For many women, peri-menopause, or the time around when they stop menstruating, can be physically and emotionally draining.
Symptoms can include everything from hot flashes to night sweats to vaginal dryness to change in mood and temperament. For some women, these symptoms are so unbearable they feel they must take something. For others, they are merely a minor disruption, and after the time passes, they move on to the next phase of life.
In short, each woman is affected uniquely. But traditional prescription medications to deal with the symptoms of peri-menopause are relatively standardized. Enter bio-identical hormone replacement therapy.
According to Brenda Plavik, CPHT, of Saveway Pharmacy in Newark, Del., the term “bio-identical” means that “the chemical structure of the compound is identical to the structure of the hormones produced in the human body.”
“Most of these bio-identical hormones are extracted from plant sources, such as soy, yams and rice. Estrace, Climara, Vivelle, Vagifem, Prometrium and Estratest are all examples of manufactured products made from bio-identical hormones,” said Plavik.
And, because they can be compounded to meet individual needs, they can be more effective for the woman taking them. SaveWay Compounding Pharmacy is a licensed pharmacy where all medications are customized formulations prepared specifically for each patient. SaveWay does not dispense commercially available drugs. Instead, each prescription is prepared on-site with the basic chemical ingredients required by the doctor’s order.
“Hormones are potent chemicals and serve as chemical messengers that circulate through the bloodstream to all the tissues,” said Plavik. “Some of the hormones affected during the aging process are estrogens, progesterone, testosterone, DHEA-sulfate, thyroid and cortisol.
“There is a long list of symptoms associated with this period and, although some women may share similar experiences, none will be exactly the same. Even heredity is not an indicator for what to expect,” she noted. “Each and every person will have her own unique experience as her hormone levels start to decline. Just as no two women are the same, neither should their therapy be.”
For women who feel that their symptoms of menopause are enough of a disruption that they must take something, they have long been prescribed a synthetic form of estrogen/progesterone for conventional hormone therapy.
But in 2002, the “estrogen-progestin versus placebo” study at the National Institutes of Health’s Women’s Health Initiative was halted because of reports of elevated risks of breast cancer, heart disease, stroke and blood clots with the use of such therapies.
One woman, in March 2008, was awarded a $27 million judgment against drug manufacturers Wyeth Inc. and Pfizer’s Upjohn unit after a jury said warnings to patients about an increased risk of breast cancer had been insufficient. The company settled last month with two Nevada women who made the same claims, and an estimated 5,000 lawsuits are said to still be pending while the drugs remain on the market.
Despite the controversy, what was not widely reported was that the Women’s Health Initiative trial was on a single drug therapy.
“That study was all done on women taking Premarin and Provera,” explained Dr, Julie Hattier of Beach View Family Practice in Ocean View. “Afterwards, they said maybe the study was flawed — well, duh, it was.”
Premarin is an equine-based drug made from the urine of pregnant mares. In addition to concerns that the unnatural horse estrogen stimulates human breast tissue differently than natural human estrogen, many organizations — including the People for the Ethical Treatment of Animals, HorseAid and Friends of Horses — opposed the medications based on inhumane treatment of mares used to get the urine needed to manufacture the pills.
Investigative studies on the PMU (pregnant mare urine) farms in the late 1990s and early into this decade showed pregnant mares were often forced to stand — for six months or more — in stalls with little or no room to move around and no room to lie down, and were sometimes deprived of water to get the urine need for Wyeth Inc., the world’ eighth-largest drug maker.
The reports also said that the foals born to those mares were generally immediately separated from their mothers at birth, sometimes being sent straight to meat auctions, or fattened on feedlots to sell for slaughter, with the meat mostly exported to Japan.
Ollie Bracken, a retired PMU farmer from Manitoba, Canada, stated in a 1995 interview that he had retired from PMU farming because of the treatment of the foals — often considered a mere byproduct of the urine collection.
“When you have to see a colt being born and then have to destroy it, it’s rough because they’re just babies,” he said. “I just didn’t think it was right to continue what I was doing.”
Regardless of those reports, as of November of 2003, more than 9 million women — a reduction from 12 million in 1999 — were still taking Premarin in some form. But as more information came to light of the inhumane way in which the drug was extracted, and the questionable good it was doing for their health, many women turned to a more natural way of dealing with menopausal symptoms.
“Bio-identical hormones are safe,” said Hattier, in a claim supported by the American Academy of Anti-Aging, of which she is a member and through which she is board certified. “They are not for everybody — some women breeze through menopause and don’t need it. But for many women who suffer through it, they are a blessing.”
Hattier rejected recent reports emphasizing that the FDA has not approved bio-identical hormones. The agency recently sent letters to seven compounding pharmacy operations, questioning the claims made by such operations of safety and effectiveness of bio-identical hormone replacement therapy, or “BHRT” products, based on a “citizen petition” from Premarin and Prempro manufacturer Wyeth Inc. Hattier said, “The FDA doesn’t like it because it can’t control it.”
Hattier, a 16-year breast cancer survivor, and herself a user of the bio-identical hormone therapy, said that, at 52, she feels great. The fact that it is not a “once-size-fits-all pill,” like many of the drugs available for everything from depression to erectile dysfunction to allergies to asthma, is something that patients and Hattier herself can appreciate.
“It’s individual to each person’s needs. It can come in a topical cream formation or a troche (or under the tongue) dissolve, to bypass the liver metabolism.”
As for conventional hormone replacement therapy, Hattier had this to say: “In the 1950s that’s all we had, but it is just not applicable anymore. [Bio-identical hormone therapy] is exactly structured like what the ovaries used to make and to be able to do that — God, what a blessing.”
Other treatments
may be considered
Dr. Kim Furtado, a naturopathic doctor in Lewes, reminded women that while bio-identical hormone therapy is an alternative for people who don’t want to use synthetic hormones, and can be vital to some women in the short term, they shouldn’t be looked at as a long-term solution, as there can be too much of a good thing.
“There are always concerns, whether with bio-identical or conventional therapies, with connections made to heart disease and cancer,” Furtado said.
“In post menopausal women, estrogen and progesterone is made in the adrenal gland,” she explained. “Menopausal symptoms are a sign that the adrenal gland has an insufficient reserve and is being asked to do another job. For short-term management, bio-identical hormones can give the adrenal glands a rest, but for the long term, you have to look at the underlying adrenal gland fatigue,” which she said can be affected with herbs, nutrition, lifestyle changes and looking at stresses in the body and toxins in the environment.
Furtado also noted that some indigenous people that have been studied do not even have a word for “menopause.” She said symptoms may be a sign that a woman’s body is not making the transition as it should.
“In the naturopathic perspective, we look at menopause as a time of transition — the ovarian function does retire, but menopause can be experienced in a healthy way,” said Furtado. “A lot of aspects can help women who are in this transition period happily enter this new part of life, and how she relates to herself, to her family. The body helps us learn about that process. It is an opportunity for a woman to learn about her body.”
“As a naturopathic doctor, you treat the whole person,” she continued. “Use it [bio-identical hormone therapy] if you need to, but do the underlying work of treating the adrenal fatigue.”