Lions, Tigers and Hormones, Oh my!
Understanding Your Hormone Therapy Options:
A Guide for Patients
Hormones play a crucial role in maintaining your body’s health. They are chemical messengers that regulate functions like metabolism, mood, and reproduction. The discovery of hormones in the early 20th century revolutionized medicine, offering insights into how our bodies work and how imbalances can affect us. For women, one of the most significant hormonal transitions is menopause, a natural phase of life that often comes with challenges such as hot flashes, mood changes, and sleep disturbances. Fortunately, modern medicine offers treatments to ease these symptoms, including hormone therapy.
Before 1880, treatments for menopausal symptoms primarily consisted of herbals, along with a selection of belladonna, cannabis or opium. In the 1890s Merck offered these chemicals along with the flavored powder Ovariin for the treatment of menopausal symptoms and other ovarian ills. Ovariin was made by dissecting and pulverizing cow ovaries, and may have been the first substance commercially available for treatment of menopausal symptoms derived from animal sources.
In 1929, estrogen was successfully isolated, and by 1933, Emmenin became available as a commercial hormone therapy. Initially derived from human placenta, it was later formulated using estrogen extracted from the urine of women. Diethylstilbestrol (DES) was first marketed in 1939 as a far more potent estrogen than Emminen but was later found to cause significant birth defects.
In 1942, Ayerst Laboratories began marketing Premarin, which would eventually become the most popular form of estrogen in the U.S., and Prempro, a combination of Premarin and Provera, which eventually became the most widely dispensed drug in the U.S.
Today, hormones are developed using advanced biotechnology, starting with plant sterols that are chemically modified to replicate human hormones. They are found in many different doses, routes of administration and formulations, let’s explore the options further!
Hormone Terminology
Chemical Makeup of Hormones: Bioidentical vs. Synthetic Hormones
Bioidentical Hormones
Bioidentical hormones are chemically identical to the hormones your body produces. They are often derived from plant sources like yams or soy.
Benefits of Bioidentical Hormones:
They closely match your body’s natural hormones, potentially leading to fewer side effects.
Available in FDA-approved forms or as compounded medications for additional customization.
Drawbacks of Bioidentical Hormones:
Compounded versions are not FDA-approved, raising concerns about consistency and safety.
Marketing can be misleading, portraying them as completely risk-free, which is not accurate.
Bioidentical hormones also do not offer contraceptive benefits nor are they typically strong enough to treat gynecologic condition such as heavy or irregular menstrual bleeding.
Synthetic Hormones
Synthetic hormones are chemically altered forms of natural hormones. Examples include conjugated equine estrogens (Premarin) and medroxyprogesterone acetate (Provera).
Benefits of Synthetic Hormones:
Widely available and often covered by insurance.
Used for menopausal hormone symptom relief, contraception and treatment of certain gynecologic conditions (e.g. heavy or irregular menstrual bleeding).
Drawbacks of Synthetic Hormones:
Some patients report more side effects compared to bioidentical options.
They do not perfectly replicate natural hormones, which can affect individual responses.
As compared to micronized progesterone, synthetic progestins carry a small increased risk for adverse effects such as breast cancer and clotting events.
Other Hormone Options
Non-Bioidentical, Non-Synthetic Hormones: Derived from natural sources but not identical to human hormones, such as conjugated equine estrogens (e.g. Premarin).
Selective Estrogen Receptor Modulators (SERMs): These are not true hormones but mimic estrogen in specific tissues to provide targeted effects (e.g. Duavee).
Manufacturing of Hormones: Compounded vs. Commercial Medications?
Compounded Medications
Compounded medications are custom-made by pharmacists to address specific patient needs. If you have unique hormone levels, allergies, or require a special dosage form (like a cream or lozenge), a compounding pharmacy can create a medication tailored just for you.
Benefits:
Personalization: These medications are designed to fit your unique needs, whether that means adjusting hormone levels or avoiding allergens.
Flexibility: They come in various forms, such as creams, gels, lozenges, or capsules, to match your preferences.
Accessibility: For some patients, compounded medications provide solutions when FDA-approved drugs aren’t an option.
Drawbacks:
No FDA Approval: Compounded medications don’t undergo the rigorous testing required for FDA-approved drugs, meaning their safety and effectiveness may not be guaranteed.
Inconsistent Quality: The quality depends on the skills and practices of the individual pharmacy, which can vary.
Insurance Coverage: These medications are not covered by insurance, leading to higher costs in some cases.
FDA-Approved Medications
FDA-approved medications go through extensive clinical trials to ensure they are safe, effective, and consistent. These drugs also undergo ongoing monitoring once they are on the market.
Benefits
Proven Safety and Efficacy: Rigorous testing ensures these medications work as intended.
Consistency: Uniform manufacturing processes mean you get the same quality with every dose.
Insurance Coverage: Most health insurance plans cover FDA-approved medications.
Regulatory Oversight: Ongoing monitoring by the FDA ensures safety over time.
Drawbacks
Limited Personalization: These medications may not be customizable to your exact needs and contain ingredients like dyes and fillers to keep them shelf-stable.
Access Issues: Shortages or specific restrictions can sometimes limit availability.
Formulations of Hormone Therapy: Which Is Right for You?
Oral Pills
Benefits: Easy to use and often cost-effective.
Considerations: They pass through the liver, which can influence risk and benefit profiles.
Transdermal Patches
Benefits: Avoids the liver and first-pass effect, provides a steady hormone release.
Drawbacks: May cause skin irritation and in some individuals skin texture and make up leads to poor absoprtion.
Topical Gels and Creams
Benefits: Flexible dosing and fewer systemic side effects.
Drawbacks: Absorption can vary, and there is a risk of transferring the product to others.
Vaginal Rings and Creams
Benefits: Ideal for localized symptoms, such as vaginal dryness.
Drawbacks: Limited systemic symptom relief (with the exception of a product called FemRing which is dosed for systemic relief).
Injectables and Pellets
Benefits: Long-lasting and convenient for those who prefer fewer doses.
Drawbacks: Harder to adjust once administered and often more expensive.
Making the Right Choice for Your Health
Choosing the right hormone therapy is a personal decision that depends on your unique health needs, preferences, and goals.
While compounded medications offer customization, FDA-approved options provide consistency and reliability.
Understanding the differences between bioidentical and synthetic hormones can empower you to make informed decisions. Remember, there is no ONE-SIZE-FITS-ALL method for menopausal hormone therapy!
