Estrogen in Bioidenticals? I Hope So!

When my doctor and I finally figured out that the wacky symptoms I'd been having - whiplash mood swings, insomnia, irregular periods, feeling hot minute, cold the next - pointed to perimenopause (that period of 4-10 years when your body transitions to menopause), she presented me with a variety of options. One, do nothing and learn to live with it. Two, try natural remedies like black cohosh, Vitamin E, flax seed, and whatever else worked for me. Three, get a prescription for synthetic hormone replacement therapy (she gave me a sample of a Premarin patch I could try, and an RX.) And four, if I didn't want the Premarin, she suggested bioidentical hormone replacement therapy, and slipped me the business card of a compounding pharmacist who she claimed was God's gift to women.

Option 1 was already out. When I'm not sleeping, I want to kill people, and that's bad. I considered Option 2 and would have gone there if my symptoms were not as severe. I eyed the prescription and sample patch that was Option 3…and it made me queasy. I'd read about the 2002 study that once again put HRT in the doghouse for increasing cancer and stroke risks. My mother had already stopped taking it. Option 4, from what I'd heard about it, seemed like my best and safest bet.

"He'll work with you and come up with just the dosage you need," my gyno said. "This guy knows more about menopause than most women."

I called Glenn, a soft-spoken and incredibly patient man, and we talked for the better part of an hour. He told me that while he'd started doing general compounding (a compounding pharmacist creates special versions of medications for people – and sometimes animals – who can't tolerate the usual prescription stuff), his wife had such an awful, wrenching time with menopause that he shifted his focus. He didn't want to see another woman go through what his wife went through. Not only did he compound various forms of "natural" estrogens and progesterones (he said that these substances are as close to what your body normally makes – or made – as you're going to come) but he offers weekly workshops on the hormones involved in menopause and what's happening with your body at different stages.

After experimenting around with differing dosages (he judges effectiveness not by blood or saliva tests – which he and many others call ineffective, since they fluctuate like crazy – but by how the patient is feeling), we found a formula I could live with. This has changed as I've progressed through perimenopause to menopause, but Glenn has always been right there, working with my doctor and me, and when time comes for me to taper off (which is also my choice), he'll be there to walk me through that, too.

Yes, like all alternative therapies, "natural" HRT has had its ups and downs in the public eye. Every so often, Big Pharma tries to shut down compounding pharmacists and especially the form of estrogen they use (estriol) which is approved for use in Europe but not in the US (I don't know why). They parade out studies that bioidentical hormones aren't FDA approved, have not been shown to be effective, have the same health risks as HRT, etc. But if you look closely at many of these studies, the funding can be traced back to one source: the pharmaceutical firm that makes Premarin, the top-selling synthetic HRT.

How about that.

You also might have seen or read Suzanne Somers' book about bioidentical hormones, or saw her when she appeared on Oprah to promote it. This caused a major hooplah, and many called Somers a "quack" who had no business telling women to ditch their Premarin patches and start rubbing progesterone cream into their arms.

Last year, thanks to grassroots support and the IACP (International Association of Compounding Pharmacists), compounding pharmacists like Glenn were able to beat back an FDA lawsuit that would have banned them from selling compounds made from estriol. Which would have forced me to take synthetic hormones or wait the month or two it might take for things like black cohosh and Vitamin E to work.

Now, I guess, the FDA has regrouped and is itching for a rematch. An article put out by the AP yesterday chapped my rump. The headline? "Bioidentical not FDA-approved, contain estrogen."

Well, duh. That's why I take them. Any woman who works with an ethical, licensed compounding pharmacist should know that their bioidentical HRT (unless you're taking just progesterone) contains estrogen. Every order (at least my order) comes with a warning – just like the literature you'd get if you filled a prescription with a traditional pharmacist – outlining the risks and the possible side effects.

And FDA approval? Holy Christmas. I've seen what drugs have been put out under the blanket of FDA approval, and what they can do to people, myself included. One of the main reasons the FDA approval has been withheld from compounded bioidenticals is because the dosages vary depending on the prescribers' needs, and there's no way the FDA can verify the effectiveness of all of these doses. But being able to get a dose that fits my body is one of the main reasons I chose bioidentical HRT. I can get lactose free capsules free of the dyes and fillers and whatever that can be added to synthetic prescription drugs.

In this article (which was horridly biased, in my opinion), the writer found a couple of women to interview who seemed only to know that bioidenticals are "natural" and better than synthetics. These women had "no other knowledge base than fear" when they made their selection.

Then, several unreferenced doctors nodded in agreement that women are getting products of "unknown risk" that "still contain the estrogen many of them fear."

Which, in my opinion, is another bogus attempt to discredit a form of treatment that has benefited so many women. Odd how in this article, no interviews were done with women who may have been tremendously helped by BHRT.

I don't know for certain that bioidenticals are indeed "natural." I do know that for me, they work. I take them, fully informed, and feel much better about it than slapping a patch full of God-knows-what on my ass. Maybe you feel differently, but that's OK. Everybody is different, and you have to do what feels right for you.

However, if you are interested in trying bioidentical hormone replacement therapy, don't feel discouraged by the FDA machine or by your own doctor, who might be buying into the Big Pharma misinformation campaign. But do educate yourself. Go to the IACP website. Choose a competent, licensed compounding pharmacy. Talk to the pharmacist. Know the risks and the benefits. See if it's right for you.

So…if any of you are going through perimenopause, how has it been for you? Have you chosen to tough out your symptoms, or get help from your gyno? Have any of you tried bioidenticals? If yes, what's been your experience? And those of you who are trying alternatives like black cohosh, how's that working out for you?

Photo by Alex Capelli