The Bioidentical Debate
In The Great Debate: Should You Replace Your Hormones?, Oprah said all women over 35 will eventually face hormone imbalance, which can cause you to feel flat and tired. "This is about your hormones being out of whack, and you don't even know—we haven't had the language to talk about it yet," she said. "All women need to be armed with this information."
During the conversation, Robin McGraw, Dr. Phil's wife, opened up about her own experience with HRT, saying she went from feeling tired and lifeless to feeling vibrant. Dr. Northrup, author of The Wisdom of Menopause, helped navigate the HRT maze, breaking down the basics of menopause, perimenopause and bioidentical versus synthetic hormones. "'Bioidentical' means it matches exactly the molecular structure of the hormone that your own body produces," she said. "[Synthetic hormones are] made from horse urine and are natural for a horse, but they're synthetic for a human body. ... It has completely different effects, [but] many women do well on these."
Get more answers about HRT.
After the initial dialogue, thousands of women wrote in to The Oprah Show to say enough is enough, and they are ready to take charge of their health. The conversation isn't over, Oprah says. "There's so much to learn," she says. "Is it right for you?"
Suzanne says bioidentical hormone replacement therapy (BHRT) saved her. "By replacing my hormones with bioidentical hormones, I got my life back. I got my health back, I got my figure back, I got my happiness back," she says. "Everything in my life is better."
Though Suzanne recognizes she isn't a doctor, she says she can't keep quiet about how bioidentical hormones have helped her. "I understand [the criticism], because if everybody can feel as good as I feel, then there would be no need for all the drugs that women take from middle age on," she says. "I went from doctor to doctor to doctor, and I was offered antidepressants, sleeping pills, muscle relaxants, painkillers, antianxiety [medications], and I said to myself, 'This is a menopausal cocktail.'"
Oprah says Suzanne's lifestyle can be interpreted in two different ways. "Many people write Suzanne off as a quackadoo," Oprah says. "But she just might be a pioneer."
Suzanne says this is very common among women with hormone issues. "The big unmentionable is when you don't have any sex hormones. You can't feel sex. You can do it, but you'd rather have a smoothie," she says. "I call it the Seven Dwarfs of Menopause—Itchy, Bitchy, Sleepy, Sweaty, Bloated, Forgetful and, my favorite, All Dried Up."
Suzanne also injects 2 milligrams of estriol vaginally every day and takes 60 oral dietary supplements—40 in the morning and 20 at night. "You don't have to take all this, although the deeper you get into it, the more you're apt to want to keep adding to it," she says. "I know I look like some kind of fanatic. But I want to be there until I'm 110, and I'm going to do what I have to do get there."
"I try to do yoga four times a week because you have to move your body," she says. "You're doing yourself such a disservice if you don't find some form of exercise that you really enjoy."
Watch Suzanne explain her healthy living lifestyle.
To get a daily dose of essential nutrients, Suzanne and her husband, Alan, eat organic vegetables grown in their garden. "One of the greatest things we've ever done for ourselves is plant and grow our own food," Suzanne says. "It's just so exciting to eat fresh food. It's a privilege."
Dr. Streicher says the belief that compounded or "bioidentical" hormones are different and, therefore, safer and more natural than what you get from the drugstore is not factual. "The reality is that whether you go to your corner drugstore or your compounding pharmacy, you're most likely to get an estrogen that was synthesized," she says. "They're all synthesized from plants, and it has the exact same chemical structure."
There is one big difference if you go to a pharmacy that's not approved by the FDA, she says. "They have absolutely no obligation to support their claims. They can say what they want. ... That it's safer, that it has less side effects, that there are no risks, that it will prevent cancer," she says. "The truth is, you can get the exact same product in an FDA-approved pharmacy from true experts."
Dr. Streicher also wants to make one thing clear—"bioidentical" is a made-up term. "'Bioidentical' does not exist in any medical book," she says. "Marketers made it up. It sounds really catchy. It sounds scientific. It sounds natural."
Whether you're getting hormones from a compounding pharmacy or your corner drugstore, Dr. Streicher says you need to be monitored by a qualified physician.
"We do regular, prescription-type medicine, but what we do mostly now is prescription compounding, which is making our own prescription into different forms such as creams, capsules, suppositories and the like," Sharon says. "We do that here in our compounding lab."
Since compounding pharmacies are not regulated by the FDA, Sharon says some of the controversy may stem from concerns about quality-control. "Some people that question compounding pharmacies may not be really confident that the product that they're getting is what the doctor [has] written," she says.
Doctors do turn to places like Central Pharmacy when they need a medication or a dosage that's not commercially available, Sharon says. To complete these individualized prescriptions, Sharon and her team mix hormones—shipped to them in powder form—with basic moisturizing cream. Then, the mixture is put through an "ointment mill," which crushes the hormone particles so they blend smoothly with the cream.
The FDA sent The Oprah Show this official statement: "The FDA does not recognize the terms 'BHRT' and 'bioidentical.' Many compounding pharmacies use 'bioidentical' as a marketing term to imply that drugs are natural or have effects identical to those from hormones made by the body. FDA is not aware of credible scientific evidence to support these claims. There are potentially serious adverse effects associated with long term use of these products—even when consumers use FDA-approved hormone therapy drugs that have been proven safe and effective. FDA recommends that women use these products at as low a dosage and for the shortest amount of time necessary."
While you can get chemicals like natural progesterone in a regular pharmacy, Dr. Northrup says your doctor or nurse practitioner needs to know exactly which ones match your body. "It can be done with the regular mainstream pharmacy, and the regular pharmacies started to carry these because of the pressure from the compounding pharmacy," she says. "I, for years, recommended the compounding pharmacies because I couldn't get what I needed in a mainstream conventional pharmacy."
Suzanne says women should know that the hormones that work for you won't necessarily work for someone else. "I absolutely agree," Dr. Northrup says. "It's not the same size for everyone."
Photo: © 2009 Jupiterimages Corporation
- Follicle-stimulating hormone (FSH)
"A high FSH, combined with irregular periods, is the best indicator that you have entered perimenopause," Dr. Northrup says.
- Thyroid-stimulating hormone (TSH)
"Thyroid problems and menopause often go hand-in-hand," she says.
Robin arranged for her own physician, Dr. Prudence Hall, to meet with Michele.
After a discussion of her symptoms, Dr. Hall explains that a blood test shows Michele's hormone levels are extremely low. While a normal level of estradiol—the main type of estrogen—is 200, Michele's is less than 7. Michele's progesterone level is just 0.3, while the normal range is 10 to 20. And though her testosterone level should be in the 50 to 80 range, Michele's is 24. "And on top of all these hormones—the estrogen, progesterone and testosterone—being low, your thyroid is very low," Dr. Hall says.
Dr. Hall prescribes bioidentical hormones to help Michele get back on track.
Michele says after her last appearance, friends she hadn't heard from in a while began reaching out to her again. "[They] said: 'We used to invite you to everything. You were the life of the party. You would mingle. You were confident. You put other people at ease.' They said, 'We just stopped inviting you because you would never show up to anything.' Because I would do anything to get out of going anywhere," she says. "That would mean I would have to get dressed, put some makeup on—and I just wasn't motivated to be nice. I felt like I had one foot in the grave."
Now, all of that has changed. "I don't remember ever feeling this good," Michele says.
The main problem with BHRT, she says, is how women receive their medicines. "[BHRT] is a billion-dollar industry—probably a trillion-dollar industry after last week's show—which is really marketing to women to say: 'This is safe, and the other stuff isn't. This is going to protect against breast cancer.' How can they say this without data? My concern is [with] many of the so-called experts that are prescribing it. I've talked to some of the women here. They've done it online, they have doctors who don't examine them, they're not gynecologists," Dr. Streicher says. "Women deserve transparency in the pharmaceutical industry."
Suzanne says her use of HRT is about choice. "It's restoration versus deterioration," she says. "By replacing what I have lost in the aging process, by putting back in the exact ratio that my body requires, individualized just for me, I am experiencing the best years of my life. I thought at 62, I'd be going downhill. I feel better at 62 than I have ever felt ever in my whole life."