This is a good question that baffles and troubles me and some of my colleagues, since Bioidentical hormones are available and widely prescribed in many other states.
Bioidentical hormones seem to be safer and more effective than conjugated equine Estrogens (Premarin) and medroxyprogesterone Acetate (Provera). Premarin does provide relief from hot flashes and urogenital symptoms, but it is a nonhuman formulation. It consists of about 11 compounds, each of which is further broken
down and metabolized into several other compounds. You end up with a large hodgepodge of estrogens circulating through the body that, although it does have some benefit, also exerts other effects that are not well defined and may be harmful. In
addition, we cannot monitor the level of Premarin because it is a complex mixture. On the other hand, with Bi-Est and Tri-Est (In either a topical cream or capsule form), one
can measure estradiol after the initiation of therapy to accurately determine the level of that hormone in the blood. That way, your physician knows if he/she is prescribing an inadequate dose or a possibly toxic dose (estradiol in very high doses can be harmful).
The chance of having a malignancy develop or a thromboembolic event occur exists
even when bioidentical estrogens are used, but we can monitor the blood level
of bioidentical hormones and keep their concentration in a physiologic (normal)
Some studies indicate that Premarin builds up bone and protects the vagina, but
others show that estradiol, estriol, and estrone, which are derived from plants and
are identical in structure to endogenous human hormones also provide benefits.
Why use estrogen from horse urine in humans when plant-based derivatives are
identical to human estrogens?
Benefits noted by patients taking
Hot flashes sometimes disappear with the first dose, although more time may be required
and the dosage may have to be adjusted. When prescribed, I recommend that the physician start with a low dosage and work up. An improvement in bone density may require 3 to 6 months. Most patients treated with estrogens feel that they experience an improvement in memory and in generalized mood, and treatment with progesterone reduces irritability and emotional lability.
Is progesterone safe to use in BHRT?
Plenty of evidence points to progesterone as a safe hormone and that it should be the preferred progestin for use in hormone replacement; Many physicians have neglected it. They were taught that progesterone is not absorbed through the gastrointestinal
tract and that it can be administered only intravaginally. Actually, progesterone
is absorbed by the gastrointestinal tract (although it does undergo some first-pass
metabolism), and it works very well when applied in a cream to the trunk or the arms.
Double-blinded studies are still lacking on the use of progesterone in hormone replacement, but there is a great deal of compelling evidence that it may
protect the breast against cancer and benefit the bones, the mind, and the mood. It also does not seem to exert negative effects on the heart. When the storm of phone
calls and e-mails came in regarding the results of the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) trial, I was able to tell all my clients not to worry, because they had not been taking Prem-Pro. That was a tremendous sigh of relief!
Are Bioidentical hormones being used more now in Long Island, since the latest studies were released?
Even with all the negative results of the HERS II trials, many Long Island physicians are still prescribing PremPro. You as the patient do have choices. Enlighten your physician about the Bioidentical hormone option; do your own research and present the possibilities to yourself to make the decision that can affect you for the rest of your life. S&P; Prescription Compounding Services can help you and your physician be guided in the options. For more information or to request a free consult call us at 516-644-2470