1.       You need to be tested by someone who knows what they are doing. Many times women say to us that they were tested by their primary care providers who told them that their hormonal levels were perfectly normal. “Normal,” unfortunately,  is still a relative thing in this field and you need to be tested by someone who can read the results with a skeptical eye.

2.       You need to use the right product. Compounded products can be extremely tricky, and may not work as well. Biodentical products are probably the way to go but need to be adjusted accordingly. Work with someone who has significant experience with using specific products.

3.       Too weak a dosage or too short a time of usage are unlikely to yield any reasonable results or any results at all. This may be more frustrating than doing nothing, so be ask the right questions and be compliant when you are prescribed.

4.       Be conservative. Make sure all the relevant blood levels are monitored regularly and that you are being followed by a professional in a way that feels thorough and responsible.

Having warned you about the issues – it’s definitely worth a try!

You know,  I’m not a doctor.  So this is not a recommendation.  But I am in a tizzy over the recent article from the NY Times Magazine on April 18, 2010  on estrogen replacement in perimenopausal or early menopausal women. The article is called The Estrogen Dilemma, written by Cynthia Gorley.  

 The article is balanced and intelligent.  It details the research errors in the W.H.I study of the early 90′s that damned hormone replacement therapy [the misinformation surrounds the age of the women in the study (10+ years beyond menopause), the kind of therapy (the pregnant horse urine-derived hormone), and how conclusions about stroke and cardiac problems were surmised].

I don’t know about you, but I’m wrestling with this strange phase and wondering about how to manage it.  And there I was, in the voices of the scientists and the reporter in this article.  It is balanced, yes, and delineates all the uncertainties in any hormonal regimen.  But make no mistake:  when the author talks about Alzheimers, my phone is dialing my gynecologist asap.

Here’s a blip from the article.  The author is referring to her conversation with a woman, a scientist studying the brain at USC:

 ”We were sitting in a campus garage in her Prius one day, and I asked her what made her so sure her own midlife difficulties — she had the hot flashes, which were obvious, but also the sleep disruption and the infuriating distractibility — were the product of hormonal events, not some womanly existential crisis. We get a lot of that, societally. It’s meant to be empathetic. Your role in life is changing, Mrs. Brain Seized by Aliens! Your children are growing up, you’re buying expensive wrinkle cream, ice cream makes you gain weight now, of course you’re distraught! “Because with estrogen — ” Brinton looked at me sharply, and then smiled — “I don’t have attention-deficit disorder.”  ”

Read on, girlfriends.  Let me know your thoughts.

 http://www.nytimes.com/2010/04/18/magazine/18estrogen-t.html

There is so much confusion and misinformation when it comes to “bioidentical hormones.” Let me see if I can clarify a little: 

• “Bioidentical hormones” does not mean that the hormones are “organic.”
• “Bioidentical hormones” does not mean that the hormones are “natural.”
• “Bioidentical hormones” does not mean that the hormones are “not really hormones.”

 “Bioidentical hormones” means that the chemical makeup of the hormones exactly matches the chemical makeup in the same hormones in your body. It can be man-made but the molecular components are exactly the same as that same hormone in your body. For example, if you look at bioidentical estrogen under a microscope it would look exactly the same as the estrogen your body makes. It could have been created all chemically, in a laboratory, but the components of the compound match your body.

 “Hmmmm…” you ask, why would anyone make non-bioidentical hormones to replace those in your body. Well, for one thing bioidentical hormones can’t be patented. The same way you can’t patent water, unless you add some flavorings to it, you can’t patent estrogen unless there is something different about your estrogen. So drug companies are incented to change the chemical compound. Sometimes makers of specific hormones suggest that the difference they have made is a “good” difference and thus justify the changes. We haven’t found that to be the case. In general we find that women seem to respond better to bioidentical hormones.

 But don’t worry about the drug companies. Now that many realize that women prefer the bioidentical compounds they have found ways to patent their product by developing better or unique delivery systems: a specific cream to hold the compound, a patch, a pellet.

 So, if a practitioner wants to prescribe a hormone, you can discuss the options intelligently. For more information you can read these two articles, the first is authored by the Mayo Clinic and is a negatively predisposed to bioidentical hormones; the next comes out of Harvard Medical School and is more balanced. Let us know your thoughts!

So what’s the real answer? Like everything else: moderation! If you need hormone therapy, use it. It will make your life better. But use as little as you need and don’t assume you will need it forever. After a few years your body may adjust and you may do fine without it. But please don’t suffer!

The white knight turned out not to be a knight or an axe murderer. He’s just the guy next door who, like most of us, have their good points and bad points!!