Experts Voice Concerns on 'Natural' HRT Alternatives

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Ever since a study showed long term hormone replacement was risky, many women have avoided it. Many are turning to so-called "natural" hormones instead, but some health groups are raising new concerns about the safety of those compounds.


This is MORNING EDITION from NPR News. I'm Steve Inskeep.

Our health news for today starts with a trend in hormone therapy. Ever since a study showed long-term hormone replacement was risky, many women have avoided it. Many are turning to so-called natural hormones instead. Some health groups are raising new concerns about the safety of those compounds, as NPR's Patricia Neighmond reports.

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Bellevue Pharmacy Solutions in St. Louis, Missouri, a pharmacy which compounds medications, meaning it prepares and mixes medication on site. Bellevue specializes in what's called bioidentical hormone replacement therapy. These are hormones derived from plants instead of animals, and custom-mixed for each patient. Bellevue claims the therapy is just as effective as traditional hormone therapy without the risk.

Ms. LINDA LEVINE (Bio-Identical Hormone Replacement Patient): My name is Linda Levine, and I am now 59. I'm a real estate agent with my husband, Jeff.

NEIGHMOND: Linda Levine is pretty much through menopause now, but a few years ago, when she was 54, she heard about Bellevue. She was very interested.

Ms. LEVINE: I did not want to take the real McCoy because, you know, you constantly hear about cancer.

NEIGHMOND: At the same time, Levine said, she was really having a miserable time.

Ms. LEVINE: Oh, hot sweats, just having hot flashes like crazy, feeling down in the dumps.

NEIGHMOND: Levine lives in Louisville, Kentucky. She spoke to one of the pharmacists in St. Louis. She described her symptoms, medical history, medications she was taking. Then she spit into a tube and sent it to the pharmacy. Bellevue says it can measure levels of estradiol, progesterone and a number of other hormones in saliva, for a cost ranging anywhere from $45 to $300.

Pharmacist Paul Hueseman is a co-owner of Bellevue Pharmacy Solutions. He says to restore individuals back to their most vigorous self, you need a precise mixture.

Mr. PAUL HUESEMAN (Bellevue Pharmacy Solutions): The whole premise of bioidentical hormone replacement therapy is really to individualize that woman's hormone levels to a physiologic level of a woman in her prime reproductive years. The true goal of bioidentical hormone replacement therapy is not only to deal with symptoms but to minimize the aging processes that occur in the body when there is a deficiency or imbalance of hormones that occurs.

NEIGHMOND: Aging processes like weight gain, hardening of the arteries, bone loss, fatigue and an increased risk of diabetes. If it all sounds too good to be true, a number of health officials say it is. The American College of Obstetricians and Gynecologists put together a special committee to look at the risks and benefits of hormones derived from plants. Dr. Michelle Curtis(ph) chaired that committee, which concluded bioidentical hormones are no more safe or effective than synthetic ones.

Dr. MICHELLE CURTIS (American College of Obstetricians and Gynecologists): Estradiol is estradiol, whether you got it from a plant source or if you created it some other way in a lab. The reality is you can't assume that these are safer. You should, as a patient, be thinking that the same risks and benefits that apply to the drugs you get from a large pharmaceutical company apply to these as well.

NEIGHMOND: As for preparing a precise mix of hormones, Curtis says treatment should be aimed at how a woman feels, not at a snapshot of hormone levels taken at one point in time.

Dr. CURTIS: Very rarely do we measure estrogen levels in women when we put them on hormone therapy. If I have a woman come in and she's having hot flashes and I start her on hormone therapy, the first thing I ask, `How are you feeling with it? How is it treating your symptoms?' because her symptoms reflect her own natural bioassay of whether or not she's got enough estrogen on board.

NEIGHMOND: Curtis is also concerned about studies suggesting some compounding pharmacies fail to meet quality standards. Paul Hueseman says his pharmacy has strict quality controls. The Food and Drug Administration does not regulate compounding pharmacies.

Patricia Neighmond, NPR News.

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