BIOIDENTICAL HORMONES - NEWSLETTER #2

Bioidentical Hormones – Facts and Myths of Hormone Therapy for the Menopause

Facts:

· Bioidentical hormones are ones that have the same makeup as those produced by the ovaries – the term “natural” is frequently used to mean the same as “bioidentical.”

· Bioidentical hormones are available in FDA-approved products from your regular pharmacy.

· You do not have to get bioidentical hormones from a compounding pharmacy.

Myths*:

· Bioidentical hormones are only available at compounding pharmacies.

· Compounding pharmacies are FDA-approved. Bioidentical hormones from a compounding pharmacy are safer than FDA-approved products.

· The best way to find out what hormone therapy should be used is by saliva testing.

*All of these statements are FALSE!

 

What about compounded hormones versus those available in pharmacies that distribute FDA-approved hormones?

Compounding pharmacies are regulated by the individual 50 states, not the FDA – this can result in a wide variation in the quality, purity, safety, and dosage of the products. Frequently, compounded hormones contain products that are not FDA approved. Two major, respected medical societies, The American College of Obstetricians and Gynecologists and The North American Menopause Society, do not recommend the use of compounded hormones. Additionally, these societies do not recommend the use of saliva testing to determine hormone levels. A number of years ago, I was a member of a national medical society (AAAAM) that promoted the use of compounded hormones. At a national meeting of this society, I was listening to a number of speakers on the program and realized that a majority of the physicians speaking had a financial interest in the topics about which they were talking. As far as I am concerned, this invalidates the information.

The Women’s Health Initiative study showed hormones are dangerous.

A large medical study, the Women’s Health Initiative (WHI), in 2002/2004/2005 turned our approach to hormone therapy upside down.  The WHI showed an increased risk of heart attack, stroke, and breast cancer when taking hormone therapy.  There were several problems with the study.  Many women were older (years after their menopause) when they started the hormones. We now know hormone therapy should be started at or near the time of menopause. Also, the only hormones studied were oral pills called Premarin and Prempro. These hormones are not bioidentical – Premarin is a mixture of estrogens from pregnant mare (horse) urine; Prempro contains the same estrogens plus medroxyprogesterone acetate, a synthetic, non-bioidentical, progestin. The WHI did show that this progestin, not the estrogens, was responsible for a small increase in the risk of breast cancer.

What can hormone therapy do?

· Reduce menopausal symptoms including hot flashes, night sweats, dry skin, vaginal dryness, and mood swings

· Reduce the risk of heart attack, stroke, and osteoporosis

What hormones should I take?

· Estrogen in the form of estradiol provides most of the benefits of hormone therapy.

· Progesterone should be used by women who still have a uterus (have not had a hysterectomy) to reduce the risk of uterine cancer – an alternative is to wear an IUD containing a progestin call Mirena.  Recent data also suggest that women who have had a hysterectomy and still have their ovaries should use progesterone to reduce the risk of ovarian cancer.

· Testosterone has been shown to increase libido (sex drive), but recent attempts to get FDA approval have failed due to concern over an increased risk of cardiovascular disease (it does not make sense to increase sex drive and die of a heart attack).

· Other hormones are promoted by some physicians, but have not received FDA approval for hormone replacement.  The most common ones are DHEA and growth hormone.  

Does it matter whether I take a pill, use a patch or gel, or take a shot?

The options for estrogen hormone therapy include:

·  a pill,

· transdermal therapy (through the skin – a patch, gel, lotion, or spray),

· a vaginal preparation (a ring, cream, or a suppository),

·  an injection, or

· a pellet.

The pill is absorbed through the stomach and makes a first pass through the liver before going into the system. Several medical studies have shown the first pass through the liver (by the pills) causes a 4-fold increased risk of blood clots, not seen with transdermal therapy.

 

How long should I take hormone therapy?

If you choose to take hormone therapy, it should be started at the time of natural or surgical (after removal of the ovaries) menopause. Delay in taking hormone therapy may increase the risk of heart attack and stroke, rather than reduce it. Once you begin hormone therapy, there are two different opinions of how long you should continue the therapy. One side says take the medication only long enough to treat symptoms such as severe hot flashes and night sweats. The other side says take the medication as long as you live to reduce the risk of cardiovascular disease and osteoporosis. Also, there are medical studies suggesting hormone therapy may reduce the risk of Alzheimer’s disease. You should discuss your options with your ObGyn.

 

IN THE KITCHEN WITH DR. B. – Black Bean Quesadillas with Corn Salsa

It is fun to try cuisines that are different from your day-to-day food. This is an easy, quick Tex-Mex recipe adapted from Gourmet (Sept 2007) and Bon Appetit (Aug 2009).

Corn Salsa

2 red or orange bell peppers quartered

3 ears of corn, husked

1 bunch green onions, roots removed

4 tablespoons olive oil

2 garlic cloves minced

1 teaspoon ground cumin

2 tablespoons fresh lime juice

1 tablespoon bottled chipotle hot sauce

2/3 cup chopped fresh cilantro

Have grill (gas or charcoal) on high heat.  Brush vegetables with 2 tablespoons olive oil. Grill vegetables until charred in spots, turning regularly, about 5 minutes for onions, 10-15 minutes for peppers and corn. Cool until can be handled safely. Cut peppers into 3/8 inch square pieces (this is the most tedious part of the recipe). Cut the corn off of the cob. Heat the remaining 2 tablespoons oil in a cast iron pan (or any small heavy skillet) over medium heat, add garlic and cumin, cook for 30 seconds (do not let the garlic brown). Pour this mixture into a large bowl, mix in lime juice and hot sauce, mix in vegetables, season with salt and pepper, cool completely, and add cilantro. In addition to spooning the salsa over quesadillas, it goes well with chips and grilled chicken, seafood, and pork.

Black-bean Quesadillas

1 can (19 ounce) black beans, rinsed, drained, and “smushed” a bit

8 ounces finely-grated Cheddar or jack cheese

3/4 cups chopped cilantro

1/2 cup chopped white onion

8 10-inch flour tortillas

1 tablespoon vegetable oil

Heat a heavy, ridged grill pan (a cast iron skillet works) over medium heat until hot. Gently mix beans, cheese, cilantro, and onion together. Divide mixture evenly over ½ of each tortilla (about ½ cup each), then fold tortillas in half. Brush ½ tablespoon oil on pan and cook 4 of the quesadillas, 2 minutes on each side, turning once. Repeat with the remaining 4 quesadillas, and top with the corn salsa.

This is a delicious vegetarian dish! My wife is not particularly fond of cilantro but really likes this dish.