In Part 1, Part 2 and Part 3 of this series, I’ve said just about everything I know, or you would care to know, I expect, about HRT. But before we leave this topic, I need to say…
A Few Words About Bioidentical Hormones
One concerning impact of the Women’s Health Initiative has been the wholesale marketing of so-called “natural” hormone products to women as the safer alternative to Prempro. These “bioidentical hormones” are manufactured replicas of the same molecules our bodies use. They can be found in the FDA-approved HRT products such as Climara, Vivelle and Prometrium, to name a few.
Many women have the misguided belief that when these same compounds are made in a smaller local compounding pharmacy, they are somehow safer and better than Prempro or the FDA-approved products. There is absolutely no data to support this claim. So, until someone does a placebo-controlled, randomized clinical trial to prove otherwise, estrogen is estrogen, whether it comes from plants, mares urine or the moon.
Don’t get me wrong – I am more than happy to prescribe “natural” hormone replacement. Estrogen is estrogen, after all.
But I will not act as if somehow this stuff is risk-free and safer than it’s synthetic counterpart, or hand it out like candy to every woman who comes into my practice looking for the fountain of youth. I treat it the same way I treat Prempro. That means you can have it if you need it, and as long as you understand the potential risks as we know them today, and the benefits as they have been proven to date. The rest is all hype as far as I am concerned.
The bio-identical hormone crowd have found a new guru in Suzanne Somers, whose books tout the age-defying wonders of bio-identical hormones. Suzanne takes these hormones herself, and sells them as the risk-free answer to the problems of aging, from hot flashes to wrinkles to weight gain to Alzheimers.
Look, I love Suzanne, but she is out of control with this hormone thing and someone has got to rein her in. Here’s a quote from the cover of her latest book “Ageless”:
“The second half of life can be wonderful. I know it because I am living it. This new approach to health gives you back your lean body, shining hair, and thick skin, provided you are eating correctly and exercising in moderation. This new medicine allows your brain to work perfectly and offers the greatest defense against cancer, heart attack, and Alzheimer’s disease. Don’t you want that?”
Somers’ books are the new Feminine Forever, except that they tout bio-identical hormones instead of Premarin. And, just as Femine Forever was a marketing tool of Wyeth, Suzanne is being used as the marketing tool of the anti-aging industry. Her own use of the hormones, as well as her sincerity (and I do believe she is sincere) only make her message that much more appealing.
But we can’t hold Wyeth’s feet to the fire, and then turn around and give Suzanne and her friends a free ride. Unfortunately, this group appears to be operating under the radar of both the FDA and the media, both of whom appear to be ignoring the problem. The media, in fact, is part of the problem, letting Suzy hype her message on every talk show known to man, with nary an opposing viewpoint.
Fortunately, Somer’s book has not influenced mainstream medical practice. But it has convinced a fair number of women to go to their doctors and ask for natural hormones to fulfill some vague notion they have of health, youth and beauty. Perhaps they want look and feel like Suzanne. (This reminds me of the movie Shampoo where the little old lady sits in Warren Beatty’s chair holding up a photo of Princess Diana, saying “I want to look like her.”)
More than a few patients have arrived to their appointment toting Suzie’s book. It can take a lot to get them to be specific about what it is they feel they need hormones to treat, and to understand that natural estrogen is indeed estrogen, with all its risks and benefits. And that we are all going to get old (and look old) someday, estrogen or no estrogen.
But then again, I don’t look like Suzanne, so why should they believe me?
Addendum: Good news – the media seem to be getting the message. Head over to Kevin, MD for the links.
Patient information on bioidentical hormone here.
An excellent review article on bioidentical hormones. (Abstract only – full text for a fee for non-members)
Read the National Women’s Health Network Fact Sheet on Natural Hormones.
Category: Second Opinions