August 28, 2008
Putting Out the Fire
The world is flat. Fat-free means zero calories. Menopause is a disease. Throughout the ages, many preposterous myths have become common perceptions; but time, research and, yes, marketing, put these beliefs to rest.
In the case of menopause, yesterday's myth has been dismissed as lunacy. Safe, science-based management of menopausal symptoms, however, is still up for debate, with traditional hormone replacement therapy (HRT) and the new bioidentical hormone therapy (BHRT) prompting a fresh wave of myth vs. fact.
The Same but Different
Both therapies aim to ease menopausal symptoms caused by naturally decreasing hormone levels. Traditional HRT uses synthetic estrogen, progesterone and testosterone derived primarily from the urine of pregnant mares. Although close to a human's, these hormones are more like generic clones of the real deal.
Bioidentical hormone therapy, also called Natural Hormone Replacement Therapy, involves hormones created from plants rather than animals, with progesterone produced from yams and estrogen and testosterone from soybeans. "Bioidentical" refers to the fact that these synthesized hormones share the same chemical structure as human hormones.
Another difference between HRT and BHRT involves dosage and balance. HRT does come with choices, as in hormone combinations (estrogen or estrogen and progesterone) and dosage levels, but a manufacturer makes the pills, and the levels are fixed. BHRT tailors the dosage and balances the hormones to mirror an individual woman's body pre-menopause, creating a custom mix and specific combination. Also, NHRT is available as tablets, capsules, patches and creams.
No Magic Pill … Yet
You and your personal physician are the only ones qualified to decide if you would benefit from hormone replacement therapy and whether you would fare better with HRT or BHRT — because pros, cons, variables and questions surround both.
We know a bit more about HRT since its potential health risks went mainstream after the Women's Health Initiative (WHI) Hormone Program, conducted in the early 2000s. One of the most comprehensive HRT studies to date, WHI did identify HRT benefits but also risks, including in certain instances increased risk of breast cancer, heart disease, stroke, blood clots and urinary incontinence. These final recommendations stand today: HRT efficacy and safety depends upon an individual woman's health history and lifestyle; those who take it should use the lowest dose shown to help; and re-evaluate therapy every six months.
Addressing bioidentical hormone therapy, the story is newer but also less conclusive. In April 2007, Leonard Wartofsky, M.D., president of The Endocrine Society, addressed the United States Senate Special Committee on Aging, stating that the Endocrine Society and the broader medical community are deeply concerned about lacking regulation and overall safety of these compounds. "Bioidentical hormones have been touted inaccurately by individuals with no medical training as being safer and more effective than traditional hormone therapies," said Wartofsky. "The fact is that scientific evidence is lacking at this time to either negate or support claims that bioidentical hormones are safer and more effective than other commonly prescribed hormones for menopausal women." Wartofsky added that customized hormones might be a pipedream. "While theoretically appealing, such customization is difficult, if not impossible, to achieve."
For another side to this story, visit Women to Women, a website dedicated to the promotion of bioidentical hormones.
Somers School
If, as Wartofsky stated, no comprehensive studies establish BHRT as the safer, more effective therapy, then exactly who is touting its advantages? There are respected physicians, but there's also 61-year old Suzanne Somers and her book "The Sexy Years," in which the QVC queen, Thigh-Master promoter and '80s sitcom star describes her own menopause-related hormonal imbalances and a deep appreciation for bioidentical hormones. Is she wrong? No one knows. But grand statements put the cart before the horse. According to the FDA, "claims regarding the safety, efficacy, and superiority of compounded BHRT products have not been substantiated by FDA and may mislead patients and practitioners."
Some women won't go near either pharmaceutical or bioidentical hormones and look to even more "natural" supplementation: herbs. Some herbs that are recommended by well-known health-care practitioners include plants that cool the systemas like chickweed, elder and violet, and plants that increase oxygen utilization in the liver, such as dong quai, dandelion, Ho Shou Wu and yellow dock. In 2005, the Mayo Clinic found no relationship between black cohosh and the relief of hot flashes. Sill, black cohosh is used widely.
While the medical community, celebrities and pretty much everyone else weighs in, stay tuned for results of studies of bioidentical hormones, which are in the works in pockets of research communities in Europe and the United States.
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