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Menopause through the eyes of a gynecologist- Bio- identical Hormones


Many women assume that the word “natural” means safer or better.  But there is no control over the use of the word “natural” unlike “organic” and many things felt to be “natural” are not only unsafe but can cause harm.

I have to address this almost every day when a patient comes in demanding “Bio- identical Hormones” from some compounding pharmacy in another state.  Usually they are ready to spend hundreds of dollars because these are “safer and better” than any prescription I would give them.  The truth is that there are many prescription hormones that are bio-identical but have been thoroughly studied to get through the FDA.  Examples of FDA approved Bio-identical estrogens are Estrace Cream, Climara, Vivelle and Minivelle patches, Estrogel gel and Vagifem tablets.  With these medications I know exactly how much you are getting and they are produced in a regulated fashion so I don’t have to worry about mold.  The added bonus is that most insurance covers these with minimal out of pocket expense.  When you buy compounded hormones you do not have any consistency in the dose you are getting and open yourself to possible infections.  You will also pay the compounding pharmacy, gynecologist or any Doctor who wants to set up shop a lot of money.  Doctors who sell hormones to you out of their offices are making a lot of money doing this.  That’s why I have encountered a Pulmonologist (a Lung doctor) and several Family Practice doctors whose practices consist only of Bio-identical Hormones.   I have had patients receive Estrogen Pellets from these physicians who developed serious complications.  One patient received Estrogen Pellets that were tainted with mold and she developed a 4 cm lump on her right hip where the Pellet was placed that had to be surgically removed.  Another Patient who received these Pellets had a stroke.  They had not taken a thorough history and followed up on the cause of her 3 miscarriages.  It turns out she had 2 clotting disorders that were exacerbated by the high dose estrogen in the Pellet.  Another patient received Pellets and the doctor did not put her on progesterone to protect her uterus.  It’s been known for years that unopposed estrogen increases your risk of Uterine Cancer.  In my view Compounded Hormones are expensive and unsafe especially when they are being prescribed by a non-gynecologist.

You may ask how did we get to the point in the US  that so many vitamins, supplements and compounded medicines have no proof of  safety or efficacy?  Our wonderful Congress did this backed by the Millions of dollars the Vitamin Companies spent to remove the FDA oversight from their products.  Dr. Paul Offit wrote a very well researched book “Do You Believe in Magic?” where he outlines exactly how this happened. ” On May 11, 1994, the Dietary Supplement and Education Act became law. The act defined a supplement as “a product intended to supplement the diet that bears or contains one or more of the following ingredients: a vitamin, a mineral, an herb or other botanical, or an amino acid.”  “The law permits manufacturers to define a product as a ‘dietary supplement’ merely by saying so, no matter how artificially it was derived.”  They are doing this without any proof that their “supplements” do what they are supposed to do and without any oversight by the FDA.  I heard a story last month on NPR about a fact checking group who bought 3 bottles of supplements from GNC, Walmart and Target and tested them for content by a very reparable lab.  The lab did not find any of the stated product in any of the pills.  Even more outlandish was the fact that all three stores refused to remove these products from their shelves!  Why should they?  They are making a lot of money on these products and they are not breaking any laws.