Marcella Mee refers to her hot flashes as “glowing.” When the 51-year-old began having spotty periods two years ago, there wasn’t much else to suggest she was heading into menopause. “I would heat up a little bit. My face would get a little sweaty, maybe I’d have to take a blanket off at night,” remembers Mee, a Los Angeles-based yoga teacher. “Whatever they were, they weren’t invasive.”
Not long ago, even women like Mee—the lucky 20 percent or so who breeze into menopause, joyfully tossing their tampons in the trash—would have considered hormone replacement therapy. Hailed not only as a menopause panacea, but a way to prevent future heart disease and osteoporosis, there hardly seemed a reason not to be on it. In 2001 alone, doctors wrote 45 million prescriptions for Premarin, a synthetic estrogen derived from the urine of pregnant mares. Few imagined it would turn out dangerous, says Shelley Wroth, MD, an assistant professor of obstetrics and gynecology at Duke Integrative Medicine. “We were saying this is the best thing you can do for yourself and everyone should be taking it forever.”
The hormone heyday came to a crashing halt in 2002, when the Women’s Health Initiative (WHI), a colossal government-funded study, found that HRT, specifically Premarin combined with progesterone, significantly ups your risk of breast cancer, heart attack, strokes, blood clots and Alzheimer’s disease. Overnight, the anti-aging miracle drug became tantamount to smoking a pack a day.
Not so fast, says Erika Schwartz, MD, a New York-based expert in bioidentical hormones and author of The 30 Day Natural Hormone Plan (Warner Books, 2004). “Not all hormones are bad. The Women’s Health Initiative did not study bioidentical hormones, and that was a huge flaw.” Bioidentical hormones, which are extracted from soy and yam oils, are molecularly identical to the ones women make in their own bodies. In the aftermath of the WHI, interest in them as a possible way to combat menopause symptoms without the serious risks of synthetic hormones has surged. In 2009, Oprah Winfrey said that after three days on bioidentical estrogen, “The sky was bluer, my brain was no longer fuzzy, my memory was sharper. I was literally singing and had a skip in my step.”
And while that endorsement is likely enough to send most menopausal women racing to the pharmacy, “There is still a lot of confusion and a number of open-ended questions about hormone therapy,” says Wroth. For instance…
Are bioidentical hormones really safer? In theory, yes. Most of the cells in our body have hormone receptors, Schwartz explains. If you corrupt those receptors with horse’s urine, or any hormone that doesn’t look exactly like what the receptor is designed to bind, it will change the way the cell reacts. “Unfortunately, our bodies get used to strange and bad things,” she says. “Even if your body doesn’t react in the short run, it will react in the long run. How? It makes blood clots, strokes, heart attacks and cancers.” Wroth says that because high-quality studies are lacking, it’s tough to say definitively whether bioidentical hormones are safer. “We are talking about the same types of sex steroid hormones that increase some risks and decrease other risks,” she says. (One positive outcome of synthetic HRT, it does decrease the risk of hip fractures and colon cancer.) “It has to be an individual decision. For women having menopause symptoms, it may be worthwhile in terms of quality of life to consider using a low dose for only the time it takes to relieve symptoms.”
Are bioidenticals more natural? “The estrogen in Premarin, which is a conjugated equine estrogen, is absolutely natural to horses, just not to us,” says Wroth. “It contains at least 10 forms of estrogen our bodies have never seen.”
If bioidentical hormones are made from soy and yam, why can’t I just add more of those to my diet? “You could eat a yam forever and never get any hormones out of it,” Schwartz says. The same goes for the all-natural yam creams you find at health food stores. “Unless they’ve undergone pharmaceutical processes, our bodies can’t use them.”
There’s some evidence that the phytoestrogens in soy stimulate breast tumor growth. Won’t bioidentical hormones made from soy do the same? “The soy in edamame or tofu is not the same as the soy in bioidentical hormones,” explains Schwartz. “Think of it this way: Digitalis is a hugely popular drug for heart disease that comes from the plant foxglove. If you ate foxglove you would be poisoned.” Apply the same rationale to soy. “Eat too much soy, and the estrogen may negatively affect your breast tissue. But take the oil out of soy through pharmaceutical processes and come out with estradiol, and it can save you.”
Is there a form of bioidentical hormones that works best? Both Schwartz and Wroth are fans of transdermal preparations, which come in a patch, gel, spray and vaginal creams. They absorb quickly and contain smaller doses of hormones per application. If those don’t work consider switching. “We have so many options to try and fit what works best for each individual woman,” says Wroth. Avoid oral estrogen, however, which moves through the liver and stimulates C-reactive protein, associated with heart disease and stroke.
What’s the difference between standardized bioidentical hormones and compounded forms? Most patients start with standardized forms, which are FDA approved and are more likely to be covered by insurance. “If a woman can’t tolerate the standardized doses or delivery methods, she might consider a compounding pharmacy,” Wroth explains. While there is more flexibility—your doctor knows exactly how much of the active hormone you are getting. Wroth cautions that success “comes down to a physician having a strong relationship with the compounding pharmacy and testing frequently, so she knows how a woman’s hormonal levels are changing.”
How much do we really need to be supplementing with hormones at all? “The question is, how handicapping is menopause?” asks Schwartz. “And if it is, take hormones without a second thought, as long as they are biodentical and you’re working with someone who knows what she’s doing and cares about you.” Hot flashes should not cause you to go into hiding. “I believe that’s how women have been kept down for hundreds of years, because we dropped out as soon as we got hot flashes, got fat, and couldn’t think straight.” It’s up to the individual, says Wroth. “Some women stop bleeding and say, this is the best freaking thing that’s ever happened to me. And for other women, their world stops. To try to give the same answer to each of those women with radically different experiences in every aspect of their life is ludicrous.”
Ed. Note: This story is the first in a two-part series. Look for Part II on men’s hormones.
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