Bonnie on Biodenticals

As a certified menopause educator, I thought it prudent to comment after hearing about Oprah Winfrey's show on bioidentical hormones.

Logic dictates that human identical, bio-identical products are the only acceptable products when we are restoring hormones or nutrients. Why use a product that acts like the real thing when you can get the real thing? Oprah's show, as well as the latest research study linking synthetic hormones to a higher risk of breast cancer, brings to the forefront the discussion of what is safe for women (and men, although I rarely counsel men on hormone therapy issues).

Bio-identical Estradiol (E2) delivered through the skin has been shown to decrease clots and risk of stroke and heart attacks, as opposed to E1, delivered through the mouth (i.e. Oral PremarinTM used in WHI) which increases clot heart attack and stroke risk because of the first pass through the liver which makes clotting factors.

The FDA has over 20 bio-identical hormone products approved and on the market such as Climara® patch, Vivelle® dot, Evamist® spray, and Prometrium® capsules (progesterone). They can not patent the hormone, since it is a natural product, however they patent the delivery systems ( i.e patch, dot, spray, gel).

At times one needs a 25 mg dose of progesterone, which is only available at the compounding pharmacy. At times one needs 100 mg of progesterone, which is available at CVS® and Walgreens®. At times one needs Estradiol at .05 mcg available as Climara patch at CVS and Walgreens. At times one needs a lower dose available compounded.

When choosing a compounding pharmacy check credentials, certifications, quality checks, sterility processes and membership in PCCA and other national organizations that assess their quality standards and adherence to the principles of compounding medicine.

My opinion is that oral hormones are far more risky than topical because the liver has to process them. The only bioidenticals I would consider would be the lowest dose topical.

If you are fearful of getting higher dose products, whether from a compounder or an FDA approved prescription, I recommend very mild dosing from a standardized cream or gel, such as Bezwecken Ostaderm (natural estrogen with progesterone) or Progonol (natural progesterone alone). I have worked with this doctor-owned company for 18 years and their safety record is excellent. I have personally used Ostaderm for 14 years.

If the mild topicals are not enough, to stop menopausal symptoms, I often recommend the very safe, non-hormonal Black Cohosh, and/or vitamin E vaginal suppositories.

Quality of life is important. Safety is important as well. I hope this helps your quest.

Bonnie