How Are Bioidentical Hormones Different
Bioidentical hormones are different from those used in traditional hormone replacement therapy in that they’re identical chemically to those our bodies produce naturally and are made from plant estrogens. The hormones used in traditional HRT are made from the urine of pregnant horses and other synthetic hormones.
Why Use Hormone Pellets And Creams
When hormones are absorbed rather than swallowed, they go directly to the tissues and are not altered by the liver. This is called the first pass effect. Bypassing the gastrointestinal system also avoids many possible side effects. We use pellets as a convenient and measurable way to provide your hormone replacement.
Increased Vs Lowered Risks
The WHI has found that women in the study who took estrogen and progesterone in combination had an increased risk of coronary heart disease, stroke, deep vein thrombosis and breast cancer, but women who took estrogen alone actually had reduced risks of coronary heart disease and breast cancer. All of the women who took hormones had reduced risk of colorectal cancer, fractures, diabetes and all-cause mortality.
Those increases in heart disease and breast cancer risk sound scary, but in absolute numbers, the risks are pretty small, Manson says.
An analysis of the WHI data Manson and her colleagues published in 2017 found that women in the study who used hormone therapy for five to seven years did not have an increased risk of all-cause, cardiovascular or cancer mortality during the 18-year follow-up. And for women in their 50s, there was actually a trend toward a reduced risk of mortality, Manson says.
But perhaps the most important thing to understand, Manson says, is that the WHI was not designed to look at hormones used to address menopause symptoms. Instead, it was examining whether they could reduce chronic conditions such as stroke, heart disease and cognitive decline. It is like the difference between asking whether aspirin is safe to take for a headache vs. whether it is safe and effective to take it on a daily basis in hopes of preventing heart attacks.
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Is Bioidentical Hormone Replacement Therapy Approved By The Fda
This therapy is a not a new approach to hormone replacement it has been used since the 1930s. Bioidentical hormones are legal to prescribe and use in the US, although the FDA has not given its specific approval. The lack of FDA approval is because there are no official placebo-controlled studies to prove whether bioidentical hormones are safer than standard hormone replacement therapy.
Why Would A Woman In Menopause Take Hrt Some Women Take Hormone Replacement Therapy To Ease Menopausal Symptoms Hrt Is Medicine That Contains Hormones That The Ovaries Make Less Of As Women Age And Reach Menopause Hrt Can Be Taken As Estrogen Only Or As A Combination Of Estrogen Plus Progestin Combined Hrt Is Most Commonly Used Estrogen
Combined HRT may help relieve menopausal symptoms, protect against osteoporosis and reduce the risk of colon cancer.
Research shows that long-term use of combined HRT increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism . The research suggests that the risks of long-term combined HRT use outweigh the benefits for most women.
The decision to take HRT is personal and should be made with the help of your doctor. Concerns about cancer, heart disease and stroke should be discussed when considering the benefits and risks of HRT.
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Interplay Between The Er And Ar
A number of studies have suggested that androgens and the AR play a critical role in breast cancer biology and considering that the AR is expressed in about 90% of primary breast tumors , it is not surprising that AR-targeted treatment for breast cancer is actively being investigated. However, the precise role of the AR in breast cancer is dependent on whether ER-A is present. While the AR generally plays an anti-proliferative role in ER-A-positive breast tumors by inhibiting the activity of ER-A , the AR can also mimic the role of the ER-A in ER-A-negative breast cancers and promote breast cancer development . As a result, clinical trials are currently evaluating the use of selective AR modulators in ER-A-positive breast cancer therapies, and anti-androgens for use in ER-A-negative breast cancer therapies . One suggested mechanism whereby the AR can attenuate the activity of ER-A is by displacing ER-A from ER-binding sites, either via binding to androgen response elements that are in close proximity to ER-binding sites in estrogen target genes or by competing with ER-A for binding directly to EREs in target genes . Another mechanism may be an AR-mediated increase in ER-B expression, which is known to inhibit the activity of ER-A, as increased ER-B expression has previously been shown in the presence of natural dihydrotestosterone and the synthetic androgen mibolerone in MCF-7 and ZR75 breast cancer cell lines .
Bioidentical Hormones And Cancer: Is There A Connection
Like most medications, hormone therapy has both benefits and risks. For some women, hormone therapy increases their chances of developing certain conditions such as blood clots, heart attack, strokes, or breast cancer. There is no concrete data exposing the risk of using these hormones however, for women that decide to seek therapy, it’s important to use the lowest possible dose for the shortest length of time.
Medical experts do not recommend long-term use of bioidentical hormones to relieve menopausal symptoms and suggest monitoring use with a complete risk assessment. Compounded bioidentical hormones have not been shown to prevent breast cancer they may actually increase the risk of the disease.
While some health risks are associated with these hormones after a short period of use, other health risks may not present themselves until years later. A major obstacle in understanding the actual safety of their use is that studies remain inconclusive about the risks associated with bioidentical hormones.
If your hormones are imbalanced and the body does not respond well to improvements in nutrition and exercise, you may want to discuss BHRT with your doctor. If you choose to incorporate bioidentical hormones into your menopausal treatment, additional factors such as nutrition, fitness levels, and lifestyle should also be adjusted to increase your overall well-being.
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For years, research has suggested a potential link between MHT and an increased risk of breast cancer. In 2002 and 2004, the Womens Health Initiative released reports that showed women who used combination MHT were more likely to develop breast cancer. MHT use fell after the reports received widespread coverage. That was followed by a decline in breast cancer rates.
But there wasnt much information on whether that risk persisted, or how it differed based on the type of MHT a woman took. So an international group of researchers pulled together data from dozens of studies published and unpublished to examine the issue more closely. They took a womans age at first use of MHT, how long she used the medication, and the time elapsed since she last used it into account. The mean age of women starting menopause was 50, which was also the mean age at which women started using MHT.
The researchers found that compared with women who never used MHT, women who did had a significantly higher risk of developing invasive breast cancer. They estimated that 6.3% of women who never used MHT developed breast cancer, compared to 8.3% of women who used the combination drug continually for five years. Thats roughly one extra cancer diagnosis for every 50 users.
Estrogen/progestin Combination Hormone Therapy Causes Breast Cancer
On July 9, 2002, officials from the National Institutes of Health announced that one form of hormone therapy , Prempro, was found to cause breast cancer in previously healthy women. These women were volunteer participants in the Women’s Health Initiative, the largest and longest trial ever of estrogen therapy and HT. The WHI began in 1991 as the first randomized clinical trial to look at the long-term health effects of post menopausal hormone therapy. Just over 16,000 women participated in this section of the trial. Half of the trail participants were given an estrogen/progestin combination in the form of Prempro, and the other half was given a look-alike placebo with no active ingredients. Prempro is a combination of a synthetic estrogen with a progestin .
By the time the trial was stopped, women had been taking their pills for an average of 5.2 years each. During that time, 166 women taking the hormone combination developed invasive breast cancer, compared to 124 women on placebo, an overall increase of 26 percent. Another way of expressing the increased risk caused by Prempro is that each year, among 10,000 postmenopausal women taking estrogen/progestin, eight more will have invasive breast cancer. This increased risk of breast cancer does not appear until the hormones have been taken for at least two years. It also appears that the risk continues to increase with longer use.
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Not An Elixir Of Youth
Hormone therapy is not a magic bullet or an elixir of youth, and it shouldnt be used willy-nilly, Manson says.
But women who are suffering with menopause symptoms should not be denied hormone therapy, she says, unless they are at increased risk of cardiovascular disease, breast cancer or other estrogen-sensitive cancers.
The pendulum has swung widely from the perception that hormone therapy is good for all women to the perception that its all bad for all women, to now a more appropriate place in between where hormone therapy is perceived to be good for some but not all women, Manson says. Were recommending that hormone therapy be used for the duration that its needed to address symptoms at the lowest effective dose and with ongoing reassessment of the balance of risks and benefits.
The time to start therapy is as soon as the symptoms start. Intervening earlier, rather than later, actually seems to carry less risk, Santoro says.
Once symptoms start, they are unlikely to get better soon. On average, the menopause transition lasts about four years, Santoro says. Some women have symptoms that persist even longer, however. Although there are exceptions, most women wont go through menopause before 45, Santoro says.
If youre 45 or older and starting to have hot flashes, night sweats or mood or sleep changes, it could be your hormones and it might be time to start some active management, she says.
Herbs And Supplements During Menopause
Many over-the-counter natural products are promoted in stores and online as helpful with menopausal symptoms. These include vitamins and soy-based and herbal products . There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements . They have not been evaluated by the Food and Drug Administration to be sure that they work or even that they are safe. Some supplements have been tested in small clinical trials, but often the studies only looked at taking the substance for a short time , so it isnt clear how safe it would be if taken for a long time. Another concern has been applying the results of a study of a particular version and dose of a supplement to others that werent tested.
Most of the plain herbs that are touted for menopausal symptoms carry a low risk of harm for most women, but some can interact with other drugs and/or cause unexpected problems. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use.
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The Optimal Type Of Hrt
There is now evidence demonstrating that transdermal estrogen in association with natural micronised progesterone represents one of the optimal HRT regimens.6 Transdermal estrogen is the preferred route of administration because, in contrast with oral estrogen, estrogen as a patch or gel is not associated with an increased risk of venous thromboembolism. It can be safely given to women who have a history of migraines, gallbladder disease, diabetes, or who are obese. The optimal progestogen is micronised progesterone which is body identical. This usually has less side effects associated with it compared with the older progestogens.7 In addition, there is no increased risk of breast cancer for the first 5 years of taking estrogen with micronised progesterone.8
Are Bioidentical Hormones Safe
The bioidentical hormones that are approved by the FDA have been tested for safety. They have passed the FDA’s strict standards and are safe for people to use. Like all hormone treatments, there are risks involved. You should weigh the pros and cons of even the FDA-approved bioidentical hormones with your healthcare provider.
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Who Are The Two Professors Of Gynecology
Both Drs. William T. Creasman and Philip J. DiSaia are highly regarded academic professors of Obstetrics and Gynecology, and authors of medical textbooks of Gynecologic Oncology and Womens Health . They first advised in the 1980s that hormone replacement was beneficial for the breast cancer survivor, and did not increase breast cancer recurrence. Over the many decades of their careers, they have written extensively about hormone replacement in the breast cancer survivor. Left Image: Courtesy of William T. Creasman and Philip J. DiSaia Receiving Award for Excellence in OB Gyne Surgery.
Three Cases Of Endometrial Cancer Associated With Bioidentical Hormone Replacement Therapy
We describe three women who developed endometrial cancer after taking bioidentical hormone replacement therapy to relieve menopausal symptoms. Although pharmaceutical HRT is a well established and tested therapy, little is known about the quality control, safety and efficacy of bioidentical HRT. Women should be advised to avoid bioidentical HRT, and those who continue to use it should receive regular endometrial surveillance.
A 71-year-old non-diabetic woman had been on some form of hormone replacement therapy since the age of 49 years. She took oral oestrone sulfate 1.25 mg daily and medroxyprogesterone acetate 10 mg for at least 10 days a month for 8 years. For the next 2 years, she used a 3.2% compounded topical progesterone cream . In December 1997, she had some irregular vaginal bleeding, which was investigated by diagnostic hysteroscopy and curettage. The tissue diagnosis was atrophic endometritis.
Between June 1998 and July 2002, she used bioidentical HRT as troches. Each troche contained: oestradiol, 1.75 mg progesterone, 300 mg testosterone, 4.5 mg and dehydroepiandrosterone , 5 mg. The initial dose was half a troche per day, dissolved in the mouth.
Between July 2002 and December 2004, she used one-eighth of a troche in the morning and one-quarter in the evening. Each troche contained: trieste , 3.0 mg progesterone, 400 mg testosterone, 1.5 mg and DHEA, 5 mg.
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Is Estradiol The Same As Progesterone
The US Food and Drug Administration has approved a number of preparations of bioidentical estradiol and progesterone, which are molecularly identical to the structure of the hormones generated by the human body. They have been through testing for safety and purity and to be sure each dose has the same amount of hormones.
Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
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Bioidentical Hormones Linked To Endometrial Cancer
Bioidentical hormones have been touted as the safe, gentle, and effective alternative to traditional hormone replacement therapy , and have become especially popular since HRT has been proven to increase risk for cancer, stroke, and other significant health problems. The medical community has long warned that there is insufficient evidence to merit these claims for safety and efficacy, however, and their caution has now been justified: new research published in the Medical Journal of Australia has linked use of bioidentical hormones with three cases of endometrial cancer.
Do Bioidentical Hormones Cause Cancer
Bioidentical hormones are a hotly debated and controversial topic. They are often used to treat menopause related symptoms even though some experts suggest that they cause cancer. Many women wonder if there is any real correlation between use of bioidentical hormones and cancer. Continue reading to learn more about this divisive topic.
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The Book That Made Hormone Therapy Famous
Without estrogen, can you still be feminine? It may sound like a crazy question today, but a book published in 1966, Feminine Forever, had women asking themselves if they could. Author Robert A. Wilson wrote that taking estrogen would allow a woman to remain feminine forever, but if she didnt do so, she would not.
Wilson claimed that menopause was a preventable event, because women could simply add back the estrogen their body was no longer making by taking hormone pills. With this therapy, a womans breasts and genital organs will not shrivel. She will be much more pleasant to live with and will not become dull and unattractive, the book claimed.