are less knowledgeable on HRT and their side effects that are more "HRT friendly".

BTW, I am by no means giving professional advice; I'm simply sharing knowledge like everyone else.

If I were to go to a doctor for perimenopausal or menopausal symptoms I would definitely ask:

a. What are his/her qualifications on HRT, did he/she do any fellowship in Menopause?

b. Why would he/she prescribe HRT for osteoporosis when it's not recommended by the ACOG. Why can't we try different non-hormonal treatments.

c. What is he/she trying to accomplish with HRT? And why does he/she think that the risks outweight the benefits.

I hope this helps anyone out there.

Josee

free skin care · Tue Jul 21, 2009 9:27 am

Here are some useful resources:

From the FDA: "Bioidenticals: sorting myths from facts"

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm

National Institute on Aging: "Hormones and menopause"

http://www.nia.nih.gov/HealthInformation/Publications/hormones.htm

NIH/US Deparment of health and human services: "Menopause and menopause treatments"

http://www.womenshealth.gov/faq/menopause-treatment.pdf

BTW I forgot to say that in the end it's everyone's personal choice. I know women who take hormones to look better, others because the hot flushes really affect them, others for other reasons, etc. Each one is empowered to do whatever they want with their body, and as long as it's a decision based on knowledge, and you know the risks and benefits, then it's a free country Smile

free skin care · Tue Jul 21, 2009 12:32 pm

Would supplements like red clover be considered a form of "bio-indentical" hormones?

I am worried about the approach of menopause and what effect it may have on my coronary system (heart disease is rampant in my family history), sexuality, metabolism, bones, etc.

If one already has a healthy diet and exercise routine - what more can be done?

I know Suzanne Somers talks about "hormone balancing" in her books, but I am not really sure what that means.

BF

Tue Jul 21, 2009 1:16 pm

Hello Josee,

Thank you for your very knowledgable response. I appreciate the info especialy since you have the qualifcations to back up your opinions.

I have also read everything you have told me and I know that hormones by any name can not be taken lightly. But you have to admit there is so much written on the subject by some very qualified and intelligent people that just maybe the medical community will one day get on board with bio-identical hormone therapy.

I am 54 years old and am past the symptoms of menopause so that is not why I am using them.

My doctors are aware of my family history of breast and ovarian cancer and still insist that it is safe for me to use BHRT. Of course I do not want to jeopardize my health so I get regular check-ups, take vitamins and supplements, don't smoke and eat healthy. My weight is 112 lbs on a 5'2" height and I exercise most weeks 5 times a week. Except for osteoporosis, which my mother and grandmother had I am in excellent health. Even though I did everything possible to prevent this disease I still developed it. I tried Actonel and my bone density test worsen over three years. I do not want to take any more of the bone saving drugs with all there side effects if it has not helped me in the past. I even took Forteo but quit after 18 mos. because of expense and possible dangers of long term use. So you see hormone therapy from what I have read might be what will help me. I did allot of research before I choose a doctor and my OBGYN and the internist I sought for a second opinion felt that this is the route I should go.

Am I 100% sure of their safety? No. But I do feel that these doctors and all the others I have read would not feel so positive if there were not sure of their safety and effectiveness in treating health issues related to hormone deficiency. I think its like replacing insulin or thyroid hormone if the body no longer produces it. I know that nature intended for sex hormones to deplete with age but now that we are no longer dying of old age at 40 maybe that's something to think about.

I will check out your web sites and will continue to read all I can on the subject. I hope I am making the right decision.

free skin care · Tue Jul 21, 2009 1:38 pm

You know... you may have already been tested but I'll just throw this out there.

Many people are deficient in Vit. D. Especially since we now make a strong consorted effort to avoid the sun. We need Vit. D to, among other things, to processes calcium (is my understanding).

I know a handful of people that live in California, and who were having that 85 y/o feeling and when finally tested for Vit. D... NONE...Nothing... nada! The supplementation of Vit. D. is certainly a LOT LESS controversial than HRT (assuming you need some), and has changed lives in the deficient individuals. Obviously, not necessarily your answer. But I'm surprised more and more about how much I hear how a person's symptoms of a large variety of problems... disappear. Like the person that just feels depressed and can't come up with a single reason as to why.

I know, through testing, I'm on the low end of desirable range. My Dr. gave me the go ahead to take it... and WOW! Big improvements.

free skin care · Tue Jul 21, 2009 2:38 pm

HI, I've been taking D supplements along with Calcium/Mag. for over a month. 2,000 I.U. of D daily. What I have definitely noticed is an improvement in my overall mood. I heard D can help with a sense of well-being. Something is helping me. Maybe it is indeed the increased D. Smile

Would love to use some estriol for my skin, but I'm afraid. Family history of breast cancer worries me.

free skin care · Tue Jul 21, 2009 4:40 pm

Yeah, with a history of Breast Cancer I'd be really nervous about supplementing with anything that might "make it so."

Tue Jul 21, 2009 4:45 pm

Hello Mars and Claudia,

Yes I have been tested for vit D and was found deficient. I have been taking 5000iu and now my levels have come up from the teens to the sixties. My doctor wants it to be close to 100. This is the same doctor who is treating me with the bio-identical hormones. .

She seems to be current on anti-ageing practices.

Mars I do share your fears regarding BHRT but I know of no one so far who has developed cancer, had a stroke or heart attack because of BHRT and neither has my doctor and she has been prescribing this regimen for about 20 years.

For the time being I will follow her treatment plan for me and as always continue to do my homework.

free skin care · Tue Jul 21, 2009 5:33 pm

I went though hell with menopause..I didn't even think about going on any type of hormones Bio or pharm. I had gone on birth control pills for 1 week after I had my first son. I developed phlebitis in my leg and was quickly taken off of them. I do eat a lot of soy which is suppose to mimic estrogen? All though it didn't help with menopause symptoms. My girlfriend used some kind of vaginal cream that the dr gave her. She uses it 2x a week. It seems to help her with this rough patch she is going through. You just have to try and read up on all you can to see what might and might not work for you...Everyone is different. My vit D level was scary low. I have lived in the Southwest most of my life and have gotten plenty of sun. Calcium is almost above the "normal" range. I have to take buckets of vit D. I also have a host of autoimmune problems to go along with this worn out old body..But I do look good Very Happy

free skin care · Tue Jul 21, 2009 9:21 pm

arym wrote:

Mars I do share your fears regarding BHRT but I know of no one so far who has developed cancer, had a stroke or heart attack because of BHRT and neither has my doctor and she has been prescribing this regimen for about 20 years.

The breast cancer registry of the MGH found an increased risk of breast cancer in women using BHRT. It was smaller than with HRT, but nonetheless greater than non-users.
It is unclear whether the difference is due to the fact that with BHRT the overall hormonal load is less or due to something else.

free skin care · Tue Jul 21, 2009 9:29 pm

Barefootgirl wrote:

Would supplements like red clover be considered a form of "bio-indentical" hormones?

I am worried about the approach of menopause and what effect it may have on my coronary system (heart disease is rampant in my family history), sexuality, metabolism, bones, etc.

If one already has a healthy diet and exercise routine - what more can be done?

I know Suzanne Somers talks about "hormone balancing" in her books, but I am not really sure what that means.

BF

Hi BF,
Red clover is not a "bioidentical hormone", it goes into the category of "phytoestrogens".

A good approach is to start talking to your OBGYN from the start about menopause, even if you're not on your menopause yet. Prevention is always the key!

Regarding CVD, HRT has unfortunately not shown to improve CV outcomes, so for now the best bet still continues to be having a healthy BMI, normal lipid and glucose profile, normal BP, and eating healthy and excercising. With that, you'll already be in a better position than the majority of the population. There is absolutely no substitute for that, and no magic pill for it either.

Regarding one loss, the best thing is to get an assessment of your osteoporosis risk, and based on that, get a treatment. Nowadays there are so many nonhormonal options to treat and prevent osteoporosis that you should be fine.

I think it's important to find a competent doctor who will take your worries seriously and take his/her time to design a plan for you, possibly in combination with other specialists.

HTH!

free skin care · Thu Jul 23, 2009 5:57 am

BTW, I realize that I somehow "hijacked" the thread with my unsolicited opinion!

So if anyone out there has been using bioidentical hormones, has experiences to share, and advice to give arym, please do so!

I promise I'll stay out Smile

free skin care · Thu Jul 23, 2009 12:23 pm

I have been taking bi-est and progesterone for a couple years. I live in NZ where they are only available by prescription. It's kind of an expensive thing, because I have to pay for frequent saliva tests to measure hormone levels. It is definitely effective in keeping you young-looking and managing symptoms. But you have to be committed to the tests and follow-ups because of the danger of excess estrogen levels.

free skin care · Thu Jul 23, 2009 1:35 pm

I have not entered menopause that I know of nor do I have symptoms - my auntie, whom I seem to resemble said she never was aware of going through menopause. So I'm hoping I'll follow in the footsteps.

I do however have baseline osteopenia (based on simple heel test) and keep it monitored. My overall baseline dexi-scan shows good bone in many areas and borderline in others (hips). My risk factors - caucasian and small-boned add to my risk. The factors I have control over I do! I can't imagine what else a physician would recommend for me. I understand the Vitamin D and Calcium mix (I teach Nutrition at a college). I am very skeptical about Rx such as Fosamax - studies have shown necrosis (break down or decrease in bone density) in the mandible - jaw area. I don't think we have enough long-term conclusive studies to convince me to do this kind of therapy. I am very active - exercise - all my life. But if Josee can come up with something else or a direction for me to try to maintain the condition of my bone density I'm all ears. I'd appreciate it.

Other than that I'm scheduled for a blood/saliva testing done at a naturopath doctor soon. He is also a Johns Hopkins trained Western medicine doc who loves the off-beaten track ideas as well (sort of like Andrew Wiel)- he works with pharmacists to compound BIHRT. (bio-identical).

free skin care · Thu Jul 23, 2009 4:52 pm

I just turned 50 this year and am not in menopause but rather in that awful zone before (at least it feels that way to me) called perimenopause. After taking a blood hormone panel confirming my hormone levels, my practitioner prescribed .5 mg estrogen daily and 100 mg progesterone cycled for 3 weeks every month which I have been taking for the past 2 years; both administered by sublingual troche (sort of like a gummy bear) placed under the tongue.

The best way to describe the symptoms I had is a mean PMS that just didn't let up! (I've always had PMS which gradually worsened in my mid 40's.) Additional symptoms were depression, forgetfulness, foggy brain function, constant wakening at night, night sweats, hot flashes, anxiety, low energy, body aches, no or low libido, and the list goes on.

About this time bioidentical hormones were being talked about more (i.e. Suzanne Somers, Dr. Elizabeth Vliet, etc.) and women spoke of finally finding some relief and even feeling youthful again. Several things convinced me to give it a try: I read and was also told by physicians, that the general age group of the women in the WHI study were post-menopausal and that would have affected the results of the study; the hormone dosage with HRT was even lower than BCP's; maintaining hormone levels lessened the risk of bone loss and cardiovascular disease. But to be honest, I was so desperate to just feel better.

It's been two years and I can honestly say it's helped me with most of my symptoms, I feel sane .... well, most of the time. I'm not sure how long I will remain on it but it's working for now.

free skin care · Fri Jul 24, 2009 8:24 am

Josee - of what benefit are phytoestrogens?

Thanks, BF

The comment about BHRT being a lower dosage than BCP is interesting.

free skin care · Sat Jul 25, 2009 2:35 pm

Just a heads up to anyone considering phytoestrogens in the form of soy. I was warned explicitly about soy by the specialist who prescribes my BHRT. The only soy that is acceptable is fermented soy products like miso and tempeh. Other than that, it should be limited to 15 gm a day. The link between excess soy and thyroid problems is well established, quite aside from it messing up your hormones. Soy is also a big danger to cats' thyroids.

Sun Jul 26, 2009 10:19 am

Hi Josee - I'm glad you joined the discussion. My questions is - What do you recommend for menopause? I'm 52, stopped having periods gradually over the past several years. All of a sudden I'm menopausal, no symptoms at all - except weight gain around the middle and slightly sagging facial skin. I know I have no way to go but down in the aging department - as hard as I try. I've contemplated asking for bio-identical hormones so I don't turn into an old lady before my time. It's not just vanity, but it's really depressing to think as good as I feel I'm supposed to just accept looking old when I feel better than I did in my 20's. Any suggestions?

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