A week ago, Oprah featured a segment on her show regarding hormone replacement therapy and the controversy between synthetic and bioidentical.  You can go to Oprah.com to read some of the show’s excerpts.  I can understand the controversy from the stand point of lack of knowledge on both sides (pro and con).  I’ve made my decision to stick with BHRT with my patients based upon the Women’s Health Initiative Study.

On May 31, 2002, the WHI study of conjugated estrogens 0.625 mg/day, plus medroxyprogesterone acetate 2.5 mg/day in postmenopausal women was stopped after a mean of 5.2 years of follow-up because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits.

Three years after stopping hormone therapy, women who had taken study pills with active estrogen plus progestin no longer had an increased risk of cardiovascular disease (heart disease, stroke, and blood clots) compared with women on placebo.

Source: FDA website

The estrogen-alone study was stopped at the end of February 2004 because the hormone increased the risk of stroke and did not reduce the risk of coronary heart disease, a key question of the trial. The study was to have ended in March 2005.

Source: National Institute of Health website

Many Medical Doctors and the FDA are standing up to refute claims against BHRT products claiming that BHRT is “a marketing term not recognized by the FDA.”

And the Endocrine Society issued this position statement back in October 2006, expressing concerns about these products: ” ‘Bioidentical hormones,’ particularly estrogen and progesterone, have been promoted as safer and more effective alternatives to more traditional hormone therapies, often by people outside of the medical community. In fact, little or no scientific and medical evidence exists to support such claims… Additionally, many ‘bioidentical hormone’ formulations are not subject to FDA oversight and can be inconsistent in dose and purity.”

Source: Washington Post.com

At the end of the article, they state that testing for hormones through saliva is not as accurate as serum.  But there are numerous studies that refute that claim:

Direct assay for progesterone in saliva: comparison with a direct serum assay.
Webley GE, Edwards R. Ann Clin Biochem (1985) 22:579-585.

Study compares direct serum and saliva assays for sensitivity, precision and recovery. Twenty women in various stages of their menstrual cycle were compared using serum and saliva. Conclusion: Saliva showed a significant correlation (r=0.71, P<0.001) compared to serum with the added advantages of convenience and reduced stress (no needles).

Hormones in Saliva.
Vining RF and McGinley RA. Critical Reviews in Clinical Laboratory Sciences. (1986) 23(2):95-146.

An excellent review article looking at the constituents of saliva. Conclusion: “Saliva flow rate does affect saliva pH and the concentration of many salivary ions. This has led many clinicians to assume that it would also affect all salivary steroid levels. This is not the case—a number of clinically important steroids, such as cortisol, testosterone, estriol and progesterone, have salivary concentrations which are not appreciably affected by saliva flow rate. However, the conjugated steroids (e.g., DHEAS) and some unconjugated (e.g., cortisone) may exhibit marked flow rate dependence.”

One of the big reasons why most MDs disagree with the use of salivary hormone testing and bioidentical hormones comes from how they’re trained in terms of ‘healthcare.’  Modern day medical schools teach the best techniques in emergent care.  We have the best emergent care doctors on the planet.  Modern day medical schools, however, lack the proper instruction on functional wellbeing and solving issues of chronic disease.  Don’t get me wrong here, if I’m having a heart attack or was in some serious traumatic incident, I’m going straight to a medical doctor.  If I’m suffering from a chronic illness, I’m seeing a functional medicine practitioner.  Functional medicine practitioners like Dr. Mark Hyman, Dr. Jeffrey Bland and myself are trained to look at all aspects of the body not just your ‘digestive system’ or your ‘nervous system.’  Remember the song: “the hip bone’s connected to the knee bone…”  It’s all connected.

We’ve developed a healthcare system of specialists, which has been our downfall. It’s like running into a burning building, but only looking in one room that’s not on fire and saying ‘nothing wrong here.’

So back to the subject at hand: if synthetic HRT was the answer, then we would not have the hormonal issues in our society as we do today.  I state that BHRT is a better choice than synthetic HRT, but I do agree with the FDA and most OB’s that you need to do your research.

• First you need to understand the pros and cons of synthetic HRT (please visit the Women’s Health Initiative study).
• Secondly, understand why your hormones are out of balance.
• Thirdly, get your hormones tested.  In my opinion, I’d do serum, saliva and urine just to cover all bases.
• Fourthly, find a functional medicine practitioner to work with you on rebalancing your hormones.  Remember, it’s not just about your hormones, but you have to look at how the entire body is functioning.  Are you in adrenal gland fatigue?  Do you have some type of impaired detoxification mechanism?  Are you laden with chemical toxins that can act as hormones (xenoestrogens)?  So as you can see, there’s more to it than just getting your blood drawn.  Figure out the cause and eliminate it.  That’s how you achieve wellness.

Links of interest:

Hormone replacement therapy webcast

Labrix resource page on hormone balance

North American Menopause Society

Harvard Medical School: what are bio-identical hormones?

Bio-identical hormones: sound science or bad medicine?

Mayo Clinic: bio-identical hormones: are they safer?

Dr. John Lee’s website on natural hormonal therapy

Compounding pharmacists

If you have any questions, feel free to contact me or leave a comment below.  You may also schedule a complimentary 15 min phone consultation with me via phone 949-559-7999.

One of the most commonly prescribed forms of HRT is Premarin, which is actually Pregnant Mares Urine (PreMarIn).  Nice huh?  Most of the other forms of HRT drugs are synthetically produced and have adverse effects upon your body’s biochemistry.  The Women’s health Initiative looked at the effects of HRT on women and found that it had serious adverse effects such as increased risk for heart attack, stroke and blot clotting.  See WHI study here.

So what causes theses menopausal symptoms and what can we do about them?

Cause: Estrogen dominance and progesterone deficiency

Here’s a list of symptoms of estrogen dominance (source: The Estrogen Alternative – Raquel Martin & Judi Gerstung, D.C.)

• Hot flashes, Night sweats, Insomnia
• Weight gain
• Fibrocystic breasts
• Endometriosis
• Depression
• Fluid retenion and bloating
• Thyroid imbalance
• Infertility & risk of miscarriage
• Irregular menses and PMS
• Cramping
• Acne, Psoriasis
• Inflammation
• Loss of libido
• Vaginal atrophy and yeast infections

Solution: test your hormone levels and supplement with topical progesterone cream and phytoestrogens as needed.

I use salivary hormone testing in my office.  You can read why here.  After determining if there is estrogen dominance we supplement with topical bio-identical progesterone cream and we may also use supplements such as black cohosh to help balance the endocrine response.

Q: Why don’t you use oral prescription progesterone?

A: Oral progesterone must pass through the liver before it is distributed in the blood stream.  Topical goes straight through the dermis and into the blood stream, by passing the liver, thus we can use a lower dose.

Q: Why bio-identical and not synthetic?

A: Bio-identical hormones have the same chemical structure as the hormones naturally made in your body.  Synthetic hormones are foreign to the body and may trigger adverse responses.

If you would like to solve your hormonal issues, send me an email with the subject: Hormone Testing and we can mail you a salivary hormone test kit and help you on your road to recovery!

Years have passed now and you begin to enter into a new hormonal phase.  Something I call: The Second Puberty (or commonly known as Menopause and Andropause).  As much as men will not admit they go through this, well…we do (it’s usually put off as a ‘mid-life’ crisis).  Menopause is actually the cessation of menses, meaning there’s no eggs being released!  Andropause, on the other hand, basically means that there’s a moderate decrease in testosterone production.  But males still produce sperm through this time.

So here’s what’s happening:

Essentially your body begins to make less of the primary sex hormones: Estrogen (females) & Testosterone (males).  So physically speaking, women begin to form more male characteristics and men begin to form more female characteristics. You know the saying, “the longer you’re married to a person, the more you begin to look like them.”

Menopause usually dominates the scene, because women are more attune to their bodies and men just shrug it off.  But both usually are afflicted with hot flashes, night sweats and usually a decrease in libido.  Here’s the kicker: you can actually prevent this from happening.

How Doc?

Well we have to step back and give you a brief schooling on your hormonal system.  Your sex hormones are primarily produced in the gonads (ovaries and testes) and also your adrenal gland cortex.

When you go through these phases, the drop off in sex hormones produced by the gonads should be buffered by the production of sex hormones in the adrenal glands.  The majority of the time the culprit tends to be decreased levels of progesterone.

The common treatment for menopausal symptoms has been hormone replacement therapy, specifically synthetic estrogen.  Most women are given Premarin.

What is premarin?

Hold on to your seats when I tell you this, but premarin is actually horse urine.  Yes, they get premarin from pregnant mares (hence the name Pre (gnant) Ma (res) u(Rin)e.  Every time I tell patients this, they look at me in disbelief and shock that their OB/GYN didn’t disclose this information.  We’ll leave this topic for a discussion at another time.

What’s the solution to hormonal balance:

1. You need to have your hormones levels properly tested.  I highly recommend salivary hormone testing which looks at the bioavailable forms of estradiol, progesterone, DHEA, testosterone, and cortisol.  I work with Labrix, which specializes in salivary hormone testing.
2. Once you get your test results your treatment plan may include support for your adrenal glands (glandulars, adaptogens and supportive nutrients), topical bio-identical progesterone, dietary change and exercise.
3. Other tests may be warranted such as a liver detoxification capacity test and thyroid panel.

If you would like to have these tests run, please call my office at 949-559-7999 and request these tests and I can help devise a treatment plan for you.