Dr. Matera then goes into a discussion of the three different types of estrogen in the human body: 1) estradiol, 2) estrone, and 3) estriol.
Dr. Matera goes on to say that estriol (3), which is commonly included in compounded-hormone formulations, is only made in the placenta, and "why are we giving a placental estrogen to a menopausal women. This is "not natural".
I would take issue with this attempt to disparage estriol as unnatural. It is very natural. Although estriol is made by the placenta, it is also present in high concentration is the blood stream of all pre-menopausal women. Estriol circulates in the bloodstream of all women at nearly 10 times the concentration of estrone and estradiol (2). So this omission by Dr Matera is really a piece of misinformation.
Not only is estriol very "natural" it is also the safest of the three estrogens. Estriol has been used as the sole hormone for relief of menopausal symptoms, and found safe and effective in medical studies. (3) Dr. Stefan Gold actually states that estriol is the SAFEST of the three estrogens (4).
Dr Matera says she stopped prescribing Premarin after the Women's Health Initiative Study showed that oral estrogen tablets are associated with increased blood clots and inflammation. (See my article on this.) Instead, Dr Matera uses transdermal hormone preparations applied to the skin. This is all very good and correct. We follow the same protocol in our office. Premarin stands for pregnant mares' urine. Dr Matera has stopped using Premarin since WHI because it is an oral estrogen; she prefers transdermal through skin with less risk of blood clots. Transdermal hormones also allow for more variation in adjusting dosage for her individual patients.
What We Use Bi-Est combined with ProgesteroneWe use the popular transdermal Bi-Est estrogen formulation, which contains estriol and estradiol. We add progesterone, so the hormone cream contains all three hormones in the proper ratio.
What about the Progestin? One glaring omission from Mr. Matera's discussion is the form of progesterone used by Dr. Matera. I would assume she uses micronized progesterone, the bioidentical form, but this is not specifically spelled out in the interview.
The Issue is More Complex
Dr. Julia Files from the Mayo Clinic points out "the claim that the safety profile of bioidentical compounds is better than that of FDA-approved Hormone Therapy belies the complexities of the topic. Both Compounded and FDA-approved Hormone Therapy are available in various dosages, combinations, preparations, and routes of delivery that may have differing effects on risk to an individual patient." (5)
Dr Files is correct; there are many variables to consider when judging a hormone program as safer or riskier. You have to look at the hormones used, whether synthetic or bioidentical, the route of delivery, whether oral or transdermal; as well as the dosage and other components of the program.
To make a blanket statement that one hormone program is safer or riskier than the other is not a valid intellectual exercise unless all these variables are considered. That is what the doctor should be doing to come up with the safest hormone formulation possible.
The Great Omission -- Synthetic Progestins are the Monster HormonesThe great omission, of course, and my greatest objection to the Dr. Christina Matera interview, is the silence regarding synthetic progestins such as Provera, chemical name medroxy progesterone, commonly used in the combination pill Provera, the discredited hormone pill used in the Women's' Health Initiative, terminated early due to increased cancer and heart disease.
So, when we declare that bioidentical hormones are safer, we are really talking about how bioidentical hormones are safer than synthetic progestins such as medroxyprogesterone, and other synthetic progestins (there are many). This whole issue was carefully avoided by the Matera interview.
Bioidentical hormones do not cause cancer or heart disease, while synthetic progestins do cause cancer and heart disease. By omitting this information, Dr Matera has done a disservice to her listening audience and potentially harmed some women who actually took her seriously.
I would urge Dr Matera or any other physician to read the following article by Dr Neal Rouzier, which explains why bioidentical hormones are safer than synthetic hormones such as Proempro and Provera.
Click Here: Neal Rouzier MD on Estrogen and safe alternatives for hormone replacement.
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