Hormone replacement therapy, bioidentical hormones or a UFO?

​You are not alone when it comes to hormonal hell. You would think by the age of 50 that those wretched hormones that have been driving a woman to drink for about 35 years would have settled down. Just when you thought it was safe to float happily Into the twilight years you have more hairs on your chin than a pubescent Swedish male, surging hot flushes that could incite a rather embarrassing strip tease or an outburst of rage at an unsuspecting victim! Whilst there is help out there, confusion reigns as what should a girl do to re-balance those wayward and unbalanced hormones.
Estrogen gets a lot of press but what about another hormone that is just as important and declines prior to menstruation and production lowers with age.  Progesterone is a steroid hormone made by a woman's ovaries when she ovulates and in smaller amounts by the adrenal gland. With age, a woman’s progesterone level declines and by the time perimenopause sets in , it is estimated that 75% or more may be lost. Progesterone is useful in balancing excessive estrogen which is a major risk factor for both Breast and endometrial cancer. Progesterone, is a precursor material to create other hormones such as adrenal hormones and  it can convert it into both estrogen and testosterone if required. If you are thinking I got to get me some of those, then what type do you get? as there are conflicting opinions.

On the one hand you have the doctrine that provides clinical evidence to support the synthetic hormonal replacement therapy HRT as being more efficacious with minimal side effects. On the other hand there is evidence that bio identical hormone therapy is more effective with less complications. The Us Food and Drug Administration (FDA) and the endocrine society suggests that there is little or no evidence to support claims that bio identical hormones are safer or more effective. (4) FDA doesn't approve any compounded products, for any condition, because those products aren't standardized. (4)  A compounding pharmacist, on the other hand will provide a totally individualized preparation on a case by case basis. Because there is little evidence to support bio identical hormone there lays the problem.
 
 Oprah Winfry after finding a hormone altering bio identical estrogen that changed her world urges women to take charge of their health and says “it’s time to start the conversation about menopause and bio identical hormones (3) The majority of HRT , hormone preparations has been referred to as “hormone substitution  therapy”,  as most utilized do not exactly match those produced  in the body . Research indicates those synthetic hormones vary clinically in safety and efficacy. As such, women have been increasingly opting for alternative bio identical replacements. The reason being is that they match the structure and function of hormones produced by the body.

After having a discussion with one of the gynecologists, prior to having a Medical procedure, he candidly asked me if I was having the Merina placed into my uterus after the hysteroscopy. This was my Second time having this op,and I was not going to be pressured to have this kind of  UFO implanted knowing that it  could cause a cascade of hormonal distress. A visit to an endocrinologist as a result, was a complication that I chose to avoid. With an air of indifference, I said “no”. He went on to ask me the reasons as to why I was so against this device, prattling on about evidence and clinical studies ya-da, ya-da ya-da! In the meantime, there I was, prepped and sitting in a beautiful hospital gown, blue hat, long white stockings and a gorgeous paper toweling undergarment. I thought this subject had been put to bed. I could not see the point in having such a device when the investigation that I was just about to have would determine what should be done next. In my opinion, we had to wait for the results before we take further action. I went on to say,   that we can always find research that will either support or refute both traditional medicine and natural medicine depending on the school of thought. Seek and you shall find. 

I could see his rationale, as there we were again, only two years later, looking for development of endometrial cancer. My symptoms and signs fitted the profile. The merino,  not a big fan of but rather a candidate for, actually inhibited the growth of the uterine lining, thinning it out which I clearly required. But at what cost? Will having this alter my hormone profile or will it just erupt a cascade of hormonal havoc? After all, I came intellectually prepared and was armed with some research to back up my claims. Generally speaking most women trust the authorities and go with whatever the prescription of the day is. Having had firsthand experience in clinic with young women whom had this “UFO” embedded in their uterus, I was aware of the natural disaster that it could start. Being one of holistic health I had decided that if “I needed hormones” further research in bio identical hormones was required.

The Merina or the LNG-IUS has been introduced as an alternative therapy for endometrial hyperplasia. Cohort studies have shown promising results, however they have been observational only and do not meet the necessary requirements to create novel treatment recommendations.(7) Physiological data and clinical outcomes demonstrate that bio identical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bio identical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly.4 These studies suggest that bio identical progesterone does not have negative effects on blood lipids, or vasculature as many progestins can whilst they  pose limited risk to the rise of breast cancer.

So Why Aren't Compounded Bio identical Hormones FDA approved?​
According to the Food and Drug Administration (FDA) and several medical specialty groups, the hormones marketed as "bioidentical" and "natural" aren't safer than hormones used in traditional hormone therapy, and there's no evidence they're any more effective. (2) However if you search google sholar pub med, you will find various papers with Cochrane data bases that have found the following results. Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a synthetic progestin. Bioidentical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestin’s.
In my research I found pros for and cons against both synthetic and bio identical hormone preparations, again depending on what school of thought . The main issue with ‘bio identical’ or compounded hormone therapy products is that they are unregulated and there is little research evidence that the recommended doses are safe or effective in therapy use.” (1)There may be an absorption issue as well with  no quality assurance. The challenge is that once again we really are left  to a world where if we want to play with fire in one way or another we will get burned. No drug or natural hormone is supposed to be taken over a long term period. Whichever way you choose, do your homework and take the lesser of the two evils! After all, it’s  your body, your health and its ultimately up to you.


 References
1 https://jeanhailes.org.au
2 Are "bioidentical" or "natural" hormones safer and more effective than hormones used in traditional hormone therapy for menopause symptoms? Answers from Shannon K. Laughlin-Tommaso, M.D. http://www.mayoclinic.org/diseases-conditions/menopause
3 Oprah Is Talking About Bioidentical Hormones for Menopause; Experts Weigh In By Miranda Hitti
WebMD Health News Reviewed by Louise Chang, MD    web MD News Archive, www.webmd.com/women/news/20090115
4 Clinical Features; the Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgraduate Medicine, Volume 121, Issue 1, 20095 Francisco, Laura; ARNP Nurse Practitioner:   Is Bio-Identical Hormone Therapy Fact or Fairy Tale?
July 2003 - Volume 28 - Issue 7 - pp 39-44  Features

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