Who would you think knows more about menopausal symptoms and their treatment: an actress of very questionable scientific pedigree, or a Professor of medicine who has carried out and published a plethora of studies on the subject? I would think that University of New South Wales professor Dr. Barry Wren’s opinion would be more respected than that of Suzanne Somers, whose main claim to fame is that she once played a ditzy blond on the television show “Three’s Company.” But that’s my opinion. It seems that multitudes of women prefer to be guided by Somers’ personal anecdotes and her assertion that “bioidentical” hormones are the key to a happy and sex-filled menopause. Her new book, "The Sexy Years -- Discover the Hormone Connection" is a best seller, with the result that women who swore off hormone replacement therapy because of the worries generated by the highly publicized Women’s Health Initiative study, are now plying themselves with bioidentical hormones. It isn’t a hard sell, and usually goes like this: The female body produces a variety of hormones including progesterone and three types of estrogen, namely estrone, estradiol and estriol. Levels of these drop after menopause and can be restored by so-called hormone replacement therapy. The estrogen used in prescription hormones is extracted from the urine of horses and is coupled with medroxyprogesterone acetate which is synthesized in the lab. The estrogen relieves menopausal symptoms and the progesterone protects against uterine cancer, which can be triggered by “unopposed estrogen.” Neither the estrogen nor the medroxyprogesterone are identical with what the body naturally produces, but they are converted into the natural hormones in the body. So why do the pharmaceutical companies use these? Because these compounds are more readily and predictably absorbed when administered as pills and their dosage can be well controlled.
Chemists, being clever people, can certainly synthesize hormones which are identical in molecular structure to those produced naturally in the body. Just give them some raw materials in the form of soybeans or yams and off they go. These are the “bioidentical” hormones that Suzanne Somers and her followers worship. Why would you want to put something into your body that comes from the urine of horses, they ask, when you can restore your hormone levels by using exactly the same substances your body produces naturally? Then they refer to the Women’s Health Initiative and its findings that the common prescription hormones have been linked with heart disease, cancer and a host of other problems. Surely, they say, bioidentical hormones cannot do such nasty things, because they are “natural.” Not so. It is the raising of hormone concentrations in the blood to levels that are not natural to menopause that is the problem, not the source of the hormones. Dr. Wren in fact maintains on the basis of his studies that while bioidentical hormones can relieve the symptoms of menopause, they can also have the same negative consequences as any other type of hormone replacement therapy. Actually even more consequences, because the products are usually made up by “compounding pharmacists” on an individual basis and are not subjected to the same kind of quality control as prescription drugs. No study has shown that bioidentical hormones are in any way superior, but studies have shown that their absorption from creams, the vehicle commonly used, is highly variable. Then there is the issue of the saliva tests which are often used to determine the dosage needed. There is no evidence that preparations based on such tests are effective, and salivary levels of hormones have never been correlated with clinical response. Here then is the choice. Swallow the Suzanne Somers hype about the dangers of prescription hormones and the safety and efficacy of bioidentical hormones, or listen to experts like Barry Wren, who chose to guide their patients based upon the scientific evidence.