Bioidentical Hormones-2-1

Midsouth Wellness Guide
OB/GYN
Hormone Therapy Options: Bioidentical

By Riad Homsi, MD, F.A.C.O.G
Just For Women, PLC
separated from ction:
Fact 1: Your body produces three different

With all the bad news about hormone therapy over the past few years, more women than ever are now searching for alternatives to treat their menopausal symptoms. As a result, there is increasing interest in so-called natural herbal products and in treatment options known as bioidentical hormones. Unfortunately, there is much confusion about the meaning of natural and bioidentical female hormones. Early results from the WHI study (Womens Health Initiative) indicated that postmenopausal women using a combination estrogen/progestin medication called Prempro faced a slightly increased risk of breast cancer, heart disease, stroke and blood clots. The risks prompted the U.S Food and Drug Administration (FDA) to mandate warning labels on all estrogen products advising women to use the least amount of hormone necessary for the shortest duration to treat menopausal symptoms. In the aftermath, millions of women quit their hormone therapy cold turkey-no matter what form they were taking. However, many were surprised by the return of menopausal symptoms they had thought long gone. Since then, newer hormone formulations have been approved, more intensive review of the data has raised some questions about the WHI study itself and , slowly but surely, millions of women are returning to the option of using hormones to treat their symptoms. kinds of estrogen. These are: estradiol, or E2, the primary estrogen produced during your reproductive years: estrone, or E1, the primary estrogen produced during your menopausal years; and estriol, or E3, the weakest form of estrogen, primarily available during pregnancy and produced by the placenta. Each form works differently in different parts of your body.
during the menopause transition, such as vaginal dryness, hot ashes and night sweats. Commonly reported side effects of estrogen hormone therapy include: headache, breast pain, irregular vaginal bleeding or spotting, bloating and nausea.
Fact 5: If hormone therapy is indicated, the

FDA recommends that it should be prescribed at the lowest effective dose for the shortest time needed.
Fact 2:Natural is a marketing term, not

a medical term. Just because a medication or supplement is labeled natural does not mean it is any safer than a drug or supplement created in a laboratory. In fact, there is usually more evidence that a pharmaceutical medication is safer than an over-the-counter product made from herbs, or an estrogen created in a compounding pharmacy(a pharmacy that custom- mixes medications). That is because pharmaceutical manufacturers must submit to strict testing to receive FDA approval to insure purity, prevent counterfeiting, and submit any reports of adverse events. Manufacturers of supplements and compound hormones do not have to follow any of these requirements.
Bioidentical
When something is bioidentical, it is structurally identical to the substance as it naturally occurs in your body. Most Bioidentical estrogens and progesterone come from soy (estrogen) or yams (progesterone). Once the hormones are extracted from the plant source, they can be processed to be used by a womans body. There are two main types of bioidentical hormones: those that are FDA-approved and commercially available with a prescription, such as Estrace and Estrogel, and those that are mixed on an individual basis for women in compounding pharmacies, which are not FDA-aproved.Estrogen products produced via compounding are typically called biestrogen or tri-estrogen, since they contain varying amounts of the two or three types of estrogen. The individual prescription is typically created based on a saliva test that identies the form of estrogen in which a woman is decient. However, saliva testing is not reliable, nor is it used to determine or to monitor therapy. If you chose to have your bioidentical hormones custom made for you in a compounding pharmacy, you need to understand that their production, the purity of the product and the safety of the dose designed for you are unregulated. Continued On Next Page
Fact 3: Women today can choose from

many options to treat their menopausal symptoms. It is important to understand that the WHI study focused on just two forms of hormone therapy-Premarin, a conjugated estrogen produced from the urine of pregnant mares, and Prempro, which contains Premarin plus a synthetic progestin, called medroxyprogesterone acetate (MPA).
Facts
If a woman decides to use hormones, it is more a question of which type of therapy best meets her individual menopausal needs than whether she will use hormone therapy or not. However, few facts should be claried and
Fact 4: as with any medication, all forms

of hormone therapy have the potential for side effects. Using hormone therapy is not a requirement but rather an option available to women who need relief from symptoms associated with declining estrogen levels
December 2007 Midsouth Wellness Guide Page
Midsouth Wellness Guide Your Hormone options

Women have numerous FDA-approved options today when it comes to hormone therapy. The following outlines the nine main formulations of FDA-approved hormone therapy available in the USA.
1-Oral: most hormone formulations still come in a pill form. The only Bioidentical oral form is Estrace (micronized estradiol: estrogen in
smaller particles for better absorption).
2-Transdermal Gel: Estrogel (estradiol gel) is applied once a day to the arm, from wrist to shoulder. This bioidentical estrogen is a clear,
odorless gel that dries on the arm in two to ve minutes.
3-Lotion: Estrasorb (estradiol topical emulsion) is a bioidentical estrogen. Women apply this white, lotion-like emulsion to both their legs
(thighs and calves) on a daily basis.
4-Vaginal cream: Estrogens creams include Estrace (micronized estradiol cream), ogen (estropipate cream), ortho dienestrol cream, and
Premarin (conjugated estrogen cream). These creams are generally used to treat vaginal symptoms. Only estrace is a bioidentical estrogen cream.
5-Vaginal Ring: There are two rings currently available: Femring (estradiol acetate) and Estring (estradiol).Only Estring is a bioidentical
form of estrogen in a ring. The ring is a small piece of circular plastic silicone that is inserted into the vagina like the diaphragm, where it releases a steady dose of estrogen for three months, at which point it is replaced.Estring is approve d to treat vaginal symptoms whereas Femring is also approved to treat hot ashes, and night sweats.
6-Patches: Ranging from smaller than a dime in size to nickel and half-dollar sizes, estrogen patches are typically applied to the abdomen or
upper buttock. They are designed to stay on even when showering or swimming. They have varied dosing, with some needing to be changed once a week, others twice weekly. You have to rotate where you wear the patch. Bioidentical patches include Vivelle Dot, Alora, Climara, Menostar and Estraderm which all are estradiol.
7-Vaginal Tablet: Less messy than a cream, Vagifem is an estradiol tablet inserted into the vagina via a disposable applicator. The general
dose is one tablet daily for the rst two weeks, followed by one tablet twice weekly. It is a bioidentical hormone used for vaginal symptoms.
8-Injection: Before there creams and vaginal pills, there was delestrogen (estradiol valerate), an injection. Still available in the USA, this
form of estrogen is taken once every four weeks. It is not, however a bioidentical formulation.
9-Progesterone: to reduce the risk of endometrial cancer, progesterone is prescribed along with estrogen-only hormone therapy
products.There are two forms of bioidentical progesterone currently available: Prometrium (oral capsule) and Prochieve (vaginal gel). In conclusion, the new approach to hormone therapy is to focus rst on the symptoms, the match the treatment for the specic symptom that is affecting your quality of life. Discuss those issues with your provider in detail.
About the author

Riad Homsi, M.D. is a board certied obstetrician & gynecologist and a certied menopause practitioner. He is the director of the Just For Women practice, located at 80 Humphreys Center, suite 201, Memphis, TN 38120.For more information, call 901-50-STORK or visit www.justforwomendoc.com
December 2007 Midsouth Wellness Guide Page

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Midsouth Wellness Guide

Hormone Therapy Options: Bioidentical

separated from ction:

Fact 1: Your body produces three different

Fact 5: If hormone therapy is indicated, the

Fact 2:Natural is a marketing term, not

Fact 3: Women today can choose from

Fact 4: as with any medication, all forms

December 2007 Midsouth Wellness Guide Page

Midsouth Wellness Guide Your Hormone options

About the author

December 2007 Midsouth Wellness Guide Page

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