The ABC and Bioidentical HRT
Some of my patients have been concerned about a recent ABC report on BHRT. As I was away in Singapore and have just returned, I will repeat a blog I had some time back when this issue was raised in a local newspaper. Remember, pharmaceutical companies, especially those that produce synthetic HRT, are significant donors to various medical groups and menopause associations. This does not mean that they are swayed or influenced by these donations, as they are all ethical and moral organisations, I am sure. This issue comes up again and again. I have addressed it in many blogs I have posted.
Posted by Dr Colin Holloway My blood pressure has settled down since reading the article on HRT (specifically compounded HRT) causing cancer in the Sunday Papers. Those of you who follow my blogs, which should be all of you, will know that I have repeatedly published studies from reputable journals about the safety of the hormones that I use, in the way that I use it. I am also aware that not all doctors have the experience and knowledge that I do, and some do not prescribe bioidentical hormones (BHRT) in a safe or proper manner. Some doctors have jumped aboard the BHRT bandwagon without the required skills. These doctors have given the BHRT a bad name generally. I suspect the article is mostly aimed at these doctors. However, “cowboy”operators occur everywhere, and not only medicine. Oestrogen should never be given to someone who has a uterus, without progesterone. Oestrogen on its own can cause endometrial cancer. I am surprised at the number of times I have seen women who have not received progesterone, only oestrogen, from their doctors. This is a recipe for disaster. The amount of progesterone also needs to be adequate to have the protective effect. This is best monitored by regular blood testing. Saliva testing is not adequate and part of the poor practices I am talking about. For 25 years I have used Micronised Progesterone (natural progesterone) as being the safest and best form of progesterone. I have been attacked by the medical establishment, at conferences and the media for the use of “”unsafe and untried BHRT.” Now a commercial Micronised Progesterone is available in Australia, and it has suddenly being hailed as the safest and best form of progesterone. The hypocrisy is amazing. The other issue is how hormones are given. The safest and best way is transdermal, as a troche or a cream. Doctors who give it in any other way risk increasing the cancer rate. Also, the evidence is that BHRT should be continuous ( no week off) as any monthly break from the BHRT can increase the uterine cancer rate. I have repeatedly mentioned that some compounding chemists are not as good as others – just as not all bakeries have the same quality of products. For this reason it is important that you use one of the recommended pharmacies, because I have found them to have the best services and quality of hormones. As I mentioned yesterday, I have only had one women develop endometrial cancer in the last 25 years, and this can be verified by authorized researchers from my database on my computer of all the women I have treated with BHRT over the last 25 years. Finally, articles like the one on the weekend, do a great disservice to women, as it will scare many women away from taking HRT of any sort. These women will suffer a decreased quality of life, and many a premature death from avoiding HRT. The article below, from the American Journal of Public health and Yale university(how much more prestigious does that get) gives the actual figures, which are very concerning. Am J Public Health. 2013 Sep;103(9):1583-8. doi: 10.2105/AJPH.2013.301295. Epub 2013 Jul 18
Am J Public Health. 2013 Sep;103(9):1583-8. doi: 10.2105/AJPH.2013.301295. Epub 2013 Jul 18.
The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.
1 Departments of Obstetrics and Gynecology and Psychiatry, Yale University School of Medicine, New Haven, CT, USA. firstname.lastname@example.org
We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years.
We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women’s Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011.
Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET).
ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency
Posted by Dr Colin Holloway
One of the criticisms of Bioidentical HRT is that it is not FDA approved. It does not need to be, as it is not synthetic. It is interesting however that there has never been a complaint of an adverse event to the FDA – yet there are numerous adverse event report about the synthetic HRT. Here is part of a transcript from a recent Press conference run by the FDA.
The FDA had a press conference on BHRT. They generally were negative about BHRT.Here is one of the questions put to Kathy Anderson of the FDA (USA):
“Anna Matthews(Reporter): Hi. Couple of questions; one is have you guys received any reports of adverse events or other harm to patients from these products?
Kathy Anderson: Sorry, this is Kathy Anderson. With your respect to your question about whether we received any adverse event reports, we have not.”
Furthermore, the article did not mention the amount of damage done by synthetic HRT :
Prempro Causes Breast Cancer and Loses Court Case with Huge Punitive Damages
by Jeffrey Dach MD
A 112 million dollar punitive is a very loud statement. It states that the jury was outraged by the “wanton and reckless” conduct by Wyeth. 112 Million Dollars in punitive damages was awarded to two breast cancer victims who took Wyeth’s synthetic hormone, Prempro, all the while thinking it safe. The jury was outraged that Wyeth ignored and suppressed evidence that Prempro causes breast cancer. Wyeth paid consultants and ghostwriters of medical journal articles to play down concerns about breast cancer, and declined to study known risks. Once again, company profit was placed ahead of patient safety. This is the tip of the iceberg, as another ten thousand cases are waiting for their day in court.
Premrpro is similar to premarin or premia, as used in Australia. I have been using these compounded products for the last 25 years, and have had 1 case of uterine cancer in that time. She was cured by a hysterectomy and is still fine today.Endometrial thickening can occur in women, with or without hormones, and, as the article stated, may be caused by obesity.