Hormones: Yes, no, maybe — ugh

Now that the Women’s Health Initiative reversed its earlier theory that hormone replacement therapy (HRT) could cause stroke and heart disease, interest in hormones has rebounded. New guidelines state that hormone therapy is fine for women who are symptomatic but should be given for the shortest amount of time with the lowest dose, and many women have turned to a compounding pharmacist to get what is called bioidentical hormone therapy.

Bioidentical (also called natural) hormones are identical to hormones produced in your body, and doses can be tailored to the individual patient. No large trials have taken place yet, but so far bioidentical hormones seem to work well for most women. However, creating individualized hormones for one woman at a time doesn’t meet the definition of manufacturing as described by the FDA. In other words, bioidentical hormones are not FDA approved.

Whether you’re still taking synthetic hormones (those made by drug companies) or bioidentical hormones, some risk is part of the equation. Any decision you make is very personal and comes down to a risk/benefit discussion with your healthcare provider.

Synthetic hormones come in pills, creams and patches. Bioidentical hormones come in creams, troches and pills. Bioidentical hormones are mixed by the compounding pharmacy depending on your healthcare provider’s prescription. Synthetic hormones are manufactured in predetermined doses. Most pharmaceutical companies now have smaller doses available in pills, patches and creams.

Data suggest that transdermal patches may be safer than pills because they bypass the liver. They may also be less likely to cause blood clotting, and you can use them for small doses. Estrogen can even be compounded for use in the vagina; commercial creams are available to help with vaginal dryness, too.

Compounding pharmacies can also make testosterone cream in varying doses to combat the common complaint about decreased libido in menopausal women. Testosterone cream gets mixed reviews from my patients: Some swear by it and others don’t notice a difference.

Make sure you remember this: Bioidentical hormones mimic what’s in your body, but they aren’t without risk. I recommend using a small dose for the shortest amount of time. Usually, your estrogen needs decrease over time.

I recommend that women start hormones sooner rather than later. Doing so seems to reduce any risk that may exist. If you have had breast cancer or some other cancers, you aren’t a candidate for hormone therapy.

Send me your questions about hormones. Or about any other women’s health topic.

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