FREQUENTLY ASKED QUESTIONS

Where do natural hormones come from?
My doctor prescribes topical estrogen along with a natural progesterone pill. I feel great. Why should I consider changing to bioidentical hormone therapy?
How are bioidentical hormones administered?
Is transdermal estrogen important? Isn’t it easier to swallow a pill?
Do I need progesterone if I had a hysterectomy?
Will I have a period when I take bioidentical hormones?
Do I need to have a period?
Do you do saliva testing?
I am interested in getting started. What is the process?
Do I need to have a physical examination?
What are the costs?
Is this covered by insurance?
The FDA says there is no standardization of compounded hormones. Why use a compounding pharmacy?
The FDA questions the safety of bioidentical hormones and does not approve them. Why not?

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Where do natural hormones come from?

The estrogen, progesterone and testosterone we prescribe are derived from plant based soy or yam. These molecules are then modified to become exact replicas of the hormones produced by your own body. In every case they fit into your body’s hormone receptors exactly the same way as your own hormones do. Unlike synthetic hormones, which are derived from animal sources or are chemically formulated in the laboratory, your cells recognize natural hormones as identical to what is made in your body. You have the enzyme systems to maximally utilize natural hormones and to rapidly eliminate their breakdown products. Your body does not have the capacity to efficiently breakdown synthetic hormones, which tend to linger, provoke inflammation and can unnecessarily stimulate division of breast cells.

 

My doctor prescribes topical estrogen along with a natural progesterone pill. I feel great. Why should I consider changing to bioidentical hormone therapy?

If you are happy with your present combination therapy then by all means don’t change!

All oral and topical estrogens and natural progesterone are superior to synthetic estrogens and can provide excellent relief of symptoms. Only oral natural estrogen in proper dosages will decrease your risk for cardiovascular disease, raise your good cholesterol (HDL) and sex hormone binding globulin (SHBG), which are highly correlated with longevity. Your standard commercially made estrogen preparation does not address diminished libido, absence or difficulty achieving orgasm or adrenal fatigue. You generally do not have the intense surveillance to optimize safe estrogen levels routinely done with bioidentical hormone therapy or the ability to measure androgen, thyroid and adrenal hormone levels to assure maximal benefit and safety.

 

How are bioidentical hormones administered?

If not taken orally, estrogen and testosterone are applied on a daily basis to the labia majora or large lips next to the clitoris in a small volume of vanishing cream. This region has the highest level of absorption compared to other skin surfaces. Progesterone can be taken as a lozenge or troche under the tongue unless you have a sleep disturbance, in which case we take advantage of natural progesterone’s sleep inducing effects by swallowing it at bedtime. If it is applied as a skin cream it does not provide high enough blood levels to protect against breast and uterine cancer. DHEA is taken as a pill, lozenge or spray under the tongue. Natural thyroid supplementation is also taken as a pill.

 

Is transdermal estrogen important? Isn’t it easier to swallow a pill?

When estrogen is placed on the skin it is immediately absorbed and goes directly to targeted cells before circulating through the liver and broken down. Estrogen taken by mouth is absorbed through the intestine and goes directly to the liver, which degrades the hormone. This can result in an extremely small risk for blood clots (2 per 10,000 users) but this drawback is greatly outweighed by the benefit of reducing the overall risk for cardiovascular disease by as much as 50%. Healthy women with no family history of early heart disease or blood clots who start therapy soon after menopause will benefit the most. Women who want to start years after menopause, or who have health conditions or a strong family history making it unwise to take oral therapy can still benefit from the safety of topical estrogen.

 

Do I need progesterone if I had a hysterectomy?

Yes. For years gynecologists (myself included) believed the only reason to take progesterone with estrogen was to prevent uterine cancer. We now know that progesterone plays many different important roles in the body, such as balancing estrogen levels, supporting bone strength and helping to prevent cardiovascular disease. Natural progesterone blocks the effect of estrogen on breast tissue to help prevent breast cancer. It is an integral part of all hormone replacement regimens.

 

Will I have a period when I take bioidentical hormones?

If you are perimenopausal the medications can be taken to simulate your natural menstrual cycle. After you have transitioned into menopause it is not necessary to bleed regularly when on natural hormone replacement therapy.

 

Do I need to have a period?

No. In fact, establishing regular periods by taking progesterone 14 days a month instead of continuously you lose the benefits of this hormone’s ability to protect against breast and uterine cancer. There is no medical advantage to initiate menstrual periods.

 

Do you do saliva testing?

Sometimes. Saliva testing measures hormone levels within the cell and can be beneficial for initial assessment prior to starting treatment. There is no scientific basis for using saliva testing to adjust hormone levels. Hormone levels in saliva do not accurately reflect the amount of hormones present in the body. Blood testing provides a far more accurate hormonal picture. However, saliva testing has proven successful during the evaluation of adrenal fatigue.

 

I am interested in getting started. What is the process?

You can start by scheduling a comprehensive consultation which lasts 45 minutes to an hour. It will include a detailed discussion of your symptoms, expectations, benefits and risks, and will go over possible side effects and potential adverse reactions. A complete medical history will be undertaken and a thorough explanation of the role of laboratory testing, selection of medications, supplements and costs will be discussed.

 

Do I need to have a physical examination?

No. You can continue with your regular physician or gynecologist for regular examinations. You will be asked to submit the results of your annual Pap smear, mammogram and bone density.

 

What are the costs?

There is an initial fee which covers an extended consultation to learn your needs, explain how natural hormones are used and to plan your specific hormone replacement program. Baseline laboratory studies are included.

If you decide to begin natural hormone replacement therapy we charge one annual fee independent of the consultation no matter how many office visits or telephone consultations you have. We have found it is easier to manage than to generate charges every time you call or visit. There is no limit to the number of contacts you have during the year.

Medications from compounding pharmacies are shipped overnight directly to you. Costs vary depending upon the type and quantity of the prescription drugs. Herbals and supplements can be sent from the compounding pharmacy as well or you can purchase them directly from retail stores or website distributors.

 

Is this covered by insurance?

Our office does not participate with any insurance program and we request all payment be made at the time of consultation. However, this does not rule out the possibility of reimbursement by your insurance provider. We will be glad to provide you with properly coded invoices or superbills you can submit to your insurance company for reimbursement. Some insurance plans cover the cost of office visits according to their out-of-network provider schedule. Contact your provider for more details regarding coverage. Please note we do not submit insurance forms to Medicare for natural hormone replacement therapy consultations or follow-up care.

In our office Bioreference Laboratory® expenses are included in your overall fee.  Compounding pharmacies will request payment when services are rendered. They have dedicated personnel to assist you and will provide a properly coded statement to submit to your insurance carrier for reimbursement.

 

The FDA says there is no standardization of compounded hormones. Why use a compounding pharmacy?

Traditional compounding involves combining, mixing or altering ingredients to produce a drug by a licensed pharmacist in response to a doctor’s prescription to meet your specific medical needs. Compounding pharmacies are the only way to use bioidentical hormones and individualize their composition. The compounding pharmacies we work with are members of national organizations which assure the quality and consistency of the formulations and certify they comply with the highest standards of the industry. These compounding pharmacies submit samples of their products to independent laboratories on a regular basis for confirmation of quality and verification of potency.

 

The FDA does not approve bioidentical hormones. Why?

Good question. Despite over 30 years of use with an excellent safety record the FDA has yet to evaluate definitive studies on these products. Studies on effectiveness and safety are usually done by drug companies who submit their data for FDA evaluation and approval prior to release. Since these compounds are natural and cannot be patented there is no incentive for drug companies to pay for studies since they are unable to profit from them.

Interestingly, the synthetic estrogens and progestins such as Premarin®, Prempro® and Provera®, do have a long history of significant adverse side effects and risks yet are still approved by the FDA as ‘safe and effective’ albeit with qualifications.