Sorting Through the Choices For Menopause Hormones

[question everything]

The Wall Street Journal

HEALTH JOURNAL
By MELINDA BECK

Sorting Through the Choices
For Menopause Hormones
March 11, 2008; Page D1

Amid all the confusion over hormone-replacement therapy for women, one key aspect is often overlooked: Not all HRT products are the same. The big Women's Health Initiative that has been generating headlines since 2002 studied women using Premarin and Prempro, both made by Wyeth, which were the state-of-the-art hormone drugs many years ago. Today, estrogen and progesterone are available in forms that are much closer to what women lose in menopause. While the Food and Drug Administration has said it thinks all HRT products pose the same risks, a growing number of doctors and patients prefer the newer varieties.

Bear with me for a brief biology lesson.

Women make three kinds of estrogen. The predominant one from puberty to menopause is 17-beta estradiol, which is involved in over 400 functions in the female body, from skin to hair, bones, heart and brain. The estrogen left after menopause is estrone, made primarily by body fat. Some researchers suspect that estrone may be responsible for the higher risk of breast and endometrial cancer in women who are obese. The weakest estrogen is estriol, produced by the placenta during pregnancy and not normally present in measurable amounts at other times.

Premarin, approved in 1942, is nearly 50% estrone. It's made from pregnant mare's urine and contains several horse estrogens not found in humans. Though sales have fallen sharply since 2002, when part of the WHI was halted out of concern for heart-attack risks, Premarin remains the best-selling estrogen in the U.S. But a number of FDA-approved patches and gels that deliver solely 17-beta estradiol are gaining market share. Since "transdermal" forms don't have to pass through the liver, as Premarin does, they pose less risks for blood clots that can cause stroke and heart attack.

(snip)

Women who take estrogen and still have a uterus need to take progesterone to guard against endometrial cancer. But the synthetic version used in the WHI --medroxyprogesterone acetate, or MPA -- has been linked to unpleasant side effects such as moodiness, breast tenderness and bloating. "It's PMS in a pill," says Dr. Redmond. He also notes that in the WHI, the increased risk of breast cancer was found only in the women taking Prempro, which combines MPA and Premarin. Women taking Premarin alone had a 33% decrease in breast-cancer risk. A number of doctors have switched to Prometrium, a natural form of progesterone approved by the FDA in 1998, which has different pharmacological properties and fewer side effects.

(snip)

Indeed, since 2002, many women have flocked to "bio-identical" hormones made by compounding pharmacies, believing that they pose fewer risks than traditional hormones. These BHRT blends often contain high concentrations of all three estrogens and progesterone -- generally made from plant sources, as are the estradiol products. In January, the FDA warned seven such pharmacies to stop making unsubstantiated marketing claims that their products are safer and more natural than traditional hormones. The FDA also told compounding pharmacies to stop using estriol, since it isn't FDA approved. BHRT proponents say that women should be able to choose whatever hormones they want to use. Actress Suzanne Somers has been an energetic booster. "My libido is rockin', my weight is perfect, my hair has shine and luster, my skin is less wrinkled than my contemporaries. I have energy, passion, my brain is sharp; no senior moments for me," she wrote in an email. "Before I started on bioidenticals, I could not make any of these claims. In fact, it was just the opposite."

(snip)


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[havocmom]

1. My current physician suggested HRT cream. I am not going for it since an herb helps my flushes

and he hasn't done any blood work but wants me to use HRT! :wtf:

Years ago, I was fortunate to have a GYN who was also an endocrinologist and she didn't prescribe ANY hormone replacement without a good look at what was actually in MY blood. Having the therapy based on personal chemistry rather than supposition and guesses worked well for me. Turned out at that time there was plenty of estrogen but virtually no progesterone. If I had a doctor who didn't bother to really get the facts back then, it is likely I would have been put on HRT that was mostly, if not all, the hormone I had in abundance. Problems would have increased, along with associated risks of adding estrogen.

I STRONGLY recommend getting a doctor who actually works with what conditions are in YOUR body at the time and not writing 'scripts based on guesses, beliefs, or tendency to take the advice from drug company reps who talk to the doctors but have never met YOU.

The right therapy for YOU can be so much better than the latest fads and trends. ;)

FWIW

[Emillereid]

2. I have been using a compounded product called bi-est for years and am doing

very well on it. I also use prometrium. Bi-est is mainly estriol with a little estradiol thrown in. They had better leave my estriol alone,

Research from Europe and Japan suggest that estriol is actually protective against breast cancer as is the real mccoy progesterone found in prometrium.

[BonnieJW]

5. That's what I use.

Also use progesterone cream. I've been using these for 9 years and feel great. I don't plan on quitting ever.

[monmouth]

3. I cannot say this loudly or often enough. STAY AWAY FROM THIS

CRAP...Menopause at times, is uncomfortable. There are personality changes biopolarish, there are hot flashes, etc. These symptoms do not last forever, learn to live with it, have a cup of tea, one or two drinks and chill out. Our grandmothers took an aspirin or whatever and lived through it. Estrogen has too many unknowns. If you don't need meds of any kind stay away from them...

This advice was from my doctor. If you don't need prescription drugs, don't take them.

[fed-up]

4. I learned that certain foods triggered hot flashhes-only had a dozen or so

Soon I will celebrate almost one year period free!!!

no hormones taken....and don't plan on taking any