Our Bodies, Our Lives
By Drs. Tristi Muir and Catherine Hansen
 
For women going through menopause, current popular advice about the safety of different kinds of hormone replacement therapies can be confusing.

It’s important that every woman trying to make a decision about hormone replacement find a knowledgeable health-care provider with whom to discuss this important issue.

Your menopause is yours. Don’t let entrepreneurs and celebrities determine what you put into or onto your body.

Historically, women have used hormonal therapies long before they even lived long enough to experience menopause. Thinking that it would promote youthfulness and vigor, women used preparations made from female or male urine, crushed tissue or fluid from animal ovaries.

Eventually, commercial preparations became available. The first “bio-identical” hormone, extracted from the urine of pregnant women, was discovered in 1928 by a German chemist, earning him a Nobel Prize. Mass production of hormone medication made from the urine of pregnant mares began in 1942.

Major advancements in hormone production began in the 1950s and 60s, culminating in a new treatment for menopause symptoms — estrogen replacement therapy.

At first, the medication was made from animal-derived estrogen sources, but soon Diosgenin and Stigmasterol were isolated from yam, cactus and soy plants.

Diosgenin undergoes synthetic processing in a chemistry lab to become all of the bio-identical hormones we know today — estradiol, estrone, estriol, testosterone, progesterone, DHEA and cortisol.

It is a popular idea these days that bio-identical, custom-compounded hormone replacement therapy is safer and more natural than other alternatives.

The word “natural,” however, applies to any product produced directly from an animal, plant or mineral source. Natural does not automatically mean safe or resembling anything found in the human body. A good example is Premarin — considered safe and natural — which takes its name from PREgnant MARe urINe.

Bio-identical does not necessarily mean natural. The term bio-identical simply refers to the shape of the molecule and the way it fits into the body’s receptors — like a key into a keyhole.

Bio-identical estrogen starts from a plant source and undergoes synthetic processing to be made structurally identical to estrogen found in women. An example of bio-identical estrogen is Estrace — estradiol.

Bio-identical is not the same as custom-compounded. The term custom-compounded refers to the way a pharmacist — as opposed to a commercial pharmaceutical company — blends hormones into a product for sale. Compounded menopause preparations are in vogue but there is no evidence that they offer fewer side effects, safer alternatives or more effective formulations than the ones blended by pharmaceutical companies.
In fact, compounding pharmacies and the products they offer are not routinely FDA-approved, supervised or regulated. While this does not necessarily make them unsafe — these products are made from the very same ingredients as commercially available hormones — safety and efficacy testing has not been performed and package labeling is not required to declare potential side effects and risks. Two examples of compounded products are Bi-Est and Tri-Est.

If you have no contraindications to hormones — check with your provider on this — and you feel like you need medications for your symptoms, we suggest starting a low-dose estrogen formulation by mouth (oral) or applied to the skin (transdermal). If your main symptoms are urogenital (bladder and vaginal) symptoms, we recommend a vaginal cream, tablet or ring.

FDA-approved hormones are the safest and most effective option currently on the market. Note that if you have a uterus, progesterone must be added to protect the uterine lining from thickening. For convenience, the estrogen and progesterone have been combined in some products.

Our Bodies, Our Lives focuses on issues surrounding women’s sexual, gynecological and emotional health. Drs. Tristi Muir and Catherine Hansen are gynecologists at the University of Texas Medical Branch. For information, go to utmbhealth.com/pelvichealth.