Category: Bioidenticals and HRT

by Marcelle Pick, OB-GYN NP

The history behind HRT and new alternatives, such as bioidentical hormones

What is hormone replacement therapy or HRT? Depending on the hormone levels in a woman’s body, HRT is the replacement or the balancing of hormones through various forms of therapy. Today, HRT is commonly referred to as HT or hormone therapy, which many people believe are two completely different conditions or forms of therapy.

For more than 6 decades, menopausal women have been treated with HRT, a synthetic or “nonhuman” hormone, with the intention of keeping women young and retaining their femininity. The very first brand of HRT in America, Premarin, was made up of conjugated equine (horse) estrogens (CEE). However, during the 1950’s, there was a growing concern over this form of treatment, as statistics showed an increase of uterine cancer in women who were using this form of therapy. Many years later, this finally prompted the drug company responsible for manufacturing Premarin, to develop Prempro by adding a synthetic progestin.

Over a period of time, doctors were trained that HRT prevented heart disease, kept women’s skin and brains youthful, built strong bones, and caused very few side effects. The majority of American women experiencing menopause were encouraged by their doctors to start some sort of hormone replacement therapy for their menopausal symptoms of hot flashes, mood swings, insomnia, and weight gain. It was considered malpractice if you did not prescribe HRT for menopausal women for years.

In the later part of the 1990’s, a number of women were questioning the use of HRT. Some of the common questions that arose were: “Did all women need it?” and “Why were all women put on the same dose and not different dosages?” and “What was actually happening to the pregnant mare whose urine was being used as part of Premarin or Prempro?” These women wanted to know if there was another alternative out there and available to them.

However, many women were convinced that HRT was beneficial and would not have considered the possibility of stopping treatment. In 2002, the results of an extensive women’s study (the WHI) looked at the effects of HRT (Premarin and Prempro — neither of which are bioidentical hormone forms), its findings overwhelmed the medical community. Establishing that HRT in fact did NOT decrease a woman’s chance of getting heart disease, but rather definitively increased her risk of blood clotting, stroke and breast cancer. As you can imagine, this was not the kind of news the medical community or patients wanted to hear.

Presently, the controversy continues as to whether the early findings were conclusive, particularly in relation to younger women who initiate HRT during perimenopause. Current research has indicated that that there are differences between the effects for a 50-year-old woman placed on HRT and a woman who begins ten or more years after menopause. Researchers have been reexamining the data from the WHI study to see if there is a subset of women who might benefit from replacement hormones, as well as identifying subsets who should avoid it. Every year, experts hotly debate the significance of each reanalysis — 2006, 2007, 2008 and 2009. At the present time, it is clear that there is a difference between those women that take hormones during menopause and those that are 10 years post menopause. The risks are definitely less for the menopausal woman.

Confusion escalated with the release of the 2002 WHI findings, and massive numbers of women stopped their HRT and began seeking alternative treatments to help them with their menopausal symptoms. Many of these women found that as soon as they stopped taking their HRT, their menopausal symptoms came rushing back. This was a huge disappointment for women who were struggling to deal with their symptoms but they were also afraid of the health risks of replacement hormones, particularly in the synthetic forms. Furthermore, the pharmaceutical companies argued that there were no good or viable alternatives to HRT.

Today, there are many natural methods available that can help women ease the transition off HRT while at the same time provide the body with the care it needs to reduce or avoid menopausal symptoms. For help during this transition period, see our articles about ending hormone replacement therapy.

Bioidentical hormones

Numerous women have turned to bioidentical hormones as a superior form of HRT. These are female hormones that are typically manufactured by our endocrine system, principally our ovaries — estrogen, progesterone, and testosterone — which naturally decline as the ovaries stop releasing eggs. By “bioidentical” we mean that the biochemical structure of the hormone is perfectly identical to the main hormones that are naturally produced in a woman’s body. Neither a horse’s hormone nor an artificially contrived formula, although similar in makeup, can replace what a woman produces naturally.

You may ask ‘Why did bioidentical hormones take so long to come into play?’ Pharmaceutical companies have had to create numerous nonhuman estrogens and progestins in order to patent their drugs, hoping that the small changes made to an estrogen or progesterone molecule would not have a negative impact on a woman’s body. Today, unfortunately, we know that is often not the case. Birth control pills are an example of synthetic estrogens and progestins, and, as any woman who has ever taken them can confirm, each brand has different side effects and there are in fact some women who cannot tolerate birth control pills at all. The same can be said with hormone replacement therapy — bioidentical or synthetic! As we are all different, what works for one may not work or another.

In the 1990’s, pharmaceutical companies started developing and patenting methods of administering bioidentical hormones. One example of this would be the Climara patch, which uses a sticky transdermal hormone delivery system. While Climara was patented in 1994, the estrogen, which is identical to human estradiol, cannot be patented. The patent was obtained by patenting the glue.

Moving into the future of HRT

There are professionals who believe that true bioidentical hormones can only be developed by a compounding pharmacy, and only after measuring a woman’s own hormone levels, and then customizing the dose. In our experience, this approach is only required in a few cases or for a short period in a women’s life. In any case, Mother Nature provides a woman’s body with numerous types of hormones and we cannot accurately reproduce her delivery methods or levels in the body. What we can do is estimate her methods and work alongside her. We can also observe a woman’s symptoms and see if the right prescription has been developed. By helping to implement a good nutritional regime and supplements, appropriate exercise and other lifestyle changes, we have found that many women can manage their menopause symptoms very well!

There are times, however, when a woman can significantly benefit from a small amount of hormone replacement. We always recommend that you, together with your doctor, work through the challenges of menopause, especially if you have severe menopause symptoms, early menopause, or if you are compromising on your quality of life. It is under these circumstances that you will be able to make an informed decision about bioidentical hormones.

 

by Marcelle Pick, OB/GYN NP

Expect to be successful even if you failed the first time

There are many women who seek our help who have suddenly stopped Hormone Replacement Therapy (HRT) “overnight.” But then they couldn’t deal with the explosion of symptoms, so they returned to HRT. They feel frustrated at the need to return to HRT, but at least they’re functional.

What I tell these women is to learn from that setback and to make another attempt at stopping HRT. If they put their support in place first, and then wean off HRT slowly, there is a greater chance that they can successfully stop HRT.

Expect Success If You’re Willing to Work at It

More than 80 percent of the women who participate either at the clinic or online have challenges that are obstacles to helping them to restore their health after they stop HRT. The most common issues are digestive problems (for example, floral imbalance or leaky gut syndrome) and endocrine problems (for example, insulin resistance, adrenal exhaustion, or thyroid disorders). Not surprisingly, these issues all interfere with hormonal balance.

Problems such as these have taken years for the body to develop and they can’t be resolved in a few days. Their effect can be dispiriting to women who are seeking alternatives to HRT. Women often improve and make exciting progress in the first few weeks after weaning off HRT; however, some women find themselves with too many symptoms that remain. The tendency is to blame the lack of hormone and estrogen replacement and say, “This isn’t working.” But in reality, the natural alternative to HRT is working—it’s gradually healing the years that it took for the damaging health habits to create the conditions in the first place. Adrenal function may be one of the obstacles to fast recovery when HRT is stopped.

For many women, who like to be able to “do it all,” stress appears to be unresolvable. Stress can trigger hot flashes, insomnia, weight gain, and other menopause symptoms. The sources of stress in a woman’s life can seem beyond her control. However, we’ve seen repeatedly that women can make their lives less stressful. It is called multi-talking. If you begin to take better care of yourself, you’ll get your strength and energy back. Then you can begin to make more changes that seem easier. And it will be.

Don’t be surprised if you need help, especially when first starting.

Most women know that there are more natural alternatives to HRT, and many of those same women will spend months self-prescribing soy, dong quai, black cohosh, bioidentical progesterone and so on. Each of these herbal or medicinal alternatives can have a positive effect, and they will provide relief for you, but only if you have a few, mild symptoms. Again, those women tend to be fewer in numbers. Most women who self-prescribe get discouraged with the process, and then they don’t know where to turn for additional support.

To find out where you may be, consider taking our Hormonal Health Assessment.

Expect to feel great!

One of the great things about understanding more about our bodies is that we can now view the whole of menopause as a great awakening. Remember this is adolescence in reverse. It is the time in your life when you ask the question who am I and what do I want to do for the next half of my life. And how do I expect to feel.

This is the way that nature intends for you to begin to take better care of yourself now. Over and over, we’ve seen a woman find her voice, learn more about her miraculous body, and begin making choices that work for her. We believe it is up to you to lay the foundation for decades of health, vitality on all levels and happiness ahead.

We’re always happy to welcome new patients at our medical clinic in Yarmouth, Maine, for those who can make the trip.

by Marcelle Pick, OB/GYN NP

In 2002, a government study about hormone replacement therapy (HRT) called the Women’s Health Initiative (WHI), made women acutely aware of HRT side effects and health risks. Since then, millions of women have stopped taking HRT—sometimes suddenly. In a strange twist, it’s usually the same doctor who suggested HRT who is now encouraging his or her patient to stop HRT. Interesting how time can do that even with science.

These doctors, unfortunately, don’t have much advice for the patients who want to stop HRT. In addition, there are often misleading headlines about HRT safety for younger women, and this only creates more confusion. Recently, a woman came to see and asked for my help because her menopause symptoms had returned after she discontinued her estrogen replacement therapy. She said her health-care practitioner just informed her that he didn’t know what to suggest to help her. His best guess was that if she wanted relief from her symptoms, then she would need to start back on the HRT or try an antidepressant. That’s not encouraging for women who are trying to create a better quality of life and take care of their bodies in a natural way. It’s difficult for women to not feel a bit deceived. For those of us who seek and follow a health-care practitioner’s advice, because we trust that they know better than we do what the best options are, it is a surprise to find out that they don’t.

It also might be surprising that a practitioner would not know how to help with this situation, but remember that most practitioners were taught that HRT was a near perfect answer to alleviate symptoms of perimenopause and menopause. As a positive response to this issue, the American College of Gynecology has been developing guidance for gynecologists about HRT withdrawal. However, there is a copious amount of well documented research that exists among complementary and functional medicine practitioners that can help you make better health choices for yourself. So let’s look at an overview of HRT alternatives and what you can expect when and if you want to transition and stop taking HRT.

Can you expect HRT withdrawal problems if you quit “overnight”?

Many women who decide to transition off HRT will just suddenly stop taking it, and this is very stressful for your body. We saw this happen when the study came out, as many women flushed the hormones down the drain several days or weeks after the report was made public. Your body’s internal system has grown dependent on this additional supply. Originally your body could have made its own hormones—right through perimenopause and menopause—but it cut back production when you began HRT. The good news is that your body (the wonderful creation that it is) can resume its estrogen, testosterone, and progesterone production, and it can even develop secondary hormone production sites to compensate for the decrease in hormones from your ovaries. In reality, that is the normal and natural order. However, your body will need time and your continued support to develop those sites.

Another factor to consider is that we believe that the stronger estrogen replacement therapy drugs, such as Premarin and Prempro, actually modify the estrogen receptors in your cells, so they only recognize this strong type of hormones. It takes time for those receptors to get back to their original form and accept natural HRT. For some this may not every happen, but for most it is easily accomplished. The natural HRT can be from your body’s own hormones, bioidentical HRT, or plant-based hormonal support in the form of phytotherapy.

Consequently, the type of synthetic hormones that you have taken and the length of time that you have been on them are both very important factors to consider when you stop HRT. An additional factor to think about is how severe your symptoms were before you started HRT. The more severe your original symptoms were, the stronger your HRT would have been, and the longer you used HRT, the more likely it is that you will have symptoms of HRT withdrawal when you quit. The gradual reduction may be more appropriate for you.

Some women are surprised that their symptoms get worse when they stop HRT. And that the symptoms are worse than they were before they started HRT. One major reason is usually because of the “rebound effect” that is a common response to prescription drugs. The second major reason is that women may be taking less care of themselves now than they were before. The third reason is that once the estrogen receptors have been primed they need to be supported in other ways.

Of course, each woman is different. Some women stop HRT suddenly and have absolutely no symptoms of hormone imbalance. They are however, the lucky few. Our clinic’s waiting room is full because most women who stop HRT will experience all over again all the symptoms of menopause, sometimes with more aggression, and they don’t know where to go for relief and support.

Expect a soft landing if you take care of yourself

The essential cause of hormonal imbalance is what we call the “inverted ratio.” That’s when the body burden that you place on your body greatly outweigh the support you give it. The basket is too full with demands. If you have symptoms of hormonal imbalance, you have the inverted ratio. The facts about HRT are that it relieves the symptoms, but it will not eliminate the underlying causes. I describe this as what is going on upstream that then created the symptoms.

Your body is a marvelous machine and it has the power to create and balance its hormones at every life stage. However, to do this, it needs adequate support from you. This means rich, healthy nutrition; a well-functioning, digestive system that will optimally absorb the food, and help detoxify the hormones; a robust metabolism; and a manageable routine of exercise and stress reduction. If your hormonal imbalance symptoms are moderate to severe, you can add phytotherapy to this foundation to help stabilize your levels naturally and faster.

So do you think this sounds impossible?  Let me give you a little help to make it happen.

If you understand that your body needs the extra support while you’re going through the HRT withdrawal process, you will be better able to deal with any symptoms that might occur. If your hormonal imbalance is severe, then you’ll need more support, in fact much more support. After you’ve completely stopped taking HRT, then the maintenance phase will require less support.

Ideally, you should put this plan of support in place before you begin to wean off HRT. We advise the women we see to allow 2–4 months, if possible, for the weaning process. This will allow for the body to adjust to the changes. However, some women require a little less time, some a little more time. If you proceed with care, there is a great possibility that you will feel better than you ever have in your life.