Dr. Lasater,

One of my close friends, age 50, stopped having her monthly periods last year. She’s having awful hot flashes, night sweats and moodiness. I’m not quite 50 yet and although I’m still having periods, they’re becoming much lighter and fairly irregular. I’m also starting to have some hot flashes myself on occasion. I’ve been reading that bio-identical hormones are the best way to treat the symptoms of menopause, but my friend says that her doctor told her that it’s safer for a woman NOT to take hormones after menopause, because they can cause major problems. What is your opinion?

 — Mary C.

Dear Mary,

You are correct — bio-identical hormones ARE the best way to treat the symptoms of menopause, including hot flashes, night sweats, moodiness, depression and loss of interest in sex, among other symptoms. Just as importantly, bio-identical hormones help reduce a woman’s risk of some major health problems that become more likely after menopause, including osteoporosis, heart disease, colon cancer, diabetes and Alzheimer’s disease. The advantages of bio-identical hormones are often misunderstood because many physicians have been misled into believing that all hormones used to treat the problems of menopause are the same, but they’re not. For example, Premarin®, which contains estrogens from pregnant horses, is not the same as bio-identical estradiol, which is chemically identical to the type of estrogen that a woman’s own body has produced since puberty. Yet, oftentimes a headline in a news story, or even in a medical journal article, will state something like “Study Shows Hormones Cause…” but not all hormones are the same.

 Imagine the confusion produced if a headline, in discussing a particular drug’s side effects, were to state ‘Pills Found to Cause Side Effect...’ Which pills are supposed to cause this particular side effect — does the author really mean ALL pills, including those used to treat high blood pressure, antibiotics used to treat infections, anti-inflammatories used for arthritis, etc., etc.? Certainly not! That article would never be published unless it was MUCH more specific. But too many statements about hormones get lumped together in a headline or for a soundbite, thereby putting bio-identical hormones in with company they do not keep. When the medical literature is carefully examined, it becomes clear that the particular type of hormone in question matters greatly. For example, there is a dramatic difference between the effectiveness as well as the safety of conjugated estrogen derived from horses and that of bio-identical estradiol, which contains the same form of estrogen as the woman’s ovaries had been producing ever since she went through puberty.

Additionally, there is also a huge difference in the route by which the hormone is administered. When conjugated estrogens (those derived from horses) are given by mouth, the hormone is absorbed through the small intestine and goes directly to the liver. This sudden hormone tsunami then causes the liver to respond by producing a number of inflammatory biochemical called cytokines and interleukins, which in turn produce several undesirable effects — they de-stabilize any plaque that the woman has in her coronary arteries, and thus for a time increase her risk of having a heart attack. The cytokines and interleukins also increase the woman’s risk of developing a blood clot. Fortunately, neither of these disastrous effects occurs when bio-identical estradiol is applied on or under the skin, rather than being taken orally.

Clearly, this is a big difference, but one that is not at all apparent if the details have to be left out in order to fit the space allotted to a brief headline. Thus, in most cases, for a menopausal woman to take bio-identical hormones is truly a win-win situation: the woman feels much better, and she becomes much healthier because her risks are reduced.