Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Monday, February 6th, 2012:
What's New in S.H.I.N.E. — Part VIII: Bioidentical Hormone Replacement
Waking Up in the Middle of the NightWaking Up in the Middle of the NightWaking Up in the Middle of the Night
by Jacob Teitelbaum MD
In previous articles I discussed the hormone-generating adrenal and thyroid glands. In this article I focus on a hormone issue specific to women.
A woman's ovaries produce two key hormones in the body: estrogen and progesterone. But as women age, their ovaries' ability to produce these hormones begins to drop — with unwanted consequences. Fortunately, this problem can be treated through bioidentical hormone therapy. (Don't worry guys, I haven't forgotten you — I'll talk about testosterone therapy for men in Part 9.)
For those with CFS or fibromyalgia, Fibromyalgia and Fatigue Center physicians are very familiar with bioidentical hormone replacement.
For those simply looking for a "Whole Body Tune-Up and Makeover" (for women over 45 years of age), check out a new program called the Well Optimized Woman ("WOW")!
Until recently, the recommended dose of Bi-Est — a bioidentical hormone treatment that contains the estrogens estradiol and estriol — was 2.5 mg. Now we've found that a much smaller dose works just as well: anywhere from 1/10th to 1/4th mg.
With any hormonal treatment, lower is better, because a lower dose reduces the risk of side effects. And a lower dose means a lower cost too.
Another positive development is that prescription estrogen patches such as Climera now contain bioidentical estradiol. That's a huge advance over the days when doctors prescribed the drug Premarin, that contained estrogens derived from the urine of pregnant horses! (I suspect Premarin treatment will be one more exhibit in any future Museum of Medical Insanity.)
And the pharmaceutical drug Prometrium (progesterone taken by mouth) is also bioidentical.
The bottom line is that now that the Premarin patent has expired, you can see a conventional physician and receive bioidentical hormone therapy. It's amazing that this type of therapy was condemned just a decade or so ago by the AMA as "irresponsible quackery." Will wonders never cease!
My Recommendation: A Mix of 3 Bioidenticals
Those prescription drugs are good options, particularly because they're covered by insurance. But my preference for bioidentical hormone therapy in perimenopausal and menopausal women is a customized, compounded hormone cream, formulated at a compounding pharmacy.
The cream I prefer includes not only bioidentical estradiol, which is in all estrogen patches these days, but also a second key estrogen called estriol. Estriol is important as it serves as a balance to estradiol, as we discuss below. The creams also contain natural progesterone (30 mg), which helps improve sleep as well as maintain a calm and peaceful state, without the severe toxic side effects of the synthetic progestins (e.g., Provera).
- Estradiol handles the symptoms of menopause, such as hot flashes, night sweats and insomnia.
- Progesterone help protect against uterine cancer, a possible consequence of taking estrogen. It also helps sleep and decreases anxiety.
- Estriol may help protect against breast cancer.
This compounded cream can significantly reduce the symptoms of fatigue, pain, brain fog and disordered sleep that women with CFS/FMS have, as women with CFS/FMS often have low estrogen. (Research shows that for 25% of women with fibromyalgia, symptoms started with the onset of menopause.)
You also may want to talk to your doctor about adding 1/4 to 1/2 mg of testosterone to that compounded cream. Research shows that treating women with fibromyalgia with testosterone reduced pain. And menopausal women who add a little testosterone to their hormonal regimen often notice more energy, thicker hair, younger skin, and improved libido.
Testosterone also plays a role in chronic pain. Narcotics lower testosterone, which induces a deteriorating cycle where pain increases, leading to the use of more narcotics, which lowers testosterone further, resulting in yet more pain. Testosterone therapy can help break that cycle.
To keep it simple, here is my current recommended starting dose for hormone replacement therapy:
- 0.1 mg BiEst (1/2 estradiol and 1/2 estriol), plus
- 30 mg progesterone, plus
- 1/4 mg testosterone
ITC Compounding Pharmacy, which can mail the cream to you with your doctor's prescription, does an excellent job. (ITC can be reached at 888-349-5453.)
If needed, the dose can be raised to 0.2 mg BiEst and 1/2 mg testosterone. For those on the higher doses, if it is working well I usually leave them on the old dose, as the body will often have adapted well to that dose.
If you don't want to take bioidentical hormones — and that's a perfectly reasonable personal choice — consider these other natural options for the control of menopausal symptoms:
The supplement Remifemin from Enzymatic Therapy delivers a special form of the herb black cohosh that is very effective for hot flashes. Take two capsules twice a day for two months. By then, the herb is usually working and you can lower the daily dose to one capsule twice a day.
Another way to raise your estrogen naturally? Eat a daily handful of tasty edamame, or soybean pods, which you will often see served in Japanese restaurants. Like peas, just eat the pea-like beans on the inside, not the pod. There are many delicious recipes for edamame, and edamame is readily available in the frozen food section of many health food stores or supermarkets.
For More Information
For more on my regimen to control the symptoms of menopause, see Menopause.
To learn about the safety and effectiveness of bioidentical hormones (and the risk of synthetic hormones), see The Safety and Effectiveness of Bioidentical Hormones: Natural (Bioidentical) vs. Synthetic HRT.
For learn about treating excessive sweating, night sweats and hot flashes, see Treating Excessive Sweating, Night Sweats, Hot Flashes.
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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