While the debate rages on about Bioidentical hormones an interesting review of the subject by the Cleveland Clinic Journal of Medicine has gain shown "Bioidentical Hormones" to be more of a marketing scheme than science.  Dr, Sandra Fryhofer discusses the findings.  

Dr. Sandra Fryhofer speaks on  Medicine Matters; the topic, hormone replacement therapy and the truth about bioidenticals. A new review in theCleveland Clinic Journal of Medicine clears up common misconceptions and sets the record straight.[1] Here's why it matters.

In 2002, the Women's Health Initiative dramatically changed medicine's views on the safety of hormone replacement therapy (HRT).[2] After that, discussions on HRT expanded from the doctor's office to self-help books, talk shows, and celebrities with product endorsements.

We now have a different lingo for talking about hormones. The new buzz term is "bioidentical," but what does that really mean?

The term indicates that the molecular structure of the drug is identical to the endogenous hormones estrogen, progesterone, and testosterone. Three estrogens circulate in the human body:

17-beta estradiol, the most biologically active;
estrone, a derivative of estradiol and the second most dominant estrogen; and
estriol, a very short-acting estrogen and the least biologically active.
The first misconception is that US Food and Drug Administration (FDA)-regulated drugs are not bioidentical. This is wrong. A long list of FDA-approved hormone products contain 17-beta estradiol and, therefore, are bioidentical. Examples include oral esterase, estradiol transdermal patches (Climara®, Vivelle®) and the vaginal ring (Estring®). Prometrium® is an oral FDA-approved bioidentical progesterone product.

The next misconception is that progesterone-containing skin creams protect the endometrium. This is false; these creams are not strong enough. In addition, some creams contain an inactive progesterone precursor that the human body can't metabolize.

Many topical forms of progesterone -- gels, lotions, creams -- are made at compounding pharmacies. Some can be purchased over the counter at health food stores. Such progesterone creams are not strong enough to raise blood levels sufficiently to protect the endometrium from estrogen stimulation. Transdermal progesterones therefore do not protect against endometrial cancer in patients taking estrogen.

Another misconception is that compounded therapy is safer. That just isn't so. Compounded therapy may be marketed as being safer, but these claims are false and misleading. Because these products are not FDA-approved, there are no guarantee as to their purity, potency, and efficacy. There is also no proof that compounded products are more effective or that they have fewer side effects. They also often aren't covered by insurance and therefore may cost more.

The final misconception regards saliva hormone testing. It's a gimmick. Although the concept of making a hormone combination just for you sounds appealing, the FDA says that saliva hormone testing has no scientific basis, and it's not reliable.

These are just some key points from this study. For more details, read the entire review.[1] For Medicine Matters, I'm Dr. Sandra Fryhofer.  http://www.medscape.com/viewarticle/769969?src=mp

http://www.drjkm.com/hormone-replacement-therapy-truth-bioidenticals/.

J. Kyle Mathews, MD

Plano OBGyn Associates

Plano Urogynecology Associates

Hysterectomy for benign, non cancerous, indications is one of the commonest surgical procedures in women, but the association between the procedure and the increase risk of cardiovascular disease (CVD), heart attack and stroke is not fully understood.

Hysterectomy has traditionally been considered the method of choice for treating a variety of benign, non-cancerous, gynecological disorders due to the low surgical complication rate and definite cure of these diseases.  Incidence rates of hysterectomy in the USA and in western European countries have remained relatively stable despite recent years introduction of minimally invasive treatment options, such as endometrial ablation, for conditions, such as heavy periods and fibroids.

The majority of hysterectomies are preformed in women before menopause and the removal of ovaries after the age of 40 is common.  The removal of ovaries is often recommended as a measure to reduce the risk of developing ovarian cancer.  A number of studies have suggested that hysterectomy with the removal of ovaries prior to age 50 may increase the risk for heart attack and stroke.  Given the fact that cardiovascular disease is the leading cause of death in women, and hysterectomy is such a common surgery, further investigation was warranted.  

A recent European study published in the European Heart Journal has helped bring this issue to the forefront.  This large study looked at 800,000 women under the age of 50.  The authors conclusions were: “Hysterectomy in women aged 50 and younger substantially increases the risk for cardiovascular disease later in life and removal of ovaries further adds to the risk of both coronary heart disease and stroke.”  Erik Ingelsson  

J. Kyle Mathews, MD
Plano OB Gyn Associates
Plano Urogynecology Associates
www.drjkm.com

A report today from the influential Institute of Medicine sets the first formal recommendations for daily intakes of calcium and vitamin D for bone health, and suggests that most people are getting what they need.
The recommended amounts are higher than guidelines set 13 years ago that were simply estimates, but the vitamin D recommendations immediately drew criticism from some experts who said they are still far too low.
According to the report, children and adults younger than 71 need no more than 600 international units (IUs) of vitamin D a day and should consume 700 to 1,300 milligrams of calcium a day, depending on their age.
The committee was surprised to see that most Americans are meeting their needs for both of the nutrients, except for adolescent girls who may not be getting enough calcium and some elderly people who don't get enough of either, says Catharine Ross, professor of nutrition at Pennsylvania State University and chairwoman of the panel that prepared the report. The Institute of Medicine (IOM) is set up by Congress to advise on a variety of health issues.
Among the reasons for sufficient intakes: food fortification and more supplement use. Many foods, such as milk and yogurt products, are rich in calcium and fortified with vitamin D. Fatty fish such as salmon, mackerel and tuna also have a lot of vitamin D.

Sunlight triggers the production of vitamin D in skin and contributes to people's levels.
Robert Heaney, a professor of medicine at Creighton University in Omaha who has studied vitamin D's health benefits, says the overall daily value of 600 IUs of vitamin D a day "is way too low." He says people should consider taking up to 4,000 IUs a day.
"For me, it's a no-brainer. There is a large body of evidence for benefit at intakes above the IOM recommendations. There is no risk, and very little cost, so why not take a chance of a benefit if there's any possibility?"
The committee, made up of nutrition scientists, set the upper limit for vitamin D at 4,000 IUs a day for those who are ages 9 and older. This is considered the safe boundary and is not the amount people should strive for, the panel cautions. Excessive vitamin D can damage the kidneys and heart, and too much calcium from supplements has been linked to kidney stones, the report says.
Vitamin D has been a hot topic in recent years because research has linked lower levels of the nutrient to certain cancers, diabetes, and bone and immune system problems.
The panel concluded that more scientific research is needed to investigate the potential health benefits of larger amounts of vitamin D.
"We looked at that evidence, and it's conflicting," Ross says. "Some studies show potential benefit, but others show no benefit, and some studies show the opposite, even harm."
Steven Clinton, a committee member and a professor in the division of medical oncology at Ohio State University, says part of the uncertainty over the nutrient comes from the blood tests that are used to measure it. "There are no national guidelines for how vitamin D should be measured and what levels are appropriate," he says.
Clinton recommends that national standards be developed.
By Nanci Hellmich, USA TODAY

Follow-up  analysis of data collected for the Women’s Health Initiative study of postmenpausal women  has shown an increase risk of breast cancer in women taking combined estrogen and progesterone.  The findings suggest there is an increased risk of invasive breast cancer, breast cancer presenting with positive lymph nodes, and breast cancer related deaths.

While the absolute risk of breast cancer related death is small, it is significantly increased for women taking combined estrogen and progesterone daily.  It should be noted that the data at this point does not show an increase in breast cancer risk in patients taking estrogen alone.

Researchers suggest women considering hormone therapy for relief of menopausal symptoms should continue to be counseled that thy should use the lowest effective dose, for the shortest period of time.

J. Kyle Mathews, MD
Plano OB Gyn Associates
Plano Urogynecology Associates
www.drjkm.com
972-781-1444