Oprah has brought bioidentical HRT onto center stage.
As a result, we’re now deluged with calls about
bioidentical hormones. The basic question women ask is,
“Are they for me?”
This isn't the first time we've seen a sudden spark of interest
in bioidenticals. In her books, Ageless and The Sexy
Years, and in media appearances to promote them, Suzanne Somers
describes how bioidentical hormones relieved her
menopause symptoms. She also makes it clear that she intends to
stay on them for the rest of her life.
We’ve used bioidentical hormone replacement therapy (BHRT) for
many years in our clinical practice. And we've found that women feel
their best when they're informed about their options so they can
decide what works for them. So let‘s explore what we've learned
about bioidentical hormones and help you answer that basic question
what are “bioidentical hormones”?
Bioidentical hormones are manufactured in the lab to have the
same molecular structure as the hormones made by your own body. By
contrast, synthetic hormones are intentionally different. Drug
companies can’t patent a bioidentical structure, so they invent
synthetic hormones that are patentable (Premarin, Prempro and
Provera being the most widely used examples).
Though bioidentical hormones have been around for years, most
practitioners are unfamiliar with them. There are several branded
versions now available for use in the kind of hormone replacement
therapy (“HRT”) typical of synthetic hormones. This is generally a
one-size-fits-all dosage regime.
In our practice, we have had the greatest success with an
individualized approach. We begin with laboratory tests of hormone
levels (a so-called “hormone panel”). When warranted, we then
prescribe a precise dosage of bioidentical estrogen, progesterone, testosterone or DHEA that is made up at a compounding pharmacy. Each patient is then
monitored carefully through regular follow-up hormone panels to
ensure we get symptom relief at the lowest possible dosage. In the
initial stages, we will do a hormone panel every two - three months.
Once balance is restored, we’ll do one panel a year at the time of
the annual exam.
Are bioidentical hormones better than synthetic hormones?
We long ago concluded that the answer to this question is yes.
But that doesn’t mean bioidentical hormones are perfect.
The great appeal of bioidentical hormones is that they are
natural, and our bodies can metabolize them as it was designed to
do, minimizing side effects. Synthetic hormones are quite strong and
often produce intolerable side effects. Moreover, the compounded
bioidentical hormones can be matched individually to each woman’s
needs — something that’s just impossible with mass-produced
Are bioidentical hormones safer than synthetics?
European medical studies suggest that yes, bioidentical hormones
are safer than synthetic versions. This makes perfect sense. But we
must be cautious here, because they have not been well-studied,
especially for long-term use. And in any case, we never recommend
that a woman think of any drug as completely safe.
Let us note here that the WHI studies on the effectiveness and
health risks of HRT were based on synthetic/equine-based hormones.
Read our article
on the risks of HRT for our perspective on these studies.
What do we recommend?
The great majority of women can rebalance their hormones without
the use of drugs. We have found that about 85% can find relief
through an approach that combines medical-grade nutritional
supplements, gentle endocrine support, dietary and lifestyle changes
and bioidentical hormones. We recommend that every woman start with
this combination approach as a foundation of health.
For a guided version of this approach, see our
Personal Program. We’ve developed a three-pronged approach
that supports a woman’s hormonal pathways upstream of where problems
arise and develop into full-blown symptoms requiring stronger
hormonal replacement therapy. (Our dietary guidelines are based on
the latest research in clinical nutrition and dietary
endocrinology.) Our Essential Nutrients fill in the nutritional gaps
so common in our modern diet. And our Herbal Equilibrium offers
phytocrine support to rebalance all three of the major sex hormones
most prone to disharmony in perimenopause and menopause: estrogen,
progesterone, and testosterone.
Even with this foundation, a minority of women will need to add
prescription-strength hormone supplements to get complete relief, at
least through a transition period. We recommend they use
bioidentical hormones, preferably in a compounded form personalized
to their needs. It’s important that the hormones be used in addition
to the combination approach outlined above.
(Note that Oprah and Suzanne Somers are among this minority —
they began with a healthy diet and lifestyle that supported the
endocrine system, but still experienced intractable symptoms.)
We don’t recommend that any hormones be used long-term unless
essential for symptom relief, and then only with a complete risk
assessment. We also don’t support the idea that bioidentical hormone
therapy should be used indefinitely as some kind of fountain of
bioidentical hormones for breast cancer patients?
The pendulum has swung so far that today, very few doctors will
prescribe any type of HRT — synthetic or bioidentical — for women
who have had breast cancer or even a family history of breast
cancer. In fact, many such women are given anti-estrogen drugs.
Dr. Ferchoff feels that we just do not have enough data to rule
out HRT in every case, and prefers to look at each woman’s
particular situation, history, pathology and blood work.
Dr. Ferchoff has breast cancer patients who, like Suzanne Somers,
use low-dose bioidentical hormones by choice. These women have
researched the issues, discussed them with their doctor, and made a
well-informed decision for themselves.
Cristal was a 48-year-old woman who came to us with severe
menopausal symptoms. We changed her diet to increase her protein and
vegetables and reduce carbohydrates, added a pharmaceutical-grade
nutritional supplement, started a 3 week cleanse, and did a complete
blood hormone panel.
At her first follow-up visit 3 weeks later, Cristal definitely
felt better, but she still suffered too many hot flashes and
sleepless nights. Our next step would have been to recommend an
herbal support, but Cristal wanted immediate relief and chose to try
bioidentical hormone replacement therapy.
After reviewing her hormone panel we placed Cristal on a
combination of bioidentical Triest (a combination of 3 estrogens) ,
testosterone formula, DHEA and progesterone, in cream and pill form.
Six weeks later Cristal came back for another follow-up. “I feel
fabulous,” she said, explaining she hadn’t felt this good since her
A year later Cristal still feels great. She’s carefully compliant
with her diet and exercise regime, and takes her bioidentical
hormones faithfully. Her latest hormone panel shows she’s still in
balance and there is no need to adjust her dosages.
Not every patient is as easy to help as Cristal. Sometimes we
have to adjust the formulas three to five times to get it right. But
it’s a very effective solution.
So — are bioidentical
hormones for you?
At the Natural Wellness Center, our goal is to help inform women
about their options so that they can make the choice that’s best for
them. A woman’s hormonal balance is a dynamic equilibrium that
shifts from day to day, week to week, and through the years. When
you give your body the support it needs it can reset itself, because
it’s equipped and programmed for balance and wellness. So we
recommend beginning with the gentlest form of support possible to
allay your discomfort and tweaking it as you go. We’ll support you
in any way we can, each step of the way. The good news is that women
can feel incredibly well right through menopause.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with
nutritional supplements, our exclusive endocrine support formula,
dietary and lifestyle guidance.
If you have questions, don't hesitate to call us at
1-808-988-0800. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic
in Honolulu, Hawaii and for those who can make the trip.
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