|
The Big Debates*
Estrogens
Bioidentical Hormone:
proponents claim that the combination of natural estrogens more closely mimics
the body’s natural hormone balance. Biest (20% E2 and 80% E3)
and Triest (10% E1, 10% E2 and 80% E3) are
commonly compounded by pharmacies. Supporters suggest that E3 is
superior to HRT because (1) it is a weaker estrogen and (2) its has been shown
in studies to have decreased risk of breast and endometrial cancers
Synthetic HRT:
(1) E3 is a weaker estrogen (1/10th- 1/100th as
powerful as E2).
So, HRT supporters argue that the amount of E3 present in Biest (80%
or 2.0mg as compared to 20% or 0.5mg of E2)
is too small to be having much of an effect. Put another way, lets say E2
is 50 times as strong as E3 in its estrogenic effects. You would
assume that you need 50 times as much E3 to affect the same changes
as E2. In the Biest preparation, there is only 5 times as much E3
compared to E2, so it is proposed that E2 alone is
responsible for the symptom reduction seen with Biest. (2) While some studies
have found that E3 has a decreased risk of endometrial and breast
cancers when given in doses and frequencies matched to E2 for
estrogenic potency, it seems that E3 has the same dose dependant
proliferative changes in endometrium.
Hormonal Monitoring
BHRT: measures a
patient's saliva or serum concentration of hormones to assess what the needs for
replacement. Women are then tested after their therapy begins and together with
evaluation symptomatic relief, the physician determines if dose adjustments are
needed.
HRT:
Women are not tested for levels before treatment begins. Women are empirically
started on a dose of HRT and then the dose is titrated based solely on
subjective symptomatic relief. Proponents argue that testing hormone levels is
unnecessary (1) because they are unreliable and (2) because hormones are altered
and converted into different hormones at the target tissues. Even if the
hormone tests were reliable, the results do not represent the hormones present
in the tissues.
(Follow this button to read
the  on drug monitoring)
The Evidence:
BHRT:
HRT has been proven in various studies to have serious detrimental effects.
Natural hormones are natural. There have been no randomized control trials, but
there is 20 years of anecdotal evidence. Further more many of the risks
associated with HRT such as blood clots, and heart disease can be combated with
the appropriate nutritional supplementation. (Dr. Jonathan V. Wright’s
Nutrition and Healing vol.9, no.9, Sept 2002, p.1-4) HRT:
There are no randomized control trials of BHRT because the products cannot be
patented and drug companies cannot make any money off of these drugs. There
fore, the funding for these studies is left up to the practicioners who
prescribe or the pharmacisits who compound the natural products. Lack of
evidence is not evidence that treatment with BHRT is safe. There are proven
risks associated with HRT, but they are known and can be dealt with in other
ways.
*Unless specifically
cited, the facts contained in this page were obtained from: Boothby
LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause 2004;11:356–367. |
