Why I Recommend Pharmaceutical Bioidentical HRT
Let me tell you why I recommend bioidentical HRT. It is a therapy I have utilized in the 100,000 female patient visits that I have managed over the past 29 years since pharmaceutical topical estradiol was first introduced in 1986. I have had ample opportunity to see what therapies achieve results and what women tolerate with the fewest side effects.
An important concept regarding hormone therapy is that unlike most other prescription medicines, hormones are part of our biological make-up and are essential to the intrinsic function of our bodies. We’ve learned in previous chapters of the myriad biological actions of estradiol, progesterone and testosterone in a woman’s body. We have also seen that many of these actions are mediated through downstream byproducts of estradiol. So doesn’t it make more sense to restore what’s deficient rather than cluttering this complex, intricate system with an imitation, “wannabe” hormone?
HRT Is Not Without Risk
Female hormones have been in our bodies since we went through puberty. It is part of our original design since the beginning of time. Yes, there are some safety concerns about estrogen. So logically, if you’ve made the decision to take HRT, it makes sense to choose what appears to be the safer option. I have tried to fairly represent that bioidentical HRT is not without risks but the risks appear to be less with topical estradiol and progesterone than with imitation HRT. Should we wait another 20 years until large definitive, double-blind, placebo-controlled randomized studies produce more data in support of these findings? While some of the data are not supported by such scientifically rigorous studies, as a prudent physician needing to care for my patients today, I feel compelled to act on what is currently known and act accordingly, making adjustments as additional new studies provide us with more information.
The Goal Of Endocrinology
To those naysayers who contend that pregnant horse urine is “natural,” I choose the very same hormones, estradiol, progesterone, and testosterone that are present in a human woman’s body, not hormones from animals. Furthermore, you can take any natural substance that exists in the body, give it in excess amounts, and cause disease or death. For instance, something as essential to life as oxygen and water, given in excess, can be fatal. It is all about balance and respecting the normal physiology of the body. That is the goal of Endocrinology, a specialty that deals with diagnosing and treating diseases caused by too much or too little hormone(s.)
Bioidentical HRT is Often Given a Negative Connotation
Women are often surprised to learn that the bioidentical hormones, estradiol and progesterone, are available from pharmaceutical companies. That’s because the term “bioidentical hormone replacement” is often given a negative connotation. It often becomes a clash between pharmaceutical companies and compounding pharmacists.
Most pharmacists dispense prescription medications that are manufactured by pharmaceutical companies. Compounding pharmacists are trained to make individual hormone products from bulk raw materials. The physician writes a prescription for a particular hormone preparation and the pharmacist mixes it to those specifications. Pharmaceutical companies correctly assert that they have to meet higher manufacturing standards for quality control than compounding pharmacists. Pharmaceutical companies complain compounded hormone products are often given to women without the attendant information that outlines risks.
I Will Not Prescribe Prempro; or Any Oral Estrogen
I have no bias against pharmaceutical companies. They provide us with lifesaving and innovative therapies. However, I won’t prescribe the most commonly prescribed HRT – Prempro or any oral estrogen – because it is not as effective as topical therapy and is associated with more side effects. As an advocate for my patients, it is my ethical responsibility to prescribe the safer, more effective therapy, and that principle governs all my professional decisions. The appropriateness of my choices has been demonstrated in the medical literature, and I have personally observed it in the thousands of patients I have treated over my clinical career.
Given The Choice I Will Always Choose Pharmaceutical Bioidentical
Having been a pharmacist, I am very supportive of the important role of compounding pharmacists. However, if I have a choice of a compounded or pharmaceutical bioidentical hormone product, I will always choose the pharmaceutical product because they have to meet stricter standards of quality control, and I achieve more consistent results when I monitor blood levels.
Compounding pharmacists play an important role in providing products for patients with allergies and other special needs. They can also compound products that are not commercially available. Pharmaceutical companies sometimes withdraw drugs from the market not because of poor efficacy but because there may not be enough market demand for their product. If a physician chooses to prescribe compounded hormones, it is imperative that blood levels be monitored. These patients need to be monitored in the same manner as any other patient receiving HRT. Patients also need to be informed that compounded HRT carries the same risks as pharmaceutical bioidentical hormones.
Talking to Your Doctor
Informing yourself of the risks and benefits of bioidentical HRT is important but since these are all prescription medicines, you will ultimately require the cooperation and advice of your physician. Your own physician can advise you if you have particular health issues which constitute a relative contraindication to bioidentical HRT. If you are having many menopausal symptoms, he/she will be more likely to prescribe HRT. All physicians want the best for their patients and are usually willing to listen and consider reasonable requests. If your physician believes that hormones are in your best interest, pharmaceutical bioidentical HRT is a good choice. Make a list of all your questions ahead of time and tell the scheduling person that you want an appointment to discuss hormone therapy. If you found Outliving Your Ovaries helpful, take a copy to your physician. Do not hesitate to seek out additional medical opinions about your individual condition – caring physicians will assist you in doing so.
Outliving Your Ovaries can increase your awareness of how hormones contribute to optimal health. Healing starts with your belief that it is possible. Use my book as a guide to educate yourself about your treatment options so you can ask meaningful questions and become a better partner in working with your physician.
Excerpt from “Outliving Your Ovaries” © 2012 by Marina Johnson MD.
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