The South Magazine, Winter 2010
Val Beaudreau was only 43 when her symptoms started. “I thought I was having anxiety attacks,” she remembers. “And I’d cry, just cry. I’d hear a sad song, I’d cry. I’d see a commercial, I’d cry.” She also started gaining weight, struggling with insomnia, having debilitating hot flashes and losing her interest in sex. “I was up, I was down, I was around and around,” says Beaudreau. “I’d tell my girlfriends, ‘Oh my God, I think I’m going nuts!’”
Her doctor prescribed her an antidepressant, but it didn’t relieve her symptoms. “I was on it for about eight months and then I thought, ‘No, I’m not doing this,’” recalls Beaudreau. “That’s when I started being my own health advocate.”
She hit the books, and in her research she came across a copy of Suzanne Somers’ bestseller Ageless. In the book, Somers describes symptoms similar to what Beaudreau was experiencing—symptoms related to the inevitable loss of hormones that goes along with aging. Somers also carefully documents her treatment through the controversial use of bioidentical hormones.
Beaudreau was intrigued, but first she needed to find someone who was trained in bioidentical hormone replacement therapy (BHRT) and willing to administer it. And this was harder than Beaudreau ever could have imagined.
Doctors have been prescribing synthetic hormone replacement therapy (HRT) to women for 75 years. Initially, physicians touted it as a preventative medicine and believed that every woman should use HRT when she turns 50 to prevent osteoporosis and heart disease, improve memory, and perk up overall well-being. Treating the symptoms of menopause was simply considered a bonus feature. However, in 2002 doctors significantly scaled back the use of the therapy after a study conducted by the Women’s Health Initiative linked HRT to an increased risk for blood clots, stroke, heart attack and breast cancer.
Dr. Dina Linfoot of Provident OB/GYN Associates at Memorial University Medical Center is fully aware of the public’s negative perception of HRT, but she still considers it a safe and effective treatment for certain patients. “People have to weigh for themselves the risks and the benefits,” Dr. Linfoot explains. “There are some people who are not candidates [for HRT]. People who have had some sort of estrogen-dependent cancer—mainly breast cancer—or a strong family history for that, or carriers of the breast and ovarian cancer genes. These people are not going to ask me for hormone replacement because they’re too scared.”
But Dr. Linfoot feels the need to put the risks into perspective. “The Women’s Health Initiative suggested an increase of eight cases of breast cancer per 10,000 women, which is not really a lot,” she explains. In fact, Dr. Linfoot believes that women should pay careful attention to the therapy’s link to an increased risk for heart disease. “Women in general are more likely in their lifetime to die of heart disease than to die of breast cancer, but we all walk around fearing breast cancer and not fearing heart disease,” she says.
Dr. Linfoot does not deny the benefits of HRT: “In terms of skin, vaginal health, bone health, cholesterol, there’s definite benefits.” But she believes that doctors must administer it sparingly and with caution. “The recommendations by our governing bodies and by what science supports right now is to offer hormone replacement to perimenopausal and newly menopausal women who are having the true, life-altering symptoms of perimenopause and menopause, like hot flashes, night sweats, trouble sleeping, mood changes, skin changes, vaginal atrophy—changes like that,” advises Dr. Linfoot. “It should be used not for the potential benefits but mainly for symptom relief and for the shortest time possible.”
Enter the bioidenticals.
Searching for a safer alternative to HRT, a relatively small number of physicians began experimenting with bioidentical hormones in their practices. Several years ago, Dr. Mary Kay Ross, an E.R. doctor at Memorial University Medical Center, learned that her stepbrother and his wife were using BHRT under the supervision of a physician in St. Augustine, Florida. Concerned that her family may be experimenting with a risky treatment, Dr. Ross made an appointment to meet with the physician. She was surprised to find that he was very well-informed about a therapy that had a long list of benefits for both men and women. She began studying with the physician, became a patient herself and eventually opened a practice in Savannah called Live Well MD that specializes in bioidenticals.
Dr. Ross now treats more than 150 patients ranging from 14 to 82 years old. Her practice extends beyond treating the symptoms of menopause: She works with men and women looking to improve their overall well-being and slow the symptoms of aging.
Kelly Hawkins, a health-conscious woman in her mid-40s, asked Dr. Ross to test her hormone levels because she was suffering from bouts of insomnia. The results showed that Hawkins’ estrogen levels were high but still within the normal range. “My estrogen wasn’t off the chart,” she explains. “It was at the very high end of normal. And my testosterone and progesterone were at the low end of normal.” Even though her hormones were not alarmingly off balance, Dr. Ross prescribed Hawkins a combination progesterone and testosterone cream that she uses every night. “It alleviated the symptoms almost immediately,” she recalls.
Patients using BHRT tend to believe that it is a more effective, safer alternative to HRT. But the real difference between synthetic and bioidentical hormones may be more of a matter of semantics than anything else. Bioidenticals are really no more “natural” than synthetic hormones. Premarin, one of the drugs tested in the Women’s Health Initiative study, is a widely prescribed form of synthetic estrogen that comes from the urine of pregnant mares. Its organic structure is not identical to the hormones produced in humans, but it’s a close match. Bioidenticals are derived from plant oil extracted from soybeans and wild yams, and then they’re chemically altered in a lab to make them identical in organic structure and function to human hormones. However, as Dr. Linfoot points out, “Most estrogens that we use today are plant-based phytoestrogens.” In other words, most synthetic hormones are just as natural as bioidentical ones.
Dr. Ross agrees. “All of them really do come from nature,” she says. “The term ‘bioidentical’ simply means that the entire hormone is molecularly identical to the hormone produced by the human body.”
Because the study done by the Women’s Health Initiative only followed patients using Premarin and Provera (a synthetic progesterone), the same risks do not necessarily apply to patients using bioidenticals. Dr. Linfoot concedes that there are probably people for which BHRT is safe, but she does not believe that bioidentical hormones are safer than synthetic ones: “Estrogen is estrogen and progesterone is progesterone, and [patients using BHRT] are not at any decreased risk for breast cancer and they are not at any changed risk for heart disease just because what they’re taking is being called natural and bioidentical.” She emphatically adds, “Ultimately, the risks are absolutely the same. Nobody would say otherwise.”
But Dr. Ross does say otherwise—sort of. “If you look at the studies being done—most of them in Europe—[bioidenticals] are not really harmful for women,” she explains. “But nobody can tell you 100 percent whether or not there are risks.”
Given that bioidentical and synthetic hormones are both natural products carrying what seem to be equal risks, then why do women like Hawkins insist on using BHRT over HRT? Why does Beaudreau travel to Atlanta and then to Jacksonville and back again, trying to find someone qualified to administer bioidenticals? Why do patients fly in from out of state to see Dr. Ross?
Patients receiving BHRT believe that they are getting a highly individualized form of treatment—an experience that is just about unheard of in most medical practices today. Unlike synthetic hormones produced in mass quantities in large plants, bioidenticals are made in “compounding” pharmacies on a case-by-case basis. For instance, when Beaudreau eventually found a nurse practitioner skilled in bioidenticals, she found out that her estrogen levels were low. Hawkins’ estrogen, however, was high. The women were given an individualized prescription based on their test results. A pharmacist at a compounding pharmacy mixed a medication based upon each patient’s unique needs.
Some bioidentical hormones are made by drug companies in standard doses and approved by the FDA, but those made at compounding pharmacies on a case-by-case basis are not FDA-approved because they aren’t standardized. Dr. Linfoot believes that there are very good compounding pharmacists out there, “but the problem is that you really don’t know for sure that every little bottle, pill and cream or whatever it is that you’re getting is equivalent from one month to the next because there are inherent variations.”
Nonetheless, this highly individualized care makes many patients feel as if they are receiving a better treatment. “I don’t want a universal patch that is for everybody,” Beaudreau explains. “I want to be on something that’s designed just for me—for my symptoms.”
Dr. Jules Victor, an internist and a 30-year veteran of Savannah health care, started using BHRT in his practice a year ago. He now treats an average of 125 patients a month with bioidenticals. “Until I started using BHRT,” Dr. Victor says, “I explained to many of my patients that the symptoms of fatigue, sleeplessness, low libido and loss of mental clarity were normal aging signs. I can now offer them a new lease on life, and I have seen dramatic improvements in their sense of well-being and long-term health.”
Dr. Victor’s BHRT method, called SottoPelle therapy, involves placing bioidentical pellets under the skin to deliver the hormones that a man or woman’s body needs. “It is fascinating that the body knows exactly how to [absorb the right amount of hormones], often after it has been years since the hormone levels have been correct,” Dr. Victor raves. He explains that pellet therapy is not a “mystical alternative to traditional medicine” and that it has actually been used in other parts of the world for more than 60 years. “[It’s] not a patented pharmaceutical product that can be marketed,” he explains, “but due to media exposure, the public is beginning to listen and learn.”
To ensure individualized care, specialists in bioidenticals often spend a great deal of time listening to their patients. A first-time visit with Dr. Mary Kay Ross generally takes an hour. She talks with her patients about what they are experiencing and gets their full medical history. Dr. Ross also educates her patients about BHRT and performs a risk assessment, which is particularly important for people who have had cancer.
Roxanne Shatter, an X-ray technician for a family physician, found immediate relief with BHRT after her menopausal symptoms became too much to bear. “I was ready to hurl myself off a cliff,” she remembers. “I was at the brink.”
Shatter didn’t remain on BHRT for long, partly because of the costs involved. Most insurance companies cover HRT but not bioidenticals. Combine that with quarterly visits to a specialist to evaluate your progress and you can spend thousands of dollars each year.
For some, the high price of individualized care is priceless, but Shatter decided to at least try a synthetic before making the financial leap. She took Premarin and found that it worked for her. And while Shatter feels mostly symptom-free, she hasn’t ruled out returning to a specialist to see if BHRT could still improve her overall well-being.
Since starting BHRT, Val Beaudreau has been satisfied with the results. “I’m feeling better than I have in the last seven years,” she raves, “and I feel like I’ve got someone that’s going to listen.” Could Beaudreau achieve the same results with HRT? Maybe, but the choice is hers. “To say, ‘I just want what my doctor says’—I’m not a believer in that,” she says. “You need to be knowledgeable. … I want my medicines to be what I want, not just what someone tells me I need to have.”