Exploring a new option in women’s hormone replacement therapy
If you’re like many women today who are in the early stages of menopause, you might feel a little lost.
Years ago, as soon as a woman experienced her first hot flash, she headed straight to her gynecologist to talk about hormone replacement therapy (HRT), which involved using a prescribed, synthetic form of estrogen or estrogen plus progestin, usually in the form of a pill, patch or cream, to alleviate symptoms. However, when the Women’s Health Initiative (WHI) Hormone Program, sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute (NCI), performed postmenopausal hormone therapy trials and released a report in 2002 that linked HRT to side effects like heart disease, stroke and an increased risk of cancer, women became anxious and concerned about the popular treatment option, and many backed away from it entirely. Eventually, the furor died down, and better, more positive news about HRT began to make its way into the media, but the apprehension remained for a large percentage of patients.
Just when it seemed that there were few options available for those who felt hesitant about HRT but still wanted relief from the symptoms of menopause, actress and author Suzanne Somers came out with her books The Sexy Years: Discover the Hormone Connection: The Secret to Fabulous Sex, Great Health, and Vitality, for Women and Men and Ageless: The Naked Truth About Bioidentical Hormones, which shed light on an alternative: bioidentical hormone replacement therapy (BHRT). With her revelations about using estrogen and progesterone lotions, giving herself vaginal injections of estriol and taking 60 pills each day, the seemingly new-age option sounded questionable and a bit extreme to some. However, the basis of her books—using natural hormones instead of synthetic pharmaceuticals to manage menopause and the physical symptoms of aging—does have merit. In fact, the use of bioidentical HRT has surged in recent years, and many women are singing its praises. While it may not be right for everyone, it certainly is worth taking a look at what is known about this alternate treatment.
Back to basics
When it comes to menopause, women typically understand what’s happening to their bodies on a very basic level. There’s really no mystery about the process itself. As a woman ages, her ovaries produce less estrogen and progesterone, her supply of eggs is depleted and her menstrual cycle eventually ends. According to Sharon Bent-Harley, MD, board-certified OB/GYN and founder of the Harley Anti-Aging Institute in Atlanta, the average age that women begin menopause is 53. Someone who is entering menopause can experience an array of symptoms, from the much-talked-about hot flashes and night sweats to the lesser-known vaginal dryness, weight gain, insomnia, dry skin, anxiety, difficulty focusing or concentrating and chronic fatigue, among other manifestations, including migraine headaches. Kenneth Byers, MD, founder of the Byers Wellness Center in Atlanta, also points out irritability, mood swings, urinary incontinence, loss of libido and a decline in energy as possible symptoms.
Yet, the effects of menopause actually go beyond the standard physical symptoms with which women are so familiar. “As we get older, our cell reproduction slows down because our hormones, which are the gatekeepers to all of the organs in our bodies, start to decline,” explains Jeff Semel, DC, founder of the Atlanta Medical Institute. “When hormones like estrogen, testosterone and progesterone decline, so does the body. The reason is because those gatekeepers that send signals for regeneration have started to die off.” This occurrence can affect various systems in the body, including the immune system, which “needs the hormones to function at 100 percent,” according to Semel, who adds that it’s not only women in their 50s or older who experience this decline. In fact, the average age is around 40 when a woman’s hormones begin the process, and some women may feel the symptoms as early as their 30s. This period of time leading up to menopause, when a woman’s hormones begin to decline but she continues to have her menstrual cycle, is called perimenopause, and it can last from 2 to 8 years.
The challenge to managing the decline in hormones is that many women simply don’t recognize the many signs of menopause or perimenopause unless they are accompanied by hot flashes. “If someone is always tired, for instance, she automatically may think that it is related to her environment or what is happening in her life,” Harley says. “She may not associate it with a hormone imbalance.” Byers agrees, stating, “Women presume that the way they are feeling is just a part of aging, but they don’t realize that we can actually reverse those signs.” And as Semel reveals, all it takes is a simple blood test to decipher how out of balance your hormones might be and put you on a path to feeling better.
The bioidentical buzz
Traditionally, when a woman entered menopause, the prescribed treatment included something like Premarin or Prempro, a compound drug manufactured from the urine of pregnant mares. The synthetic hormone is designed to balance out a woman’s hormone levels and reduce the symptoms of menopause. The debate about its long-term safety began with the 2002 WHI report, and the National Cancer Institute notes that the U.S. Food and Drug Administration (FDA) currently advises women to use menopausal hormones for the shortest time and at the lowest dose possible to control symptoms; however, traditional HRT has proven to be effective for many patients and is still prescribed and in widespread use today.
Bioidentical hormones, on the other hand, are engineered from plant-based sources, typically yams or soy. “Bioidentical hormones are identical in structure and function to the hormones naturally produced in our bodies,” Byers says. “They are biologically identical to the human forms of estradiol and testosterone. So essentially the body is given back what it can no longer produce naturally.”
As Semel explains, “The body cannot break down a synthetic hormone, and what happens is that it causes a decrease of the immune system and an increase in disease processes such as cancer, diabetes and heart disease. Bioidentical hormones have been shown to decrease these types of diseases by 70 percent. When you have a bioidentical hormone, the body is able to read the hormone, break it down, utilize it and synthesize it properly so you’re using the whole hormone to the benefit of your body instead of having these molecules that build up and are not recognized by the body.”
Harley likens the use of bioidentical hormones in replacement therapy to a chemical equation in the body. When the body is expecting 1 plus 5 to equal 6, the introduction of a synthetic hormone is like trying to make 2 plus 2 equal 6 instead. The body simply doesn’t understand the equation. “Your body is not accustomed to the synthetic hormone, so it can’t detoxify properly. With bioidentical hormones, the body understands because they’re the same in terms of chemistry and physiology.”
And according to Byers, “When administered correctly in the proper doses, bioidentical hormones can help restore a woman’s health to the point where she feels like she did when she was in her 20s or 30s—we have this happen in about 90 percent of cases. And there are virtually no side effects.”
The power of the pellet
BHRT can be administered through a gel, a cream or a pill. However, many physicians who offer BHRT use SottoPelle® Hormone Therapy, which involves inserting a bioidentical hormone pellet under the skin during a painless, in-office, outpatient surgical procedure. “We make a small incision in your bikini line about the size of the edge of your fingernail,” Semel explains. Then the pellet, which is smaller than a Tic Tac, is inserted into the incision through a tiny tube; a Band-Aid is placed over the incision when the procedure is over, and no stitches are required.
“When you use a pellet, it’s not something you have to worry about daily. In fact, one pellet can be effective for between 3 and 8 months,” Harley asserts. “Your body does not absorb the hormone all at once—it only absorbs what it needs and automatically adjusts to changes in your body. It’s like having a designer dosage every day without having to remember to take your daily dosage.”
Byers notes that women who receive SottoPelle Hormone Therapy usually begin to feel relief from their symptoms in 1 to 2 weeks and experience everything from an increase in energy and the ability to sleep better to improved mental clarity and an increase in libido. They also have added protection from such conditions as osteoporosis, cardiac disease and cancer. Overall, he observes, “Women on BHRT get back their inner sense of well being.”
Of course, to ensure that you get the most from BHRT, there are other essentials that you must attend to, including basic lifestyle issues. Harley asserts that practices like eating right, exercising regularly and getting enough rest are as important to the treatment of menopause as getting your hormones in balance. It’s also beneficial to consider taking natural supplements like fish oil and multivitamins to boost your body’s systems, as well as work to keep stress under control. “The body is like a hormonal symphony,” she says. “If one element is out of tune, then you’ll feel it. Keeping everything in sync is very important.
The debate
So why isn’t every woman offered BHRT when she visits her gynecologist? There are a couple of reasons. First, bioidentical hormone replacement therapy has been used in Europe for many years, but Semel explains that it has become popular in the United States only within the last decade. Therefore, it is not traditionally taught in medical school, which means that most physicians, whether they’re family practitioners or gynecologists, do not know enough about the treatment to administer it. That’s why women who are interested in learning more about the option need to find a physician who specializes in anti-aging medicine. “You have to find a physician who is educated in this field,” Semel maintains. According to Harley, there are doctors who have completed fellowships in anti-aging medicine and are very knowledgeable about the most current research and techniques in BHRT. The key is to find the right provider for you.
Secondly, although the number of physicians who are being trained in BHRT is rising, the debate about the treatment’s effectiveness and safety continues, due in large part to the fact that many of the bioidentical products used today are not FDA approved. Byers points out that because the products are made from naturally forming substances, they cannot be patented and it would be difficult to get universal FDA approval for them. In addition, approval would require long-term, double blind studies; research and studies are being done, but reliable results may not be ready or released for many years. What’s more, for those products that are customized for patients through compounding pharmacies, FDA approval is not possible because those products are engineered in facilities that are not subject to the quality assurance standards required by the government agency. Without the ability to standardize, there simply is no FDA approval. For that reason, and to safeguard yourself, Byers suggests that if you visit a physician trained in BHRT, you should ask about the source of the pellets being used to make certain that they made in a safe, high-quality facility.
The decision
The decision to undergo either HRT or BHRT is a very personal one, and it should not be taken lightly. The arguments for and against both options are compelling, and it’s up to you to educate yourself enough about the issues to make the appropriate choice for your needs. Just keep in mind that a hormone imbalance can affect you more than you realize, and it’s important to be on the lookout for symptoms that you just might have control over. And in the end, as long as you find the solution that makes you feel young, vibrant and your absolute best, there’s no way you can go wrong. As Semel asserts, “We age from the inside out, and my philosophy is, ‘Get it before it gets you.’” Harley agrees. “It’s never too late to start,” she says. “You can always prevent further damage.”
Personal Story Spotlight
Jan Hardy-Fanslow: Back in Business
As the natural process of menopause gradually crept into her life, Jan Hardy-Fanslow began to experience the common symptoms that women everywhere talk about. Yet, as a very health-conscious woman, she won’t even take an aspirin unless she absolutely has to. She is highly sensitive to almost all pharmaceuticals, from allergy medications to antibiotics. So she knew that when her time came to consider HRT, she was not going to go the synthetic route. “Synthetic hormones could be right for others, but I knew they wouldn’t be right for me,” she says. In fact, she had already told her gynecologist that she wanted to have bioidentical hormone replacement therapy to treat the symptoms of menopause. Of course, at 50 years old, she wasn’t ready yet—or so she thought. “I just didn’t feel 100 percent. I thought I was just stressed, tired and overworked,” Hardy-Fanslow explains, recalling the earliest stages of menopause. It was especially bothersome because she is a very fit individual, working out 5 days a week and always making the best possible food choices.
She heard about Kenneth W. Byers, MD, and the Byers Wellness Center from her friends. Ironically, Byers previously had been her physician when he worked in internal medicine; now that he specializes in BHRT, he was the perfect person to talk to about the treatment. “He said, ‘I can help you feel better,’” she remembers. After her consultation, she decided to have SottoPelle Hormone Therapy; within three weeks, she felt like a different person. She’s been on the treatment for more than a year now, and the outcome has been consistent. “A gradual sense of well being was reestablished. I sleep better, my skin isn’t as dry and so much more. It doesn’t happen overnight, but it’s a very smooth and general process.” She adds, “I’m so grateful to have Dr. Byers. My goal is to live a long and healthy life and now I feel like I am truly in optimal health.”
Personal Story Spotlight
Cherie Martin: Fountain of Youth
Cherie Martin may be 62 on the outside, but on the inside, she feels like she’s 35. “What I’ve tapped into is truly the Fountain of Youth,” she says of SottoPelle Hormone Therapy, which she has been receiving for more than a year and a half through the Harley Anti-Aging Institute. “It’s restored the quality of my life, only better than when I was younger. The fatigue is gone and the ‘brain fog’ has been lifted—information is now retrieved swiftly. After a lifetime of severe PMS with its ups and downs, my mental attitude is even, upbeat and always positive. Best of all, my libido is operating at a 25- to 30-year-old level.”
One of the biggest differences Martin noticed was in her libido. She had not dated for six years, having no real interest in the process anymore, but after she began BHRT, she wanted to go dancing. She started with shag dancing, which led to her attending a church-sponsored regional singles conference. Out on the dance floor, she spotted a gorgeous man who happened to be there with a younger woman. Disappointed, she left after 10 minutes. But she had an opportunity to switch gears when she received an e-mail dinner invitation from a gentleman in Blairsville through a profile and photo she had posted on a singles website. Amazingly enough, the gentleman turned out to be the gorgeous man from the conference dance floor. “It felt like I had met my soul mate,” Martin says.
The couple is now married and living in the heart of the North Georgia Mountains. “We are blissfully happy,” Martin concludes. “What do I attribute this to? Bioidentical hormone replacement. I would never under any circumstances go back to the way I felt before.”
Personal Story Spotlight
Marilyn Kenoly: Sleepless in Metro Atlanta
In September 2009 Marilyn Kenoly was having trouble sleeping. In fact, she couldn’t sleep at all. Her thoughts were racing, and she felt like she could jump out of her skin. Over the next several months, Kenoly was in and out of the emergency room, seeking help for the persistent problem. She was prescribed Ativan for anxiety. She also found herself with Valium and an array of other medications that various physicians suggested she try. She purchased herbal remedies and supplements from the health food store to find a more natural way to achieve sleep. She even began acupuncture treatments to calm the anxiety that was being caused by the insomnia. When her gynecologist mentioned that her problem might stem from perimenopause in conjunction with insomnia, Kenoly, 53, was a bit surprised by the possibility, simply because she had never discussed it with anyone before. Unfortunately, her gynecologist wasn’t able to find the right solution to help her still sleepless patient.
Kenoly was desperate to see another doctor who was recommended to her. “When the blood tests came back, I was indeed in perimenopause and severely out of balance,” she recalls. “A compounded progesterone cream was prescribed for me. However, it did not work.” When Kenoly decided to find another hormone specialist, one of her sorority sisters recommended Sharon-Bent Harley MD, founder of the Harley Anti-Aging Institute. On Dec. 28, Kenoly received bioidentical SottoPelle Hormone Therapy. She also began taking Vitamin B-12 and Vitamin D supplements, as both levels were extremely low. Within a short time, she felt like she was on the right path. “While I am still experiencing some sleeplessness, I am feeling 75 percent better and getting more balanced every day,” she concludes. “You have to be your own advocate and find what’s right for you. While insomnia plagued me for 7 months, I have come out of this devoted to making sure that other women know where to go and who to see.”
