A New Approach to HRT for Women

By Christine Wideman, RN with Robert Grafton, MD

Hormone replacement therapy became controversial in 2002 after the Women’s Health Initiative identified cancer and other health risks connected to synthetic hormone replacement. Many consumers and physicians have since been searching for alternative therapies to prevent or mitigate the negative aspects of aging and menopause.

One Michigan physician has developed, and is offering, a bio-identical hormone replacement therapy. Dr. Grafton, a Rochester Hills, MI plastic surgeon, is one of a handful of physicians using bio-identical hormone treatments. His goal is to restore to women to the hormone levels they enjoyed in their thirties.

Dr. Grafton evaluates a woman’s reproductive hormone status by checking her levels of follicle-stimulating hormone, estrogen and testosterone. He also tests her thyroid levels.

“Bio-identical hormone therapy has been around since the 1930′s,” Dr. Grafton said. “It gives the body exactly what it is short of.” Instead of utilizing a ‘one-drug-fits all’ approach found with standard pharmaceuticals he prescribes a custom, individualized prescription for bio-identical hormones. With these individual results he customizes a unique prescription. A compounding pharmacy then creates a hormone pellet approximately 3/16″ in diameter which is inserted underneath the skin. The pharmacy utilizes bio-identical sources usually found in plants such as yams and soy according to Dr. Grafton.

The advantage of this type of administration, sub-cutaneous, is to avoid the oral route according to Dr. Grafton. Therefore, many of the previous negative side effects of HRT are prevented he said.

“The pellets provide a steady-state of hormone delivery which avoids the peaks and valleys associated with oral administration. Additionally, because this method bypasses the gastrointestinal tract and the liver, the stimulation of blood clotting factors are eliminated,” said Dr. Grafton.

This hormone absorption technique is both efficient and convenient because it lasts three to four months per dose rather than the chore of daily oral administration. Dr. Grafton uses local anesthetic to numb the area and makes a small incision to insert the pellet. They are usually placed in the buttock and are not noticeable. The pellets dissolve completely with no residual effects, according to Dr. Grafton.

Medical insurance does not cover the cost of this therapy yet. A treatment from Dr. Grafton costs between $450-$500 per dose. Many of his patients are satisfied with the results despite the cost. Dr. Grafton says that his patients report increased libido, and improvements in general health and well-being.

“People tell me they have improved mood, are mentally sharper, have improved metabolism and muscle tone and have more energy,” he said.

Hormone replacement therapy can be used with good results for both men and women, says Dr. Grafton. Although there have not been large controlled clinical trials to test this type of treatment at this time, he considers it to be safe. He has used the therapy himself for 8 years with gratifying results.

Christine Wideman, RN, has a degree in nursing and journalism.  She continues to work as a nurse and has written on a variety of topics for both local and national publications as a freelance journalist.

Dr. Robert Grafton is a Diplomate of the Canadian Board of Plastic and Reconstructive Surgery and earned his medical degree fom the University of Saskatchewan.  He has been practicing plastic and reconstructive surgery in Michigan since 1993.  He is an instructor at Michigan State University – Hurley Medical Center.

Natural Choices for Menopause

By Laura Kovalcik, D.O., The Downing Clinic

THE CHANGE

Women want solutions that are safe and that work. Often they suffer from hot flashes, mood changes, vaginal dryness, depression, bone loss, heavy and irregular periods, tender breasts, fluid retention, fatigue, thickening waistlines, poor sex drive, mental dullness, and just not feeling like themselves. They want vigor and youthful feelings again.

Starting around age 40, women may begin to have symptoms from hormone changes. During the 50’s, periods stop and hormone levels fall. Menopause begins when there is no period for a year. It is one of life’s great transitions, a marker for the end of fecundity. Some women breeze through it while others suffer emotional and physical upheaval.

TRADITIONAL HRT

For years, physicians obligingly prescribed strong prescription hormones to help reduce symptoms. Most often Premarin and Provera were prescribed. Premarin (made from pregnant horse urine) is many times stronger than human estrogens. Provera (synthetic progesterone substitute) does not protect the breast the way natural progesterone does. When The Women’s Health Initiative study in 2004 showed increased risks of breast cancer from these hormones, many women simply stopped taking them. Often they felt wretched, but neither they nor their physicians knew there were safer options. Bio-identical hormones have been safely used since the 1980’s, and herbal phytohormones have been around for generations.

BIO-IDENTICAL HRT

Three estrogens, and one progesterone, are made by the body. The estrogens are E1, estrone; E2, estradiol; and E3, estriol. When used for hormone replacement, Mexican wild yam or soy provide ring structures that are then completed in the lab to the same identical molecules the body produces. Hence, the term bio-identical hormones.

Estriol is a weak estrogen that competes for binding sites with the two stronger estrogens; estradiol and estrone. When estriol is on a receptor, it keeps the stronger two estrogens from stimulating that receptor. During reproductive years, estrogen is balanced by progesterone in a cyclic fashion. Whereas estrogen stimulates breast and uterine tissue to proliferate, progesterone opposes these effects.

Balanced human hormones speak to receptors in harmony with nature while artificial substitutes are unbalanced and send different and often harmful messages.

MOTHER NATURE DID IT RIGHT!

Jonathan Wright, M.D. first prescribed these same-as-the-body-makes hormones in the 1980’s for treatment of menopausal symptoms. Dr. Wright used estrogens in a balanced fashion mimicking Mother Nature. He always added progesterone to oppose and balance the estrogens. Dr. Wright used these bio-identical hormones for more than 20 years, treating thousands of women, and didn’t see an increase in breast cancer among his patients.

When a woman asks her physician for bio-identical hormones, she will receive a prescription for estrogen balanced with progesterone. Many different dosage forms exist, including capsules, creams, gels, troches. Often other hormones are used, including testosterone, DHEA, and pregnenolone. There is a wide variation in proper doses and needs for individual women, and risk factors need to be evaluated whenever hormones are used.

A key part to managing hormone therapy is routine hormone testing. This helps identify when one of the many hormones is out of balance – which will present symptoms.

HERBS

Women often seek herbal options such as black cohosh, damiana, false unicorn root, vitex agnes casti, dong quai, blue cohosh, red clover, licorice root, red raspberry leaf, motherwort, maca or sage to help with menopausal symptoms. Many of these herbs are active at the estrogen and progesterone receptors, but they are much weaker than the actual hormones. Some women combine herbs with bio-identical hormones, a good choice for women in their 60’s or 70’s. Other women rely upon established homeopathic formulas such as pulsatilla or sepia to help with symptoms. Today’s women have many good choices!

Looking and feeling great also depends upon a good diet along with physical exercise and time out for stress reduction and personal reflection. Women choosing fresh foods, lots of greens, colorful fruits and vegetables, nuts, seeds, olive oil, fish, poultry, lean meat, and whole grains, will fare the best. Especially helpful are flax seed, soy foods, leafy greens and the broccoli family.

Women today can truly live the poem written by Elizabeth Barrett Browning, “Grow old along with me, the best is yet to be; the last of life for which the first was made.” The natural choices available today combined with a healthy lifestyle will reward you with a truly enjoyable time of life.

Dr. Laura Kovalcik is board-certified in internal medicine. Her work at the The Downing Clinic focuses on internal and integrative medicine and bio-identical hormones and natural menopause treatments. She graduated from Michigan State University School of Osteopathic Medicine and completed her internship and residency at Genesys Regional Medical Center.

Ask the Doctor: May 2007

Question: I am a 62-year old woman and my doctor just told me I have osteopenia. What is osteopenia and how can I treat it?

Answer: Osteopenia is an early stage of bone thinning that occurs as we age. Osteopenia is a precursor to osteoporosis which can lead to bone fractures. Osteopenia and osteoporosis effect menopausal and post-menopausal women most commonly, but can happen to men also as they age as well as anyone who has been on high dose steroids to treat asthma, arthritis or other conditions. To treat osteopenia, I recommend calcium and weight-bearing exercise. Menopausal and post-menopausal women and anyone diagnosed with osteopenia or osteoporosis should get about 1500 mg of calcium daily in divided doses. This generally means that you should take one calcium supplement in the morning and one at night, plus one serving of a low-fat dairy product a day. Your calcium supplement should contain vitamin D, since it helps calcium to be absorbed. Everyone else (men and pre-menopausal women) should get 1000 mg of calcium a day. Weight-bearing exercise includes walking, running, aerobics, yoga and Pilates. Lifting weights is also beneficial. Ask your doctor if they recommend a bone building medication in addition to calcium and exercises. These medications are not for everyone, so this should be discussed individually with your doctor.

Question: I have heard so much about hormone replacement therapy, and I am very confused. What are bio-identical hormones and are they safe?

Answer: Bio-identical hormones are natural supplements for estrogen and progesterone, the female hormones that decrease in our system after menopause. The lack of estrogen and progesterone are responsible for the changes in our bodies during and after menopause, including hot flashes, mood irritability, insomnia, and night sweats. These symptoms vary in intensity and duration in all women. Bio-identical hormones are considered to be natural supplements and are not regulated by the FDA in the same way that synthetic hormones (the ones your doctor can prescribe) are. Therefore, nobody has studied bio-identical hormones the same way the synthetic hormones have been. Estrogens of any type have certain risks associated with them. We know this from the large Women’s Health Initiative trial that was stopped early about 5 years ago due to the increased risks of breast cancer, blood clots and heart attacks in women taking the hormones. This study specifically looked at the synthetic hormones, but to be as cautious as possible with these life-threatening issues, we have to assume that the bio-identical hormones carry the same risks. This also goes for supplements found in the vitamin aisle of your pharmacy that are called “plant estrogen” or “soy estrogen”. The risks of hormone replacement therapy are dose related, so the longer you are treated and the higher the dose, the greater the risk. Every woman’s risk is different for breast cancer, blood clots, and heart disease, so this should be discussed with your doctor. The bottom line is that bio-identical hormones are an option for treating the symptoms associated with menopause but are not any safer than traditional synthetic hormones.

Question: I want to start an exercise program for my health. How much exercise should I get a week?

Answer: The first thing you should do is to see your doctor to determine if you are healthy enough to start an exercise program. Once you and your doctor have determined that you are healthy enough for exercise, the Centers for Disease Control and Prevention (CDC) recommend that most Americans get 30 minutes of moderate to vigorous exercise 5 or more days per week. For weight loss, the time or intensity should be greater. Moderately intense exercises are walking briskly, mowing the lawn, dancing, swimming for recreation, or bicycling. Vigorous exercise includes jogging, engaging in heavy yard work, participating in high-impact aerobic dancing, swimming continuous laps, or bicycling uphill.

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to: askthedoc@healthandleisureonline.com

*Advice found within this article is for information purposes only and should not replace the advice or recommendations of your physician.