The Bio-identical Hormone Debate

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             The	Bio-identical	Hormone	Debate	
             A	review	published	in	the	Journal	of	Postgraduate	Medicine,	January	2009

             Brent	Murphy
             B.	Pharm	(Rhodes),	MPS	Pharmacist

                      he	 use	 of	 bio-identical	         cal efficacy, physiologic actions on        outcomes	 demonstrate	 that	 bio-
                      hormones,	 including	 proges-       breast	 tissue,	 and	 risks	 for	 breast	   identical	 hormones	 are	 associated	
                      terone,	estradiol,	and	estriol	     cancer	and	cardiovascular	disease.          with	 lower	 risks,	 including	 the	 risk	
             in	 hormone	 replacement	 therapy	             Their findings were that bio-identi-      of	breast	cancer	and	cardiovascular	
             (HRT)	has	sparked	intense	debate.	           cal	 hormones	 have	 some	 distinctly	      disease, and are more efficacious
             Of	special	concern	is	their	relative	        different,	 potentially	 opposite,	         than	 their	 synthetic	 and	 animal	     	
             safety	 compared	 with	 traditional	         physiological	effects	compared	with	        derived	counterparts.	Until	evidence	
             synthetic	 and	 animal-derived	 ver-         their	 synthetic	 counterparts,	 which	     is	found	to	the	contrary,	bio-identi-
             sions,	 such	 as	 conjugated	 equine	        have	different	 chemical	structures.	       cal	 hormones	 remain	 the	 preferred	
             estrogens	 (CEE),	 medroxyproges-            Both	 physiological	 and	 clinical	         method	of	HRT.”
             terone	 acetate	 (MPA),	 and	 other	         data	 indicated	 that	 bio-identical	         To	 view	 the	 paper	 published	
             synthetic	 progestins.	 Proponents	          progesterone	 is	 associated	 with	 a	      in	 Postgraduate	 Medicine,	 in	 its	
             for	 bio-identical	 hormones	 claim	         diminished	 risk	 for	 breast	 cancer,	     entirety,	 it	 can	 be	 downloaded	 at	
             that	they	are	safer	than	comparable	         compared	 with	 the	 increased	 risk	   	   no	 charge,	 from	 the	 home	 page	 of	
             synthetic	and	nonhuman	versions	of	          associated	with	synthetic	progestins.
             HRT.	 Yet	 according	 to	 the	 South	        Estriol	 has	 some	 unique	 physiologi-       To find out how to prescribe
             African	 Menopause	 Society,	 there	         cal	 effects,	 which	 differentiate	 it	    bio-identical	 hormones	 for	 your	
             is	 little	 or	 no	 evidence	 to	 support	   from	 estradiol,	 estrone	 and	 CEE.	       patients,	 contact	 the	 Compounding	
             claims	that	bio-identical	hormones	          Estriol	 would	 be	 expected	 to	 carry	    Pharmacy	 of	 South	 Africa,	 on	 tele-	
             are	safer	or	more	effective.                 less	risk	for	breast	cancer,	although	      phone	number	011	463	0310	or	visit	
               A	 comprehensive	 review,	 pub-            no	 randomised	 controlled	 trials
             lished	 in	 the	 January	 2009	 edition	     have	 been	 documented.	 Synthetic	
             of	 The	 Journal	 of	 Postgraduate	          progestins	 have	 a	 variety	 of	 nega-     Holtorf, K.; The Bio-identical Hormone Debate: Are Bio-iden-
             Medicine,	 evaluated	 the	 evidence	         tive	 cardiovascular	 effects,	 which	      tical Hormones (Estradiol, Estriol, and Progesterone) Safer or
                                                                                                      More Efficacious than Commonly Used Synthetic Versions in
             comparing	bio-identical	hormones,	           may	be	avoided	with	progesterone.           Hormone Replacement Therapy? Post Graduate Medicine,
             with	 the	 commonly	 used	 non-bio-                                                      Volume 121, January 2009.
                                                            To	 quote	 the	 authors	 conclusions:	
             identical	versions	of	HRT	for	clini-         “Physiological	 data	 and	 clinical	

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Update Apr article 42 - Solal - 1 1                                                                                                                     2009/03/20 11:54:53 AM