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Dr. Jennifer Pearlman

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Suzanne Somers reigns atop one of the most controversial issues in women's health: the use of bioidentical hormones for menopausal symptoms. Now targeting younger women in her latest book, Somers professes a bioidentical hormone solution for their peri-menopausal problems.

While Somers' message is more hype than health science, she has inspired more women than ever to ask their doctors for better solutions to their menopausal woes. Unfortunately their doctors may not have the answers and women go looking elsewhere. And so, as the divide between conventional medicine and a Somers-inspired alternative health industry widens, it has become paramount that we debunk once and for all the myths and hype.

The hype is in part fuelled by the burden of symptoms that often trouble women as they navigate the menopause transition. Hot flashes and night sweats are merely the tip of the menopause iceberg. The several years leading to and following a woman's final menstrual cycle (her menopause) are often plagued by other distressing symptoms such as mood disturbance, insomnia, brain fog, memory problems, loss of libido, and vaginal dryness. Women in their search for relief may be led down dangerous paths potentially muddied in myth and pseudoscience.

To demystify the topic of bioidenticals, it is essential that we first define it. The term bioidentical is used to differentiate amongst hormonal treatments that are equivalent to our body's own hormones and those that are not. Indeed, bioidentical hormones are simply those that are structurally and functionally equivalent to our own. These hormones work and look just like those our body produces. With a definition so straight forward it is a mere marvel that this term has stirred up such controversy and heated debate amongst women and their doctors.

One reason is the misuse of terms like "natural" and "plant-derived." Bioidenticals are actually both natural and synthetic. They may be derived from natural sources, like wild yams, but are then synthetically modified to be identical to human hormones.

Adding to the confusion is the false belief that bioidenticals are special creams that are not available from conventional medical doctors. In truth, there are numerous pharmaceutical bioidentical hormones approved by Health Canada and only legally available by prescription.

At the same time, a hormone that is "natural" is not necessarily bioidentical. For many decades doctors prescribed hormonal prescriptions that were not at all bioidentical to human hormones. Until the past decade, the most commonly prescribed menopausal hormone therapy consisted of the estrogen waste found in pregnant horses coupled with a synthetically modified progesterone analogue – PREMARIN (PREgnant MAres uRINe) and Provera respectively.

The almost knee-jerk prescribing pattern of this regimen to menopausal women came to a frantic end in 2003 when the landmark Women's Health Initiative Study (WHI) showed that users of this approach had a 24 per cent increase in the risk of acquiring breast cancer and heart disease and a 30 per cent increase in the risk of having a stroke.

While the urine of pregnant horses is indeed natural, its estrogen metabolites could not be considered to be human bioidentical. And, as it turns out, hormones that work and look like our own may be both safer and more effective than those that do not.

This is certainly the case amongst progestins (progesterone-like hormones); as large clinical trials have shown a 48 per cent increase in the risk of breast cancer when Provera is used as compared to bioidentical progesterone.

In the wake of the WHI, patients decidedly became more critical of their doctors and began to seek safer alternatives. Hence Somers' momentum. While she has delivered an important message about bioidenticals being a preferable option, it is muddied by misinformation such as suggesting that custom-compounded creams are safer than prescription bio identicals. She over-emphasized their potential benefits and oversimplifies the decision-making process.

When I meet with patients to discuss whether hormone therapy may be appropriate for them, there is much to cover; their health status, family history and burden of symptoms need to be carefully considered in deciding if hormone therapy will be a safe intervention. In the modern age of menopausal care, there is a full tool box of effective science-based interventions that I can draw from, from bio identical hormones to lifestyle interventions to certain dietary supplements. The hormones I choose to prescribe are indeed bioidentical with the important exception being when there is the need for birth control. Oral contraceptives are not bioidentical – they are synthetic hormones intended to overrun the body's cycle.

Bioidentical hormone therapy can play a vital part in helping women successfully navigate the menopause transition. But even bioidentical hormones can carry substantial risk and their use must be carefully considered and monitored. Hormones are one piece of the menopause puzzle, and should be given only to the right woman, in the right form, and by the right doctor who is expert in this area.

Dr. Jennifer Pearlman is a physician focused on women's health and wellness and a staff physician at the Menopause Clinic at Mount Sinai Hospital in Toronto. and Medical Director of PearlMDRejuvenation, a women's health and wellness facility. Dr. Pearlman was recently named a 2014 International Enterprising Woman of the Year, given by Enterprising Women and @EWmagazine.

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