Hot flashes. Vaginal dryness. Sleep disruptions. Mood swings.
It’s not a pretty picture, but that’s the unfortunate reality for a significant number of women suffering from the symptoms of menopause, which are caused by the natural reduction in hormones that accompany aging.
That’s where replacement hormones come in. By swapping in a substitute for those ebbing natural hormones, doctors say the newly restored levels can ease all that uncomfortable sweating, sleeplessness and other body changes.
First came conventional hormone replacement therapy, a practice in which doctors prescribed hormones that are derived from plant and animal sources (the urine of pregnant horses, most notably) and while similar to the ones produced by people, are not chemically identical. But when studies came out showing health risks, interest plummeted.
Then a newer option, bio-identical hormone replacement therapy, started gaining attention, buoyed in part by celebrities like Suzanne Somers
who say they are safer and more effective than hormones approved by the Food and Drug Administration. Bio-identicals—which are made from plants and come in various forms including creams, gels, patches, sprays and vaginal rings—are formulated to chemically match the ones our bodies produce.
There are two general types:
FDA-approved: Hormones produced by pharmaceutical companies, dispensed in standard dosages and FDA approved, according to Dr. Ertug Kovanci, an assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas, who specializes in hormone replacement therapy.
Custom compounded: Created by compounding pharmacies that custom mix different levels of hormones to a doctor’s specifications, and sometimes based on saliva and blood tests that indicate current hormone levels. For the most part, they have not undergone long-term studies or rigorous testing, and claims that they have no side effects are false, according to Kovanci. “The type and amount of the hormones that are in these compounded medicines are not standardized or regulated,” he says, adding, “There isn’t a single medication that is side-effect free. If you are taking a custom compounded bio-identical hormone, and you’re told the risks do not exist, they simply cannot prove that claim with the current data.”
His position is supported by, among others, the American College of Obstetricians and Gynecologists, which says that most bio-identical hormone combinations have not been tested by the FDA and there is no scientific evidence that they are effective in relieving menopausal symptoms. The North American Menopause Society also “does not generally recommend compounded” hormone treatments.
Dr. Cheryl Perlis, an ob/gyn practicing in Lake Bluff who specializes in hormone therapies, prescribes both types, saying patients simply want relief, and that’s what they get. “They always work, because they’re exactly what we have in our bodies,” she says. “I see people feel so much better. It’s night and day.”
Though happy to prescribe FDA-approved hormones, Perlis isn’t worried about custom compounded ones, saying opponents, “aren’t looking at all the evidence.” She is such a fan of bio-identicals that she uses them herself. Now 52, she started using hormone creams two years ago and within a month she was able to concentrate better, her hair loss stopped, she had more energy and started sleeping through the night again.
Sharon Lederman Burack, 56, of Highland Park, had similar improvements in energy, memory and relief from hot flashes after starting custom compounded bio-identicals about two years ago. “I feel like I’m functioning like I did when I was in my 30s,” she says. “It’s amazing.”
So what should you do? There is universal agreement on at least this point: Talk to your doctor about what is right for you.