bioidentical hormones Archives - Laura G Owens ~ Writer. Raw. Real. Chronically Ambivalent.

On July 28, 2011

*Click here for a few of my favorite natural hormone balancing products

(Photo credit: Sally Howard)

Feeling off?

Forgetful? Sweaty? Waking up in the middle of the night? Less interested in sex? Increasingly stressed, unfocused or irritable?

Your doctor might suggest you’re in peri or full menopause. Or perhaps you’ve had a complete hysterectomy and she wants you on hormone replacement therapy (HRT).

Or, maybe your cortisol (the stress hormone) levels are high, a condition that is all too common today in our stressful society, that and adrenal fatigue. Cortisol in small doses as the “fight or flight” hormone alerts you to take action. And, like all hormones it’s just doing its job. But, at chronically high levels, as in the case of constant stress, cortisol can harm your sleep and your health.

Whatever is going on your doctor (or you) may want to test your hormones and a number of other factors. The connection between hormones, neurotransmitters (brain chemicals) and our mind and body wellness is intricately complex, but infinitely manageable.

Here’s my six-prong approach to making decisions about hormone therapy:

1. Track your symptoms. Do this for several months before and and after (if you decide) you start hormone replacement therapy (HRT). Write in a journal how you feel, your symptoms based on time of day, how your symptoms change from day to day, weekly and monthly and how you feel after you eat.

Food is the first and foremost nutraceutical we take in throughout the day, and food affects our mood, hormones, EVERYTHING. Your diligent symptom tracking will provide you and your doctor with some useful patterns and information about what hormones and neurotransmitters might be off balance. Do you see patterns before your period? After? Sporadically?

2. Test your hormone levels (saliva testing is more accurate for several hormones). Get tested even while you track your symptoms.

3. Consult with an open minded doctor. Preferably find one who specializes in natural hormone and mood balancing. The gift of finding a doctor who listens, respects your symptoms and who understands women’s hormones and brains is beyond priceless.

Much of what I’ve learned is from my hormone balancing doctor, my own decade of research and Dr. John Lee’s books. He’s my guru for bioidentical hormones. (Dr. Braverman is my guru for mood balancing).

*Click here for a few of my favorite natural hormone balancing products

4. If applicable, start hormone therapy (HT). Ask yourself, do I feel increasingly crappy? Do I want to stay this way and accept feeling crappy as par for aging?

You have your answer.

5. Use bioidentical hormones (BH)

6. Use a compounding pharmacist. Most insurance companies don’t cover BH, however some might reimburse a portion. You may only need progesterone. Many women do not need estrogen replacement. Progesterone often alleviates symptoms of the common “estrogen dominance” which doesn’t mean you have high estrogen (though some women do and this is referred to as “estrogen excess”) it means your progesterone is too low. However if after balancing your progesterone you are still low in estrogen, BH estrogen is FDA regulated, therefore often covered through your health insurance and/or discount pharmacy plans.

I order my BH estrogen transdermal patches from Canada, Smart Choice Pharmacy. I’ve found their pricing and customer service to be excellent.

*Click here for a few of my favorite natural hormone balancing products

Whether you opt in or out of HRT, at least stay open to the possibility.

Read between the hormone news scare lines, don’t react against HRT until you understand the researching findings, until you understand the difference between synthetic and bioidentical hormones, until you talk to an experienced physician who understands natural hormone balancing and who keeps up with the latest research on both sides, conventional and natural hormone HRT.

Considering Bioidentical Hormone Replacement? Consider a Compounding Pharmacist.

On July 28, 2011

(Photo credit: Renjith Krishnan’s)

hormones,bioidentical hormone replacement, compounding pharmacist, hormone replacement, progesterone, testosterone, estrogen, vivelle-dot, climara

Consider using a compounding pharmacist for bioidentical hormones

Have you talked to your doctor because you think you might be in peri or full menopause?

Are you feeling off, forgetful, sweaty? Are you waking up in the middle of the night, increasingly anxious, unfocused, irritable and have little sex drive? Perhaps you’ve had a complete hysterectomy and your doctor wants you on hormone replacement therapy.

The first step is to measure your hormones. Saliva testing is preferable to serum blood tests, in some instances.

(Click image for hormone testing kit)

Click for list of ZRT Labs hormone tests)

And, if based on your test results you decide to start hormone replacement therapy (HRT), consider bioidentical HRT over conventional, synthetic forms. It’s important to get your bioidentical hormones (BH) from a reputable pharmacy who dispenses with a prescription from your doctor. (Ask your doctor what your state requires as this varies).

Find a compounding pharmacist nearest you.

While over the counter (OTC) progesterone creams are available, I don’t recommend these because of the potential for inconsistency in the active compounds and dosing. Dr. Lee however, the HRT guru I follow, recommends a few OTC formulas in his book.

(click image for more information)

One of Dr. Lee’s OTC progesterone cream recommendations is Emerita. Yet, I order my progesterone and testosterone from a local compounding pharmacy. I mail or fax the pharmacy my Ob & Gyn ordered prescription and the staff fills my script through the mail upon request.

So what exactly is a compounding pharmacy?

Writes Wikipedia:

Compounding pharmacies use commercially-available bulk drugs to create new formulations which differ (in form or dosage) from those manufactured on a large scale by pharmaceutical companies.

Custom-compounded BHRT is (bioidentical hormone replacement therapy) almost wholly restricted to the United States, where pharmacy compounding is governed at the state level while the FDA has regulatory authority over the compounded product. Some internet-based compounding pharmacies understate harm and claim benefits of compounded BHRT beyond what can be proven by evidence-based medicine, and many of their claims exceed those made by other, more mainstream, BHT practitioners.

Find a compounding pharmacist nearest you.

In the United States, compounding pharmacies are licensed and regulated by their respective state like all other pharmacies. National standards have been created by Pharmacy Compounding Accreditation Board (PCAB). Compounding pharmacies were the subject of the United States Supreme Court decision Thompson v. Western States Medical Center (535 U.S. 357, 2002).

I pay a small extra fee to have my compounding pharmacy dispense my creams in a dose-monitored pump to ensure I easily apply the exact amount of progesterone and testosterone cream my doctor prescribed. (Note: Testosterone is a controlled substance and is not available over the counter).

Syringes with tick measurements on the side are often given to customers. These work fine and usually don’t cost more.

Verify your pharmacy and the pharmacist is legitimate. I won’t mention the name, but a certain pharmacy in our area was charged (okay the pharmacists were, not the local chain) for dispensing steroids in and out of state, without a prescription.

Find a compounding pharmacy nearest you.

Before I bought my prescription from the pharmacy I now use I met with the doctor on staff (a former Ob & Gyn who specialized in hormone and brain balancing) and the compounding pharmacist.

I order my bioidentical estrogen patches, Vivelle-dot (I used to use Climara but the bi-weekly Vivelle is offers a more continuous delivery of the active ingredient because you change the patch twice a week) from a Canadian Pharmacy. Because Vivelle is not a compounded substance, it IS FDA approved. I order mine from a verified Canadian pharmacy.

Will insurance cover bioidentical hormones?

Many insurance companies don’t cover compounded medications, it’s important to ask if they pay some, all or none of the cost. Some insurance plans will cover bioidentical estrogen patches (e.g. Climara, Vivelle-dot) because these biodientical estrogen patches are regulated by the FDA.

I have a health savings plan and pay out of pocket, so I price my hormones all the time. For years I’ve found that even if my estrogen patches were covered under my insurance, it was (usually) less expensive to order them out of pocket from my Canadian pharmacy, even after including the shipping charges.

I use Smart Choice Pharmacy and have been nothing but pleased over the years. Their customer service is polite, efficient and prompt.

Hormone replacement therapy decision checklist:

Track symptoms for several months before and after starting HRT
Get tested (saliva preferable in many cases)
Consult with open minded doctor who understands or specializes in women’s medicine, natural hormone and mood balancing.
Start hormone therapy if applicable. Monitor your symptoms over time, realizing that your body may feel worse the first week or two before you feel better as you adjust ot the hormones.
Use bioidentical hormones, BHRT (my preference), using the least amount to achieve desired results (reduced or no symptoms).
Use a compounding pharmacist for your BHRT creams and compare your health insurance and pharmacy plans for bioidentical estrogen patches if applicable. Many women find they don’t need estrogen HRT, only progesterone.

Obtaining your BHRT creams from a compounding pharmacist rather than over the counter increases the likelihood that the progesterone and/or testosterone cream you use is formulated to the dosing and purity your doctor prescribed, which is critical to relieving your menopausal symptoms.

Hormone Fears Cloud Benefits of Bioidentical Hormone Therapy over Conventional

On July 26, 2011

Click here for a few of my favorite natural hormone balancing products

(Photo credit: Sally Howard)

For women who need hormone replacement, bioidentical hormones can offer a safe alternative to synthetic estrogen and progesterone.

Traditional hormone replacement therapy has become the standard protocol for women as they approach menopause or for women who have a total hysterectomy. Yet not every peri or full menopausal woman has low estrogen, progesterone or suffers from hormone deficiency symptoms. Prescribing hormones to women who don’t need them may elevate their levels and produce unwanted side effects.

Yet for women who do experience the symptoms of estrogen deficiency or estrogen dominance (due to low progesterone) bioidentical hormone or natural hormone replacement is a safer alternative to synthetic.

The Controversy Over Hormone Replacement

Hormone replacement therapy became controversial after a report suggested there was a link between breast cancer and estrogen. In July 2003 The Women’s Health Initiative, the largest government study on synthetic hormones, was halted when early results showed that women using conventional hormone replacement (specifically PremPro), had a much higher risk of invasive breast cancer, heart disease and stroke. Women began to weigh the risks of using HRT against learning to live with the unpleasant symptoms of menopause

Yet critics of that study point out that the WHI study was NOT representative of women in their 40’s and 50’s, women who were likely in the early years of peri or full menopause. In fact the average age of the women involved in the study was 63 with an average time into menopause of 12 years.

Controversy exists over bioidentical hormones (BH).

But because I worked with a natural hormone mood balancing doctor who understood BH, my Ob & Gyn writes the prescriptions, adjusting my dosing after we consult about my symptoms, and I get my prescription through a reputable compounding pharmacy I have zero concern about BH, but grave concerns about synthetic BH.

I’ve been using BH for several years.

Suzanne Somers has been the bioidentical hormone poster child, and while she may or may not use levels higher than some, her message is still the same: do what works for you.

The key is to get tested, track your symptoms, and re-test. IMO, and Dr. Lee’s, replace only to levels that alleviate or eliminate your symptoms, no higher. As you age, your requirements change. But don’t accept feeling crappy as “the way it is when you age” or “what menopause feels like.”

Don’t be afraid of hormones, be afraid of not doing your hormone homework and of accepting that feeling crappy is part of aging.

Click here for a few of my favorite natural hormone balancing products

I’ve greatly benefited by getting off 20 years of synthetic HRT (I had to be on HRT since age 19 due to my pituitary disorder, empty sella syndrome). Those prescriptions had levels of estrogen far higher than my body required, not to mention that bioidentical and synthetic hormones in most regards, act quite differently in your body.

Natural Hormone Replacement vs. Conventional

Although traditional hormone replacement has been shown to be safe in women entering peri or full menopause, synthetic hormones are radically different than bioidentical or natural hormones in how the body synthesizes them.

So what is bioidentical? Hormones are deemed bioidentical if they are exact duplicates of what your body makes.

Click here for a few of my favorite natural hormone balancing products

Advantages of Bioidentical HormonesFirst, bioidentical hormones such as estrogens, progesterone and testosterone are administered transdermally, via a patch or cream and in much lower doses than oral estrogens. Transdermal delivery methods avoid the “first pass metabolism” by the liver that occurs with oral dosing.

Second, bioidenticals mimic what your own body naturally produces.

Dr. John Lee, a pioneer in women’s health and author of “Hormone Balance Made Simple” is an advocate of bioidenticals for hormone replacement therapy, explains, “Hormones do very complex and specific jobs in the body by fitting into part of your cells called receptors, much the same way that a key fits into a lock. Once the hormone is in the receptor, it gives the cell instructions. If the molecular structure is different, even by ONE atom, the instructions given to the cell are different.”

So, comparing synthetic hormones to bioidenticals is like comparing processed white bread to all natural unprocessed multi-grain. Both share similar properties but once consumed their by-products and how the body uses them can be very different.

Flaws With Conventional Hormone Replacement Therapy

1. Doctor’s often don’t measure hormone levels prior to starting conventional hormone replacement therapy.

2. Synthetic hormones, because they are not duplicates of what the body makes on it’s own, often produce unwanted side effects.

3. The dosing level of synthetic hormones isn’t physiologic, the level your body would naturally produce on it’s own. Instead, the synthetic dose is usually much higher than what is necessary for the body to produce a desirable effect.

Click here for a few of my favorite natural hormone balancing products

Dr. Lee’s “3 Rules For Hormone Replacement”1. Use hormones only if you need them (e.g. if they are measurably low and/or you have clear symptoms)

2. Use bioidentical hormones rather than synthetic hormones

3. Use the least amount required to reduce or eliminate symptoms.

Work with Open-Minded Expert in Hormone Replacement Therapy

It’s best to consult with your Ob/Gyn or a specialist in hormone balancing with a background in endocrinology and/or gynecology. Be sure to find a physician who listens to your symptoms, is open-minded and is knowledgeable in both synthetic and natural / bio-identical hormone replacement.

They should be well-informed regarding the latest research findings. Unfortunately, hormone replacement therapy has become a profitable industry for doctors practicing in fields completely unrelated to female endocrinology. Buyer beware.

Hormone replacement has become quite common place but in reality it is a complex and specialized field. In the hands of a trained professional who understands the intricacies of a woman’s endocrine system (and more notably, the benefits of bioidentical hormones), hormone replacement therapy is safe and effective for many women.

Most doctors prescribe bioidentical hormones via transdermal delivery systems such as patches, creams, gels and sublingual (under the tongue). Some physicians however, offer hormone pellet therapy, a process of inserting concentrated pellets under the skin to provide continuous delivery of bioidentical estrogen or testosterone. Although pellets offer patients some advantages, once inserted they cannot be easily removed unlike transdermal methods.

If you’re experiencing cyclical or on-going symptoms of menopause or a hormone imbalance, ask your doctor about getting a saliva test which for some hormones is more accurate than blood. Click here for saliva hormone testing kits

Armed with accurate information and a doctor knowledgeable in bioidentical hormones, hormone replacement therapy can alleviate a number of hormone imbalance symptoms, safely and with minimal or no side-effects.

Click here for a few of my favorite natural hormone balancing products

How Safe Is Hormone Replacement Therapy? Bioidentical or Conventional?

On July 26, 2011

Click here for hormone testing kits
Click here for progesterone testing kit
Click here for testosterone testing kit
Click here for Dr. John Lee’s books on hormones, peri and full menopause and HRT after breast cancer
Click here for DHEA products.

Photo: Sally Howard

After a large hormone study scared women, many now unnecessarily avoid hormone replacement and suffer from menopause symptoms such as hot flashes and poor sleep.

Flip through any newspaper and you might read another alarming article about the dangers of hormone replacement therapy. Dig a little deeper however, to reveal fact vs. fiction.

The uproar began in July 2003 when the The Women’s Health Initiative (WHI) during the largest government study on synthetic hormones ever conducted, halted their research after early results indicated that women using conventional hormone replacement therapy (specifically PremPro), had a much higher risk of invasive breast cancer, heart disease and stroke.

Largest Hormone Replacement Study Criticized

Critics of the study point out that the WHI study wasn’t representative of women in their 40’s and 50’s, women who were likely in the early years of peri or full menopause. In fact the average age of the women involved in the study was 63 with an average time into menopause of 12 years, and therefore more likely to have other risks related to breast cancer, heart disease and stroke.

Estrogen plays an important role in your body. It’s responsible for puberty changes in girls such as menstruation, and the development of breasts and hips. In adult women estrogen contributes to the softness of the skin and to vaginal lubrication, it helps maintain bone density, and plays a crucial role in brain function. In men, estrogen serves to assist the function of testosterone and can also influence bone density and cognitive functioning.

Estrogen however, is a double-edged sword hormone. Too much of it without the balancing effects of its bedfellow progesterone, or the wrong kind of estrogen, and it can indeed, be harmful.

When Estrogen Can Be Dangerous

Dr. John Lee, pioneer in natural women’s health and author of “Hormone Balance Made Simple,” coined the phrase “estrogen dominance” to describe what happens when the ratio of estrogen to progesterone is changed by excess estrogen or inadequate progesterone .

Ten to fifteen years before menopause, a woman may actually produce enough estrogen, but not make enough progesterone, which puts her into estrogen dominance. Over a long period of time too much estrogen may put her health in danger.

Estrogen dominance is known to cause and/or contribute to:

Cancer of the breast, ovary, endometrium and prostate (men).
PMS, mood changes, anxiety, irritability
Menopausal symptoms
Weight gain
Bloating
Mood swings
Tender breasts
Headaches
Fatigue
Depression
Hypoglycemia
Uterine fibroids
Endometriosis
Fibrocystic breasts.

**Dr. Lee advises women to use bioidentical hormones. Synthetic estrogen and progesterone hormones hormones like PremPro (combines Premarin and Provera) do not act the same in your body as bioidentical and can cause unwanted side effects or risks.

Substances that Mimic Estrogen

In addition to estrogen dominance, there is a growing concern regarding Xenoestrogens, substances that have estrogen-like and potentially detrimental affects in the body. These are found in most pesticides, plastics, acetones (e.g. nail polish remover) and in industrial pollutants such as PCBs. They can be very potent and toxic, and unlike natural hormones they don’t efficiently clear from the body. As a result, xenoestrogens tend to accumulate in the tissue over time. Even coffee can increase estrogen in the body.

Deciding If Hormone Replacement Therapy Is Right For You

Your decision regarding hormone replacement therapy should be based on clear and accurate research information, your age, health history, lifestyle, menopausal symptoms, and your individual concerns.

Read Between the Research Lines. Don’t let the WHI study scare you away from considering HRT if you’re suffering from peri or menopausal symptoms. Discuss the implications of the WHI results with your doctor.
Get Hormone Levels Checked. If you do decide to try hormone replacement therapy,measure your hormone levels first (saliva tests are more accurate than blood).Click here for hormone testing kits.
Only Consult with Experts. Only consult with a physician who is extensively trained in natural and conventional hormone replacement therapy (preferably an Ob & Gyn or endocrinologist), and who is up to date on all the research.
Consider bioidentical instead of synthetic HRT. While bioidentical hormones (BH) are not FDA regulated, a reputable, licensed compounding pharmacist can formulate bioidentical HRT creams to provide regulated, dose-accurate HRT. Dose-regulated transdermal (on the skin) bioidentical estrogen patches are also available.

What Do the Experts Say?

Bioidenticals are not safer or more effective, according Mary M. Gallenberg, M.D, Mayo Clinic gynecologist and obstetrician:

“According to the Food and Drug Administration (FDA) and several medical specialty groups, bioidentical hormones may be riskier than standard hormone therapy, and there’s no evidence they’re any more effective.

Bioidentical hormones have become popular in recent years, partly because of celebrity endorsements and partly in reaction to reports of increased health risks with standard hormone therapy. The term “bioidentical” means the hormones in the product are chemically identical to those your body produces. In fact, they are — but so are the hormones used in many FDA-approved hormone replacement products.”

But, I put my money on Dr. John Lee, author of numerous books on natural hormone replacement and the primary hormone expert I follow, and on Dr. B., a former Ob/Gyn I consulted with for three years. Dr. B left her traditional practice so she could work with women and men to naturally balance their hormones and manage their mood issues, tired of trying to treat her patients with synthetic hormones only to see their symptoms remain or get worse, Dr. B moved into natural hormone balancing.

In conversations with her and after reading Dr. Lee’s book, reviewing the research and tracking my symptoms, I gave up synthetic HRT, a regime I’d been on for 20 years (due to a pituitary disorder I have called Empty Sella Syndrome). The first thing Dr. B said to me when she saw I was on Ortho Novum for hormone replacement is “Why in the world do they (decades of doctors) have you on THIS for HRT, a birth control pill and a much too high dosage of estrogen?”

My answer back then, “I don’t know, they just did.”

That was then, this is now. Today I don’t default to doctor’s orders (nor do I ignore them if they make sense to me).

Ultimately you have to decide what makes sense for you. You have to consult with a doctor who is schooled in conventional and natural hormone balancing.

Writes Dr. Lee on his website:

“The message of steroid hormones to target tissue cells requires bonding of the hormone with specific unique receptors in the cells. The bonding of a hormone to its receptor is determined by its molecular configuration, like a key is for a lock. Synthetic hormone molecules and molecules from different species (e.g. Premarin, which is from horses) differ in molecular configuration from endogenous (made in the body) hormones. From studies of petrochemical xenohormones, we learn that substitute synthetic hormones differ in their activity at the receptor level.

In some cases, they will activate the receptor in a manner similar to the natural hormone, but in other cases the synthetic hormone will have no effect or will block the receptor completely. Thus, hormones that are not bioidentical do not provide the same total physiologic activity as the hormones they are intended to replace, and all will provoke undesirable side effects not found with the human hormone. Human insulin, for example, is preferable to pig insulin. Sex hormones identical to human (bioidentical) hormones have been available for over 50 years.

Pharmaceutical companies, however, prefer synthetic hormones. Synthetic hormones (not found in nature) can be patented, whereas real (natural, bioidentical) hormones can not. Patented drugs are more profitable than non-patented drugs. Sex hormone prescription sales have made billions of dollars for pharmaceutical companies Thus is women’s health sacrificed for commercial profit.”

So what if you want to get your hormones tested? For several hormones, saliva is ideal, but for other tests, it depends. Read more: Blood or Saliva Testing for Hormones?