The decision to begin hormone replacement therapy is a key one for many women. Women are bombarded daily with information about the “right” hormones to use. Recently bioidentical hormones have received a significant amount of attention in the media. However there is a lot of confusion and misinformation about bioidentical hormones in the medical community and in the general population.

In simple terms, bioidentical hormones refer to hormones that are identical to the chemical structure of the hormones produced by a women’s body. There are two types of bioidentical hormones available: synthetic and compounded.

Synthetic
Synthetic bioidentical hormones are manufactured by drug companies to very rigorous standards. They have undergone clinical trials and are known to be safe and effective hormone replacements. The most common of these FDA-approved bioidentical hormones are Estrace, Climara, Vivelle, and Prometrium. There are a variety of ways to take these hormones including a skin patch, vaginal creams, vaginal rings, and pills.

Compounded
Compounded bioidentical hormones are only available from a special pharmacy that mixes a hormone recipe. There is a wide variety in the quality and consistency of compounded hormones. While some of the hormones included in a compounded hormone treatment are identical to the synthetic hormones, others are precursors that are converted by the body into a useable form. There is very little information about how the compounded hormones interact with the body and with other drugs. Even though these hormone preparations are considered “natural,” they are still drugs. There can be significant interactions and dangers to taking these preparations without the supervision of a physician.

The Right Dose?
I have women who come to me and ask for a “hormone” test to make sure that they are taking the “right” amount of hormones. Saliva tests and blood tests can measure the amount of estrogen and progesterone in a woman’s body, but they are not useful to make decisions about hormone treatments. Every woman’s body is different and each woman needs a different level of hormones during menopause. There is no number that tells you if you if your hormones are “too low,” “too high,” or “just right.” The best way to judge if you are taking the right hormone dose is to examine your symptoms. If you are not having hot flashes or mood swings and you are feeling more like yourself, then you are taking the right dose of hormones. That dose will be different for every woman.

There is no easy solution to improve the symptoms of menopause. The best treatment comes from an ongoing discussion with your doctor about which treatment works for you. If you want more information about bioidentical hormones or menopause, the North American Menopause Society has an informational website at www.menopause.org.

by:  Margaret Villers, M.D.

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