Pros and cons of bioidentical hormones

Pros and cons !
of bioidentical !
hormones!
• Karen Kaufman M.D.
• Tamara Lester, WHCNP
• David Thayer M.D.!
3
Goals: •  What are Bioidentical Hormones?
•  What are the Controversies? – (Are they safe? Or safer?)
•  What are the reasons for taking
any type of hormone treatment?
Summary:
•  My meaning: - A chemical molecule
strictly identical to a human molecule.
•  Used correctly they are safe.
•  HRT will improve quality, and probably
quantity of life.
Controversies/Myths = Public Confusion
• 
• 
• 
• 
• 
“Bioidentical means natural”
“Natural means harmless”
“Obtained directly from plants”
“Non-prescription (OTC)”
“Not FDA approved”
6
What are Hormones?
•  Miriam Webster: a product of living cells that
circulates in body fluids and produces a
stimulatory effect on the activity of cells (usually
remote from its point of origin;)
•  also : a synthetic substance that acts like a
hormone.
•  examples: Insulin, Thyroxine, E1, E2, E3, P4, T
7
What are
“Bioidentical” Hormones?
•  No “legal” or “approved” meaning. – and no federal regulation.
•  False claims. Modern “snake oil” elixirs.
•  “Buyer Beware!”
•  My meaning: - A chemical molecule
strictly identical to a human molecule.
8
=
Complex reproductive system
•  Blessed!
– Capable of doing amazing things!
•  Complex -“High maintenance” system.
•  Fraught with difficulties and risks. And
hormonal changes.
9
Stages of life,"
Plateaus of hormones !
Fertile Years:!
Fairly Predictable !
Teen years:!
+/- Rough!
Perimenopause:!
Variable!
Menopause:!
Menses “Pause”!
Childhood!
0!
Age !
10!
20!
Menarche: !
The Beginning!
30!
40!
50!
60!
70!
80!
90!
100!
10
This is the area of our focus this evening.!
Ages 35 to 115.!
All cells affected
•  Target organs
•  Secondary
11
•  Tertiary
Red is estrogen, green is progesterone, and dotted lines are FSH and LH
No PMS. No abnormal bleeding.
Impact of Peri/Menopause
• 
• 
• 
• 
Hormonal changes impact cells.
Impact - depends on which system.
Symptoms (Subjective) - mood, sleep
Signs (Objective) - bleeding, bone
strength
13
Symptoms/”subjective”
•  Hormonal fluctuations - perimenopause
– PMS, PMDD, Abnormal menses, excess flow,
bloating, cyclic headaches and migraines
•  Deficiency - menopause
– HF’s, NS’s, insomnia, fatigue, brain fog,
moody, tearful
14
Perimenopause – 6 months
Hormones are out of balance. "
•  This person does not feel well!
•  Her partner is hanging out with friends a lot lately!
•  And she’s thinking about selling her kids.
Objective signs are subtle (silent)
"   Loss of libido
"   Bone (loss of mineral
density)
"   Metabolic ( insulin
"   Brain (cognitive decline)
"   ^ Macular
"   Vaginal effects
degeneration (atrophy,dry)
"   ^ Cancer
"   Blood vessels
(atherosclerosis)
resistance)
16
"   ^ Arthritis
HRT - impact on symptoms
(“short term” problems)
17
18
Interested in hormone
replacement?
•  Bioidentical? Synthetic? Animal?
•  Better? Safer?
19
Safety?
•  Controversial!
•  First - what is safe?
– Safe to drive a car?
•  Conflicting evidence.
•  BHRT =“orphans”
•  Your medical history?
20
My Opinion:
•  38 years personal experience!!
•  Premarin data.
•  Bioidentical research - FDA
approved.
•  Lowest possible dose, shortest time,
consistent with goals.
•  ~Safer to treat than
not to treat.
21
Breast cancer safety?
• 
• 
• 
• 
Media favors negative data.
No conflict - 5 years treatment.
Fear of breast cancer.
Doctors fear liability.
22
Breast cancer
• 
• 
• 
• 
Compelling evidence - no ^ risk.
Strong evidence fewer deaths.
WHI data.
Your decision. 23
BHRT Better? Safer?
•  My meaning: - A chemical molecule
strictly identical to a human molecule.
•  Difficult to prove.
•  “Thumbs up” for PMS, symptom relief.
•  Natural - ( even I get pulled in!)
24
Identical Molecule
• 
• 
• 
• 
Natural.
Synthesized.
Plant derived complex molecule.
Diosgenin
25
Molecules
26
Phytoestrogens
Comparison Human Estrogen:
17 Beta Estradiol
27
BEWARE!
•  Vested interests.
•  Hucksters.
•  Expensive labs. Repetitive testing.
•  Non-Rx “bioidenticals”.
•  Misleading claims. – “Too good to be true”
28
Goals: •  What are Bioidentical Hormones?
•  What are the Controversies? – (Are they safe? Or safer?)
•  What are the reasons for taking
any type of hormone treatment?
29
30
•  Remember no decision
31
IS a decision!
www.thayermd.com
•  Visit our website for educational info.
•  Learn more about hormones.
•  Join our medical Newsletter or stay up-todate with our Facebook page.
•  Discover our philosophy of patient care.
•  A movie about Menopause.
Understand the controversies.
And it will make you laugh.
www.hotflashhavoc.com
33