Since my hysterectomy, I have taken hormones to keep the world safe for democracy. It's my small contribution to world peace. Women who have celebrated more than 20 anniversaries of their 30th birthday often echo my sentiment. Hormones make them feel calmer, more in control, and generally more popular, especially at home. Yet controversy reigns today hormones are good, tomorrow they are going to kill you.
Dr. Randy Yarbrough explained his assessment of the dilemma. "I have been telling people for years that women don't die when they stop having babies at age 40, like in the 1840s."
Yarbrough, who has OB/GYN offices at the Southern Women's Center at St. Vincent's and at Trinity Medical Center, follows the quality of life conclusion: if you take these hormones and they make your body feel better, it's not that great of a risk to living longer, especially compared to feeling well.
Pharmacists are starting to step forward with the opinion that it is not the hormones we take, it's the kind we take. Compounding pharmacists, a growing field, support what is called bio-identical hormones, which differ from the big pharmacy synthetic hormones generally prescribed.
Bio-identical hormones have the same structure as those made by the human body, according to Scott Wepfer, RPh, owner and pharmacist at The Compounding Shoppe. He doesn't refer to the hormones as "natural" because many plant or phyto-estrogens, such as black cohosh, are not bio-identical. "The structure is what is important," Wepfer said, "not where it comes from, because in the end, the structure of the hormone determines its function in the body."
The typical plants used in bio-identical hormones are yams and soy plants, both high in natural hormone precursors. In contrast, Premarin®, which stands for pre-mare-in, is synthesized from the urine of pregnant horses. "Premarin is natural to horses," Wepfer said, "but it is not bio-identical."
Yarbrough said that "bio-identical a little bit of a misnomer," since the products do require processing. The hormones generally are mixed into topical creams, which are compounded by the pharmacist for an individual patient.
Since different pharmacists individually produce the compounds, they can vary from dose to dose. This processing caused the American College of Obstetricians and Gynecologists (ACOG) to question the quality standards of bio-identical hormones. According to Yarbrough, in 2001 ACOG tested 29 products from 12 different compounding pharmacies and 34 percent failed one or more standard quality tests. Nine of 10 assay or potency tests found the doses not as potent as claimed.
However, Wepfer points out that, "as a PCAB-Accredited Pharmacy, we are required to meet USP standards, which includes regular quality-control testing. We get consistently good results back from the testing lab."
Wepfer explained that the value of compounding pharmacies is that "we are able to offer hormones that are personalized to each woman's specific needs. The one-size-fits-all approach has failed."
Janis Randall of Compounding Solutions said that she "loves the topical creams because I can vary the amount so easily to find what works for the patient."
"I work with a lot of happy women," Wepfer said, "including my wife, who is using bio-identical hormones. We're able to treat womens' symptoms without causing side-effects. A lot of that has to do with the fact that we are able to customize the hormones to the dose and dosage form that each woman needs."
As I enter Wepfer's shop, he takes one look and pronounces me estrogen dominant, based on my height-weight distribution (I have packed on 20 pounds since my surgery.) In estrogen dominance, according to Wepfer, there isn't enough progesterone to balance the estrogen like before menopause.
"After menopause, you only make tiny amounts of progesterone in your adrenal glands," Wepfer said, "and while you're no longer making estrogen in your ovaries, you do make it in your fat cells. So, after menopause, a good rule of thumb is the heavier you are, the more estrogen you're making."
The symptoms of estrogen dominance include: weight gain, water retention, breast tenderness, headaches, depression, anxiety, and short-term memory and concentration problems, according to the Natural Progesterone Advisory Network. "There is an overlap between ovaries, adrenals and thyroid," Wepfer said.
Three pounds lighter after trying Wepfer's progesterone cream, I had addressed my main symptom: fat gain, especially around the abdomen, hips, and thighs. "If you're trying to lose weight while in estrogen dominance, you are fighting your hormones and your hormones are going to win. You can look at food and gain weight," said Wepfer, describing my personal struggle.
According to Wepfer, progesterone also prevents overgrowth, while estrogen promotes growth, leading to problems with heavy bleeding, endometriosis and fibroids. "Two studies show progesterone inhibits hyperproliferation in breast tissue that is induced by estrogen," Wepfer said. "A doctor called me to report uterine fibroids that shrunk significantly after six months on progesterone in two different patients."
Randall adds that progesterone is often called the happy hormone. According to Yarbrough, hormones can revive women. He cites one patient, who at age 93, swears by her hormone injections. "She is very with it, very sharp."
Still the question remains, why are menopausal symptoms so prevalent today? Are there just so many aging baby boomers bringing attention to the issue or are environmental factors revving up the symptoms? "I am not sure," Yarbrough said, "if there is more media attention to it, or if I have aged and my practice has aged, but I seem to see more menopausal symptoms. I know I talk about it more."
Wepfer attributes the increase in menopausal symptoms to the increase in weight. "The heavier the woman, the more estrogen she's making and that takes you right back to that list of estrogen dominance symptoms. I'm not opposed to estrogen. It's just that more post-menopausal women need progesterone than they need estrogen."
"Kids are bigger now," Yarbrough said. "I'm not sure if it's hormones or just bigger kids with more body fat. Fat will bring on periods earlier, not necessarily additives in our food."
Some blame environmental factors. According to Randall, women in Third World countries are spared much of the suffering of hot flashes, night sweats and mood swings.
"Women in this generation receive more exposure to xenoestrogens (xeno meaning foreign) with pesticides and growth hormones in the food," she said, citing early menses in girls as one warning sign.
A study by Florida zoologist Louis Guillette tracked Florida alligators that were experiencing shrinking male genitalia. The research blamed pesticide-laden waters where agriculture and lawn runoff from the nation ends up in Florida waters.
Testosterone is another hormone missing from the traditional hormonal prescription mix. Randall often sees a lack of this helpful hormone that can help women build lean body tissue, even be helpful with incontinence. It can certainly aid in diminished sex drives.
Bone loss also relates to estrogen loss. Wepfer calls it "the osteoporosis hormone." In an article on www.pubmed.gov, a publication of the National Institutes of Health, J.R Lee writes, "The hypothesis that progesterone and not estrogen is the missing factor was tested in a clinical setting and was found to be extraordinarily effective in reversing osteoporosis."
As the controversy rages with bio-identical hormones, lines appear to be drawn. "In general, you find some ob/gyns who totally won't even deal with it," Yarbrough said. "Then, there are others who base their whole practice on it." He also cited the ACOG stance against bio-identicals as unscientifically proven. In the final analysis, "I am in the gray zone. If people want to try them and they feel better, great."
Wepfer pointed out that "under the Data section of www.hormonebalance.org Rebecca Glaser, MD has collected over 800 peer reviewed articles which support the use of bio-identical hormones over the use of synthetic hormones."
