J. Kyle Mathews, MD, DVM  
Male, 63
Plano, TX

Specialties: Urogynecolog, Pelvic Reconstructive Medicine

Interests: Women's Health, Bladder Diseases
Plano Urogynecology Associates
Obstetrics and Gynecology
Plano, TX
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Bioidentical Hormones:  Sorting Myths and Facts.

Aug 23, 2010 - 20 comments

bioidentical hormones






Compounded Bioidentical Hormones have received a great deal of coverage in news, on talk shows, and in magazines over the past several years.  Claims of weight loss, increasing energy, improve mood, are safer, and many others have been made. Hopefully this article can help you answer questions and dismiss many of the myths surrounding this highly published, highly marketed topic.  

The term Bioidentical Hormones is not a medical term, it is a marketing term used to imply an exact copy of the hormones produced in the body.   Providers of these compounds often claim they are “A natural, safer alternative to prescription drugs, Can help with weight loss, Prevent Alzheimer’s” and many others unfounded benefits.   In addition, these providers often suggest that Bioidentical Hormones can only be obtained from a compounding pharmacy.  

The fact is that there are many FDA-approved bioidentical hormone products available in the U.S. today.  In fact, they have been available in the U.S. since 1975!  Most all FDA-approved bioidentical hormones have been available in the U.S. for a long time and have extensive studies to support their safety and effectiveness.  As an example, EstroGel was one of the first bioidenticals in the world with use in France since 1974, FDA-approval in the U.S. in 2004, and now used in more than 70 countries.  

To better understand what is meant by Bioidentical Hormones, specifically estrogens and progestone, the following may be helpful.  The 3 primary human estrogens are: E1, Estrone; Serves as the primary ‘”reservoir” of estrogen, and dominant estrogen remaining AFTER menopause.  It is produced primarily in the ovaries, body fat, and breast.  E2, Estradiol; Serves as the primarily active estrogen BEFORE menopause and is LOST at menopause when follicles are gone.  It is produced primarily in the ovaries with some made from testosterone in the brain, breast, and muscle.  E3, Estriol;  A weak estrogen made by the placenta during pregnancy.   There is only one progestin, Progesterone, which is converted to other progestins.  

The only FDA-approved estrogen bioidentical hormone is estradiol.  Perimenopausal and postmenopausal women do not need the hormones estrone and estriol.  However, compounding pharmacies often use Estriol or E3, which is not FDA-approved.  Furthermore, pharmacies and doctors may not (or should not by law) use Estriol unless they have an investigational new drug (IND) application with the FDA.   Obviously many doctors and pharmacies violate this FDA regulation but are not sanctioned because the FDA does not regulate compound pharmacies, the state does.  

These compounding pharmacies obtain the bioidentical or natural hormones, Estradiol, Progesterone, and Testosterone in USP raw powder from for the SAME suppliers the drug companies do.  They use different amounts of each but the hormones are the same.  Many formulations are based on Saliva testing to “individualize” hormone therapy.  It is well documented that hormone levels in saliva vary widely and do not correlate well with blood levels.  In addition, it is also known that the plastic tubes used to collect saliva alter hormone levels.  Saliva testing is not reliable, period.  If your compounder suggest the saliva test, be wary.  

Providers and compounding pharmacies often include Progesterone claiming additional health benefits.  The fact is progesterone does not add additional benefit and should only be included when a woman has not had a hysterectomy.   Progesterones should not be prescribed in women whom have had a hysterectomy.  Progesterones may increase breast cancer risk, promote weight gain, cause depression, increase cholesterol, and do not prevent bone loss.  

The use of testosterone in menopausal women has been studied and shows some benefit at low doses to treat vasomotor symptoms and decreased libido.  Higher dosages have been associated with elevated cholesterol, triglycerides, male pattern hair growth, and acne.

So what are the FDA-approved Bioidentical Hormones?  

Estrace, 1975
EstroGel, gel, 2004
Estraderm, 1985
Estace cream, 1984

Generic 1997
Estrasorb, lotion 2006
Vivelle, 1994
Estring, ring 1996

Prometrium 1998
Divigel, gel 2007
Climaria, 1995
Prochieve 4% gel 1997    

Elestrin gel, 2008
Vivelle Dot, 98
Vagifem Tabs, 98

Evamist spray, 2008
Femring, 2003

The true indications for hormone therapy are obvious, vasomotor symptoms, vaginal dryness, preventing bone loss, and it is best to start them as close to menopause as possible.  Recent data has suggested advantages of transdermal (patch) administration over oral administration but further studies are needed.  

The North American Menopause Society and others have revised their position statements on hormone therapy as of 2010 stating the use of hormone therapy around the time of menopause has a favorable benefit-risk ratio.  The go on to state that hormonal therapy may decrease total mortality when started soon after menopause but does not appear to reduce mortality when started after age 60.  

An FDA survey on quality control of compounded drugs analyzed 29 compounded products from 12 compounders for sterility, potency, and uniformity.  The found 10 of the 29 products (34%) of compounded drugs failed at least one quality test.  They also reported the products contained less of the active drug than stated on the label in 25% of the products.  

So, if you want Bioidentical Hormones, consider FDA approved drugs.  Less than 2% failed testing and most of them are covered by your insurance.  

For further information, please see www.thebuzonbios.com   This site contains the best video presentation on Bioidentical Hormones I have found to date.  Be sure and watch the 2009 video first, then the 2010 video.  It really is a great resource.  Tell a friend.  

J. Kyle Mathews, MD

Plano OB Gyn Associates

Plano Urogynecology Associates.  

Post a Comment
Avatar universal
by SherlockAndSlinky, Aug 23, 2010
You state that progesterone does not add additional benefit and may increase breast cancer risk. I've read completely the opposite and know women who are taking progesterone and have gained enormous benefit from it, especially improved emotional health.  I've read that it is oestrogen ( a certain type, cant remember which one) that encourages proliferation of cells and that progesterone opposes this and is a cancer preventative.  I am so confused at the moment because I keep reading conflicting information regarding these two hormones and dont know what to believe anymore.

I am a 49 year old woman who is perimenopausal.  I am starting to skip my cycles and I feel so unwell and can barely function.  I have started to take bio-identical progesterone cream to see if it helps and I am now worried about the medical consequences.  I am in between a rock and hard place.  Do you have any suggestions as to what might help without all the risk involved.

Thanks for an interesting discussion.

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by J. Kyle Mathews, MD, DVMBlank, Aug 24, 2010
Hello and thank you for your comment.

I agree that the Internet can be a confusing place.  It is often difficult to know just what and who to believe.   With regards to your comment, I have learned along time ago not to argue with a therapy the patient feels is beneficial as long as that therapy does not pose significant risk.  No doubt there are numerous individuals who feel they have been helped by taking progesterone.  

That said, I can offer you the following information.  The recent recommendation published by North American Menopause Society, NAMS, issued the following consensus statements: (HT is Hormone Therapy, ET is Estrogen Therapy, EPT is Estrogen & Progesterone Therapy)

"Current evidence supports a consensus regarding the role of HT in postmenopausal women, when potential therapeutic benefits and risks around the time of menopause are considered," the statement authors write. "Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable for women who initiate HT close to menopause but decreases in older women and with time since menopause in previously untreated women."

The Women's Health Initiative (WHI) trial of estrogen therapy (ET) offered evidence of considerable safety for 0.625 mg/day of oral conjugated estrogen, supporting the position that at least for this form of HT, the potential absolute risks are low.
In the WHI trial of combined estrogen-progestogen therapy (EPT), MOST risks were determined to be rare, using the criteria of the Council for International Organizations of Medical Sciences, except for stroke, which was above the rare category.

"For women younger than age 50 or those at low risk of CHD, stroke, osteoporosis, breast cancer, or colon cancer, the absolute risk or benefit from ET or EPT is likely to be even smaller than that demonstrated in the WHI, although the relative risk at different ages may be similar," the statement authors write. "There is a growing body of evidence that each type of estrogen and progestogen, route of administration, and timing of therapy has distinct beneficial and adverse effects. Further research remains essential."

It has been pretty well established that the addition of progesterone to therapy does not offer significant benefits and does increase the risk of hormone therapy overall.  For further explanation of these risks, benefits, I would direct you to the following site: http://www.thebuzzonbios.com/.    This is a great site.  Be sure and watch the 2009 AND 2010 webinars.  

Good luck and thank you for your comment.  J. Kyle Mathews, MD

Avatar universal
by deebs57, Aug 26, 2010
I have been on bioidentical hormones since I became perimenopausal - about 7 years ago.  I use progesterone cream - which I understand helps with sleep, and also I use testosterone cream.  The Triestrogen is taken in the form of a troche that is dissolved orally in the cheek.  I have tried to go off the hormone regimen recently due to the expense and also the concerns about possible long term side effects, but I felt horrible.  My hot flashes returned, my sleep was restless and my mood and energy level was not as good. My age is 57 and I am genetically predisposed to CHD.  My lifestyle habits are healthy.

My question is how long I should consider staying on hormone therapy and is it safe to go off the hormones to evaluate your symptoms and then go back on them again?

Thank you for your assistance.

Debera Bragg

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by stella5349, Aug 30, 2010
I value your service with your profession but female hormone panels are not as cut and dry as one would hope. One pill or one formula ( approved by the FDA-only) - is far from the true tales of what goes on in each individual body. I recall numerous concerns over the Depo and YAZ products for some time - even prior to the FDA's case studies but the FDA went ahead and approved these drugs for use - all to find out later - that they needed to do better in-depth studies on their effects within the body - AND other sensitive hormones effected by those products. Some extremely damaging and critcial for women's health.

I apologize but I can't toot my horn so loud on relying on the FDA and their care for the general public lately.

Same applies to the saliva testing cautions you boldy print here. A one time - one hour - one minute blood draw is far from specific daily levels each day. Is there a 24 hr draw with blood? That may be something to entertain.

Also patterned blood draws are not done, meaning - a women has a regular 28 days cycle each month. She can go on day 7 one month - day 15 another month and day 26 another month and these panels taken can show high levels of different hormones at any given time. But she will be medicated each time for that specific blood lab that was tested that day. - And in most cases other hormones.... thyroid - adrenals and others are not taken into consideration with these labs to really find out what the full hormone picture is for that individual.

Our bodies are far from a reference range given on a lab slip both saliva or blood. Unfortunately the ones using the saliva draw are most often the doctors that use compound therapy and realize the cycles are different throughout one month, while a regular OB-GYN is more opted to run a one time lab - lump a range together and shove a synthetic estrogen BC script at you to fill. Of course with a follow up visit in 6 mths to a year given after you start the BC therapy. And, completely voiding out other conditions that could be associated with estrogen dominance or pre-cancerous cell generation formation due to the lack of other hormones in this body.

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by J. Kyle Mathews, MD, DVMBlank, Aug 30, 2010

It is difficult to know what you are actually on and what dose.  In patients that present to my practice on these compounded medications, I usually try to obtain some idea about the concentration of each drug involved in the compounding.  This often turns out to be of little help because often the information is vague.  If a patient feels their current regiment is beneficial and I do not see a significant risk in what they are on, I suggest they continue.  Often patients are on high doses of hormones and have similar complaints as yours when trying to stop them.  They often find it beneficial to decrease one compound at a time over a period of several months.  The data is fairly clear that hormone replacement therapy is beneficial early on but as patients get further from the onset of menopause, benefits become less.  As patients approach 60, the benefits vs risk of hormone therapy becomes less.  Good luck and thank you for the comment.  

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by J. Kyle Mathews, MD, DVMBlank, Sep 02, 2010
Stella5349    Bioidentical Hormones

Thank you for your comment regarding Bioidentical hormones. I see from your posts you have written extensively regarding your issues with Thyroid disease and have an interest in Bioidentical hormones.  Discussions on Bioidentical hormones are often spirited with both sides being passionate about their beliefs.   One side doesn’t trust the science and the other side struggles with the lack of science supporting claims.  With that in mind, I will try to address several of your points in your comment.

The implication that Depo Provera and YAZ were approved by the FDA prior to FDA case studies is simple untrue. The issue raised regarding YAZ, and Yasmin, was in regard to the progesterone agent, drospirenone and because of Bayer overstating the approved use of Yaz while failing to adequately address the risk of the drug, specifically drospirenone.  The risk associated with drospirenone was and is well know.  Regarding Depo Provera, if you are referring to the Black Box Warning issued in 2004 about osteoporotic effects in long term use, that observation was noted only after years of use and the now much more common use of bone density screening.  I agree that the FDA doesn’t always get it right. But, I believe most people would rather have at least some peer reviewed data behind a medications claims than none at all which is the case for most if not all compounded medications used in hormone replacement therapies.

You asked if there was a 24-hour blood draw and that might be something to entertain.  I assume you are referring to normal flux in levels throughout the day.  I doubt many women would submit to such testing, but it has been done in research protocol.  Saliva vs blood testing however has nothing to do with one-time one-minute hormone levels.  True blood levels do represent a single value at a particular time but some test tell us more about what is going on over a period of time that just a single point in time.  You may be most familiar with this type of test with diabetes. HbA1C is done to tell what the patients blood sugar average has been over the last 4 weeks or so.  In this discussion, day 3 FSH levels, TSH, and Prolactin are examples. Regarding Saliva Testing, It is a simple fact that it is unreliable and should not be relied upon.  As reference please refer to:
ACOG statement
NAMS The North American Menopause Society Statement

I am uncertain as to what you mean as “patterned blood draws” given your definition (a women has a regular 28 days cycle each month).  If a woman were having a regular 28-day cycle, I would not be considering her for hormone replacement, at least not for menopause.  Hormone levels drawn for other issues such as sexual dysfunction and infertility are done so on specific days of the cycle.  While levels do change during the normal cycle, test on a specific day combined with other test can often help clarify an issue.  

The reference to adrenal gland function testing while often mentioned in anti aging and weight loss, is complex, time consuming and costly. Cortisol levels popularized by weight loss supplements like CortiSlim and others have been blamed for many conditions associated with women.  While real disease is associated with adrenal abnormalities, true accurate testing of adrenal function often requires the measurement of 24-hour urinary aldosterone, ACTH stimulation test and others depending on which disease, Adisons or Cushings is in question.  

I do find myself in agreement with your statement regarding OB-Gyn and the use of saliva levels being the doctors most often using compounding pharmacies.  Unfortunately, the saliva testing calls into question the lack of knowledge or the ethics of those who continue this practice.

If you have not already, please see the presentation, The Buzz on Bioidenticals, www.thebuzzonbios.com.  Be sure and watch the 2009 and 2010 webinars.  They are excellent.  Thanks again for your comments.  JKM

393685 tn?1425812522
by stella5349, Sep 04, 2010

In the first paragraph, one sentence you wrote has me bothered. "Discussions on Bioidentical hormones are often spirited with both sides being passionate about their beliefs."

I believe both sides should intertwine with each other instead of trying to prove one way is best.

The FDA has a goal of providing information to the public "in a perfect world”.  Yet the FDA gain cash profit for their approved recommendations. There's pharmaceutical sway with the elected representatives of the FDA – and false backing with the makers of these drugs, showing private pharmaceutical research as document - concluding that these drugs are safe. I don't want to turn this into a debate of the FDA - but you know as well as I know how things are done and promoted. There's more involved with these advanced BC medications than just the osteoporotic effects. A young or middle aged woman is naturally suppose to menstruate each month until menopause hits - and being drug induced to not menstruate has ill- health /hormonal consequences, regardless how safe the FDA say it is.

As an advocate, if I woman is miserable enough with symptoms and nothing is found by standard testing - they would comply with getting labs throughout the day if it could uncover something. Repeated blood draws done through the day is nothing compared to some of their daily lives living with these imbalances.

Please, a repeated day lab draw as a critiqued option to find a link to their illness, is the least of their worries when they are miserable with symptoms and nothing has been found per say.

I have links that provide saliva testing to be credible and a reliable fact as you have yours, in your files.  This is not a debate on how many sources we can provide to each other. Saliva testing could be an option to use effectively in addition to blood labs, to see if something can be correlated together, even in the mildest cases of hormonal phases. Accomplished professionals who use saliva testing also use specific blood labs in their diagnostic findings, and respectfully sir, are not tooting their horns saying saliva is the only testing that is 100% accurate to diagnose a hormonal disorder.

For entertainment, are you saying hypothetically, if a women in her 30's or early 40’s - is menstruating a semi normal 21-28 day cycle but comes in saying she is not sleeping, hot flashed, headaches, heavy or light periods erratically, and sweating profusely at times- then feeling ice cold - and the list of symptoms could go on pinpointing possible menopause issues but because of her age a test wouldn't be done?  

Is it prudent for me to assume, the measurement of the pituitary “signal” gland of theoretical thyroid function (Thyroid Stimulating Hormone) - would be done (with additional straight forward hormone testing) - and if this TSH came back “normal” meaning: within the wide curve of the TSH reference range (outdated as of 2003 of .4 -5.2 or above) thyroid malfunction could be entirely ruled out in your practice as one possibility?  

In my opinion and others, lumping hormones in a few universal lab tests, that in most cases pin point only "stored" or “blocked” unusable levels, on a one time /one day speculation has enormous errors. I tend to believe, as you should, the human body is more complex than these inconsistent lab results and lab rating the patient’s real condition with a one time blood draw and treat them accordingly, can be guess work with possible error too.  

ACTH is a test only to see if the development of Addison’s and Cushing's is present. (Which are critical advanced adrenal malfunctions). Weak adrenals or cortisol changes throughout the day consistently - as in adrenal fatigue - are not detected on the ACTH. Any issues associated with the adrenals are ruled out in many situations by ACTH that the adrenals are playing any role in the patient’s symptoms. Again this is based off the ACTH negative blood lab that only detects Addison’s or Cushing’s. There’s more (and I hope you can agree that there is more) to the adrenals than just Cushing’s or Addison’s.

"Ethics" is an overall base of knowledge, learned. How far continuous learning goes for the individual and is explored - so will the ethics of their practice.  A true ethical person or moral professional, willing to expand their knowledge and use a wide range of resources, is extremely valuable and hard to find for the symptomatic patient, but these other supplemental “licensed” and also moral professionals are labeled as (should I say) quacks or jokers by their peers and will be publically noted about as distressed patients look on in disbelief. "Team approach" is a dying breed in this line of care/work sir, and its ego-driven drama is getting public awareness more now, due to the lack of respect towards each that’s being engaged in professionally more and more in our medical communities. And more importantly the lack of wellness in the majority of these patients after these narrows "ethics” have been ruled as the only treatment options and labs available.

I appreciate having this correspondence with you.  

Thank you also, for extending the invitation to broaden my horizons with these upcoming webinars  - as I will also forward you further enlightening webinars that you may be interested in viewing, to empower your ethical goals to provide better wellness to your clients.

Good day and good health and wellness to you and your practice,

Yours Truly,

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by J. Kyle Mathews, MD, DVMBlank, Sep 13, 2010

I appreciate your response however; in medicine we are not so much interested in “intertwining” as getting to the truth based on the best science available.  There are many things we would like to believe as true, this pill will make you loose weight, or improve your memory, etc. but are simple not. Unfortunately, most if not all of these are an attempt to take advantage of our nature and are provided by individuals that are more than happy to take your money.  

Regarding the FDA, I am not sure what your information is based on but you are simple misinformed.  In addition I am not sure what your point is about menstruation, TSH testing, ACTH testing etc.  This is probable not the best place to discuss how to work up patients with thyroid or adrenal gland disorders or debates the FDA.  

I noted you didn’t include your reference for salivary hormone testing.  I would be interested in the links with this information.  I find that the Internet can provide me with support on virtually anything I wish to believe.  Fortunately, I have the opportunity to follow many of these issues in peer reviewed formats where there is often spirited, passionate and sometimes heated debates between sides.   Through this process, motives become clear and the science is often all that is left to debate.  

As physicians we have a fiduciary responsibility to put aside as best we can what we would like to believe as true and base our decisions on the best data available.  These debates may last for years.  Some examples are the use of tocolytics in preterm labor in obstetrics and the use of mesh in pelvic organ prolapse in urogynecology.  Tocolytics to treat preterm labor have been available for over 20 years, yet the overall preterm birth rate has not changed.  Why?  If the drugs worked we should see a decrease in preterm births.  Yet tocolytics are widely used in the U.S.  The use of these drugs falls under the consideration of medical ethics which is discussed below.  The debate on the use of mesh is in its infancy.  Time will tell if it will prove better than traditional repairs.    

Medical ethics, while requiring knowledge, is not based on it.  It is a system of values common to the medical profession whereby values concerning the practice   of medicine with standards of behavior by which physicians may evaluate his/her relationship with patients, colleagues, and society are applied.  Medical ethics is based on principles of Non-Maleficence, Beneficence, Autonomy, Veracity, Confidentiality, and Social Responsibility.  

To recommend, promote, and/or provide a medical service that you know does not provide the benefits claimed is unethical without informed consent. (Example is Tocolytics, Patients should be informed of the lack of evidence for prolonged benefits prior to use).   In some instances providing that services even with informed consent is unethical and cannot be justified. Finally, to provide services believing the service provides benefit in spite of overwhelming evidence to the contrary is delusionary.

Bioidentical Hormones is not a medical term.  It is a marketing term.  The replacement of hormones based on symptoms, and laboratory studies are a cornerstone of medicine.  There is no debate here about this practice.  Where I have issue is in the unfounded, untrue, deceitful practices many are willing to promote for monetary gain.  Medicine is unfortunately not immune to this type of practices.  One only needs to look at the diet industry as a glairing example.


393685 tn?1425812522
by stella5349, Sep 14, 2010
Hormone patients in general- doctor, should deserve the extra thinking it may require to find the root cause of their symptoms and should treat them individualized, instead of lumping them as reference - most often, unsuccessfully. When the doctor, is at a break down- utilizing only standard labs that read these references (instead of actual ratios analytically formatted) of selected hormones, that usually conclude negative results, venturing then to possible psychosis diagnosis’s or stress management is prearranged instead of using marginal hormone therapy with individualized saliva and blood lab testing and treatment can be seen as delusionary by some.

Ironically in your comment on relevant D2P scenarios:

“There are many things we would like to believe as true, this pill will make you loose weight, or improve your memory, etc. but are simple not.”  (“Simply” I believe is what is meant)

It seems the over use of “marketed” antidepressant stimulants could be mentioned and noted above. In fact, these mind stimulants are over zealously prescribed by many practicing one-side services as an overall option, and are the prescriptions most often written to the patients that have inconclusive standard hormone lab tests. In many factual cases on the other side of treating hormone imbalances using individualized tests and “bio identical” therapy, these drugs are rarely needed to effectively help the patients find stability and wellness.

The simple fact is many women (many patients) are not finding the proper answers they need under the tests being conducted on them routinely. In the majority, that are not responding well traditionally, are simply, not being cared for entirely. The patients are forced to research on their own and spend enormous amounts of money, when diagnostic tools are right at the hands of educated professionals that are servicing them.

To provide dozens of links on saliva testing or other tests sounds futile. It’s clear this is not something that will be utilized proactively. The patients reading on can find solid credible tools, and viable communications, if their conditions warrant that, to empower themselves proactively on their choices when the methods you deem ethical, are not working. Most likely, on their own, these patients will also find the high quality of care they pursue, that utilizes these tests – with other treatment, to finally help them in their quest they are not getting traditionally.

In my last effort here to mutually agree, to disagree, there’s more to the human hormonal structure then what is offered in this side of science you articulate. For some, their distinctive circumstances may be left undiagnosed and improperly mismanaged and it can cause life changing consequence to those patients. It is the job of the professionals to explore all the medical opportunities present, to meet their patient’s expectations to regain their health and live balanced (happily) again.

Avatar universal
by joyrider, Sep 15, 2010
Interesting article. Already menopause for a few years. Never been on hormone treatment. Wondering if I should be on one for my general well-being. Generally healthy and 43.  

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by J. Kyle Mathews, MD, DVMBlank, Sep 20, 2010
Stella 5349    I must agree it would be best to mutually disagree.   This discussion ends they all do regarding BioIdentical Hormones, as I stated in my first response.    Discussions on Bioidentical hormones are often spirited with both sides being passionate about their beliefs.   One side doesn’t trust the science and the other side struggles with the lack of science supporting claims." J. Kyle Mathews, MD

1344197 tn?1392819171
by J. Kyle Mathews, MD, DVMBlank, Sep 20, 2010
Joyrider,   You are young at 43 to be menopausal.  There is data to suggest hormone benefits when initiated at or near the onset of menopause.  These benefits tend to decrease over time. I would refer you to The North American Menopause Society, NAMS    http://www.menopause.org/consumers.aspx for more information.  JKM

Avatar universal
by joyrider, Sep 22, 2010
Thanks. Yeah I had early menopause. Kind of 'young but my gyno said it's not unusual. Since I had not been on any hormone therapy since the onset, more than two years now, will it be good or beneficial to start one? I will not be meeting my gyno anytime soon, long waiting period, but I know my primary care can prescribe one. I read that soya products which is part of Japanese diet can boost estrogen, will that helps?        

1344197 tn?1392819171
by J. Kyle Mathews, MD, DVMBlank, Sep 24, 2010
Plant source estrogen can help some.  If you are symptomatic, Hot Flushes, etc., and you do not have any contraindications to Hormone Replacement Therapy, you certainly could consider it with your physician.  Here is an article you might find interesting.  http://www.msnbc.msn.com/id/37830212/

Avatar universal
by levyn3, Nov 26, 2010
Ok, I am going to pass this question onto you . in hope I get an answer before my hysterestomy and bladder lift.  Do I stop my bio creams or continue to use them as prescribed?  I have aske the surgeon, he said to stop, ...family doctor says if that is what the surgeon says..do it!  My bio-doctor who does not personally talk with her patients on the phone but thru her assistant says, to stop but when other partients I have spoken to said they continued to use the ceams.  Please  advise.  I have reduced creams to once a day for the last three days and can't sleep well and also have lite hot flashes. What do you advise as to stopping or continue.    Thank you in advance

Avatar universal
by CWesty, Aug 08, 2013
Hello, just started Estrogel and Prometrium 72hrs ago and my hot flashes have increase to one an hour during the day. Is there an adaptation period before symptoms abate? My mood and mental state have improved immediately and can sleep somewhat better - waking with hot flashes only 3 times or so at night vs. ++

Avatar universal
by Shanadar, May 12, 2016
I have been on Estrogel - 1 pump and 100 mg.of  Prometrium daily  for over 5 years and I am currently 62 years of age. I was menopausal at 57 years old. While I do not have any menopausal symptoms I do find in spite of a very active lifestyle and good nutrition I experience weight fluctuations, bloating and enlarged breasts, all of which I find uncomfortable. I am thinking it is time to wean myself from HRT to see if it addresses these symptoms but am not sure how to go about it. Should I have 1 pump every other day and the same with the Prometrium?
I'd appreciate your opinion.

Avatar universal
by DBrito, May 30, 2016
DrJ.Kyle Mathews
I would love your opinion/advice on my situation.  I am 32, 5 months ago I had a full hysterectomy(no uterus, no ovaries, no cervix). For 3 months I did the Premarin 0.675 pills. They worked great but unfortunately I had horrible migraines that caused vision issues. Then I proceeded with Estradiol generic patch 0.05. All was okay but by the 3rd week my extremities were swollen after getting sun, and I, scared removed it and tried going 'natural'. I did black cohosh and St Johns wart. Wow, what was that for! I was doing horrible. I had amnesia, panic attack,and didn't sleep for days. Was hospitalized and all. Racing thoughts etc...but through it all I was not sweating just felt like a heat all over that felt like a rash. Than my gyn tried me on Mimvey .1 , and wow my memory is mostly gone, and feel empty. Now I'm on Vibrate Dot 0.05. Mind you I have no history of depression or panic attacks but I'm on a panic medication also, and I only sleep with Valerian extract drops. Otherwise I won't sleep ever. I have horrible memory, irritability, racing thoughts, insomnia, sensitivity to light and sound, and fatigue. What should I do? I don't want to take anti panic meds since my panic stemmed from the hysterectomy and would like to try to feel I eventually don't need these, and  try to get some of myself back.

Avatar universal
by DBrito, May 30, 2016
Meant Vivelle Dot 0.05

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by Chucha_B, Jun 21, 2016
Thank you so much for this information, Dr. Matthews.  I do have 1 very important question, but I will first provide a little background on myself:

I am 48 years of age and have been perimenopausal for a few years now.  Just today, I finally knuckled under to these debilitating hot flashes of mine and visited my GYN for some serious help.  My other perimenopausal symptoms are dry skin, thinning hair, vaginal dryness, frequent UTIs (typically after sex) and rock-bottom libido.  They all gradually crept up on me about a year or so after my partial hysterectomy.  I still have my cervix and both of my ovaries.  Anyway, my doctor at that time (now retired) checked my hormone levels with a blood draw and simply told me that I was in the early stages of perimenopause.  His words were, "try some natural HRT supplements and see how they work for you."  That was it.  So uneducated me. . .I go to the drug store and buy a box of Estroven. . .big mistake.  My hot flashes and night sweats became much worse.  So back to the drug store I went.  After some advanced label reading, I chose something more "au natural". . .black cohosh capsules. . .even worse.  Desperate for insight, I then proceeded to consult every online forum and review ever written.  The consensus appeared to be:

1) Estradiol is just a heaping helping of cancer, and especially so if it is not paired with Progesterone.
2) Estriol, particularly the intravaginal form, is useful if Progesterone alone is not fully effective.
3) Topical Progesterone (made naturally from wild yams) alone is absolutely ideal (downright beneficial!) in the treatment of these symptoms as long as it is applied properly in a strict regimen of daily rotating sites (inner arms, belly, inner thighs) for 3 straight weeks each month.

So I bought it. . .and I bought it. . .and I bought it.  And my symptoms really did cease for many months!  Sadly though, they began "breaking through" last year in spite of my faithful applications of the topical progesterone.  I continued to stick with the program (adhering to the recommended dosage changes), but my symptoms would only "die down" for a month or so before "breaking through" again.  Finally it was all over.  The topical progesterone no longer had any effect on me.

My most profound symptom is definitely my hot flashes.  They have become a monster and taken over my life.  Approximately once every hour or so, I click on like a microwave oven and radiate heat like a nuclear reactor for about 5 minutes straight.  Sometimes I almost pass out.  Once it is over, I am freezing cold.  I do not sleep.  I am the walking dead.

And as if you did not know enough about me now, here is a final note I must make before I ask my 1 question:

I have always had granular breast tissue, especially on the sides.  But about a year after I started applying the topical progesterone, I experienced my first abnormal mammogram. It was repeated, and the ruling was a benign looking nodule in 1 breast.  That nodule was still there upon my next mammogram along with another abnormality.  So an ultrasound followed, and then an MRI followed.  From those findings, the ruling now is benign looking nodules in both breasts, which my GYN is monitoring closely.  After reading this information, I worry that I unwittingly damaged myself with the topical progesterone.  *sigh*  It is especially scary because my mother had breast cancer (beat it with radiation), and so have my aunts.  There is also ovarian cancer in my family along with other cancers and some heart disease.  What I do have going for me, though, is that I am not overweight, and every day, I eat right and exercise.  I live as healthy and natural as I can, so here's hoping!

Well, after a lengthy conversation today, my GYN prescribed me Vivelle Dot.  My 1 question is:

Am I considered "high risk" for breast cancer or cervical cancer or heart disease given my background?  I really want to try Vivelle Dot in hopes of alleviating my symptoms.  My GYN assured me that it should be a safe enough option for me, but I still cannot help being concerned.

Thanks again for taking the time!

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