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Bioidentical Hormones

A new book, The Sexy Years by Suzanne Somers, has just hit the best seller list and I have had countless questions about it. Ms Somers relates that she was diagnosed with breast cancer several years ago but opted to continue to take hormone replacement. The instant success of her book shows how desperately women need usable advice about hormones. The WHI study and accompanying publicity provided important information (though the results have been widely misinterpreted) but completely ignored the plight of the millions of women who feel terrible without estrogen. Whether or not to take estrogen at menopause remains a dilemma for many women because at this time no other medication or supplement will consistently restore well-being during an uncomfortable menopause transition.

Ms Summers emphasizes use of “bioidentical hormones,” by which is meant estrogen and progesterone which are identical to those normally made by a woman’s ovaries.

I fact bioidentical hormones are not new; I have been prescribing them for menopause for more than a decade. Estradiol, the normal female hormone, and progesterone, have been available in reliable forms for some time. Both are derived from soy and yams. These are the only forms of hormone replacement I prescribe, unless there are very unusual circumstances.

The most commonly prescribed estrogen is still Premarin® which is normal for horses but not for humans. The form of progesterone most widely prescribed is medroxyprogesterone acetate (Provera®), a synthetic. Many women come to hate this artificial hormone which often sends weight up and mood down. Why these non-human forms are still used so often is a mystery to me.

I have to say that I do not agree with everything in The Sexy Years. Nonetheless, Ms Sommers has performed a great service to women by emphasizing the positive effects of hormone replacement and by explaining the importance for each woman of being on a regimen which is individualized for her. I do agree that for women who decide to use hormone replacement, it is logical to use estrogen and progesterone which are identical to those made in the human body. And I absolutely agree with her positive message: it is possible to feel great in the peri- and postmenopausal years.

As to whether bioidentical hormones are safer, we can be hopeful but do not yet have studies to establish this. Any decision to take estrogen should include a careful discussion with your doctor about possible risks.

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