Here I go again, starting another blog post with a discussion of the WHI (Women’s Health Initiative.) But it's nearly impossible not to, as the WHI was such a pivotal moment in the history of menopausal hormone therapy. After the media frenzy demonized hormones as killers causing breast cancer and heart attacks, doctors throughout the country hesitated or outright refused to prescribe hormones either because they believed it would do harm, or they feared a lawsuit.
This led to an immense amount of suffering in women struggling with symptoms of perimenopause and menopause. Shortly thereafter, out of defiance, what was practically a counter-culture emerged, spearheaded by the late Suzanne Somers. These women were (rightfully) demanding their hormones back. At that time (early 2000’s) nearly the only way to obtain hormone therapy was through compounding pharmacies and “alternative” doctors. They marketed their meds as “bioidentical” as a way to separate themselves from traditional medicine and the Premarin/Prempro hormone therapy of the WHI.
The term bioidentical was intended to mean hormones that are of the identical structure as our own naturally occurring ones. This does not necessarily mean that they are natural, however. Some bioidentical hormones may be completely synthetic (estradiol), as in created in a lab. Others may be derived from natural ingredients (such as yams) but chemically manipulated in a lab to turn into a hormone (progesterone.) To make things more confusing, there are hormones on the market that are natural but not bioidentical. For example, conjugated equine estrogens, or Premarin, are natural estrogens derived from a pregnant horse’s urine (hence the name PREgnant MARes urINe), but these are very different from a human’s estrogens.
The movement wasn’t completely wrong, but there were (and still are) some real problems. One is that there is significant heterogeneity in treatment between compounding pharmacies and prescriptions. Compounding pharmacies are hand-mixing meds in various carrying agents. Each preparation may be prepared and absorbed differently, making research on the safety and efficacy of these methods nearly impossible. Additionally, there have historically been issues with sterility and some unfortunate contamination cases leading to serious infections have been documented. Finally, it is simply not good practice to routinely prefer and utilize medicines that lack the appropriate research on safety and efficacy. I don’t want to be guessing with my patients!
The good news is we have bioidentical options that have been studied, FDA approved, and are regulated in sterile labs, so you can rest assured about what you are getting. What's more is the data is finally starting to catch up, and seems to be showing us that the bioidentical forms do appear to be safer options, with lower risks of blood clots, cardiovascular disease and breast cancer. While we still need more and larger studies, these are now the preferred first-line therapies for hormone treatment.
With hormone therapy on the rise and back to becoming standard of care for the appropriate symptomatic perimenopausal/menopausal woman, the “alternative” movement and compounding pharmacies livelihoods are at stake. What you find as a result is “bioidentical” is marketed as nearly synonymous with compounded meds. Some practitioners claim that women should take the precise proportions of all the kinds of estrogen made pre-menopause (estriol, estradiol, estrone, as well as testosterone.) While it is possible that they are not wrong, we simply do not have the data to prove or even suggest this. So as it stands they are treating simply based on theory. Which is just. not. good. enough.
So now you understand that bioidentical does not mean natural, and that while “bioidentical” is likely ideal, this does NOT mean you need to use a compounding pharmacy to try to give the identical dosing to a premenopausal woman. (Which, by the way, is in constant flux anyway throughout the menstrual cycle!) And let us not forget, that although bioidentical hormones are a great first choice, there are other safe and effective options (yes, even synthetic progestins!) for hormone therapy.
コメント