After having been referred to me by a colleague, a woman who was interested in bioidentical hormone therapy contacted me. She told me that she had suffered a stroke while taking FemHRT. She thought that FemHRT was a form of bioidentical hormone therapy and she asked me if the hormone therapy that I offer to my patients could put her at risk of developing another stroke.

This is a concern that many women have. In the mainstream media estrogen is depicted as a hormone that causes cancer and other health problems. It is this misinformation that causes many women to shy away from seeking treatment for hormone deficiencies or imbalances.

FemHRT DOES NOT contain bioidentical hormones. It consists of norethindrone acetate and ethinyl estradiol.

What is the difference between bioidentical hormones and nonbioidentical hormones?

Bioidentical hormones are messenger chemicals that are identical to hormones that the human body makes in its hormone glands. There is no difference. They are identical in every way. They are made from ingredients of wild yams or soy beans. So they are synthetic hormones but bioidentical. Examples of bioidentical hormones are estradiol, estriol, estrone, testosterone, progesterone, pregnenolone, dehydroepiandrosterone (DHEA), growth hormone, triiodothyronine (T3), thyroxine (T4), hydrocortisone, and aldosterone. The body’s hormone glands make all of these and more and compounding pharmacies are able to make them available for therapeutic applications.

“Nonbioidentical hormones” are not produced by the human body and as such they are considered foreign to the body. Examples are norethindrone, ethinyl estradiol, hormones from other species (e.g., Premarin which contains estrogens derived from horse urine), all oral contraceptives, and most injectable hormones. It would be better to refer to these chemicals as hormone disruptors because they are not hormones. I prefer to reserve the term hormones to those messenger chemicals that are produced by the hormone glands of a human body and their synthetic counterparts (bioidentical hormones).

In 2004, the National Institutes of Health discontinued the Premarin-Provera arm of its Women’s Health Initiative study 1 year early, citing an increase in the risk of breast cancer, heart disease, blood clots, and stroke in women taking the study medications. This study did not use bioidentical estradiol, estriol, estrone, or progesterone. Instead, in the Premarin-Provera arm of the study women were given Premarin, a drug which contains non-bioidentical hormones that are derived from horse urine and Provera (medroxyprogesterone).

There is no evidence that the use of bioidentical hormones increases the risk of developing cancer when the dosage schedule follows the pattern that we see in healthy, young individuals.

In a recent newsgroup message somebody posted a list of estrogen side effects (see below) in response to a research study which concluded that estradiol appears to be a useful treatment for women with schizophrenia.

Here is my response to that post.

This list of “side effects” of “estrogen” is misleading.

First of all, the term “estrogen” is very imprecise.

The three main endogenously produced estrogens which are also available as bioidentical formulations for hormone replacement therapy are estradiol, estriol, and estrone.

In the mainstream media and even in some of the scientific literature the term estrogens is used very loosely. It is often not clear to the layperson or health professional if it is used to reference endogenously produced estrogens, bioidentical replacement hormones, or nonbioidentical patent drugs like Premarin or ethinyl estradiol which are foreign to the body.

Many of the “side effects” listed below are unique to these nonbioidentical patent drugs which have very little in common with endogenously produced estradiol, estrone, and estriol.

When patients experience symptoms of hormonal imbalance it is important to consider the following elements:

1) The hormone levels could be too high – This is rare in the case of estradiol, except when patients are using supraphysiological doses of replacement hormones.
2) The hormone levels could be too low – This is most common in perimenopausal and postmenopausal women but is unfortunately more commonly seen in younger women of childbearing age as well.
3) The number of hormone receptors may have declined. Receptors are essential to hormonal functioning because it is only when a hormone connects with a receptor that a signal is transmitted to the cell.
4) Loss of rhythmicity – All hormones have unique rhythms that when disrupted can explain many symptoms that women experience when their hormones are out of balance.

Except for those “side effects” that are unique to nonbioidentical patent drugs, all other symptoms can be expected to improve if the bioidentical hormone replacement therapy is used to reestablish the optimal hormone levels AND the rhythm that we see in healthy young women.

“[Talking] to your doctor about the risks of taking estrogen” is usually an exercise in futility because most doctors (even endocrinologists and gynecologists) don’t know how to evaluate and treat hormone imbalances. This lack of knowledge and experience leaves women either hormonally depleted or with inadequate hormone replacement therapy using statically dosed bioidentical hormones or inherently dangerous patent drugs.

Here is a good resource for those who want to learn more about rhythmically dosed bioidentical hormone replacement:

Fred Bloem, M.D.

Sent: Tuesday, August 19, 2008 8:00 PM
Subject: Re: [IntPsy] Estrogen as a treatment for schizophrenia in women

Estrogen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

breast pain or tenderness
upset stomach
weight gain or loss
leg cramps
burning or tingling in the arms or legs
tight muscles
hair loss
unwanted hair growth
spotty darkening of the skin on the face
difficulty wearing contact lenses
swelling, redness, burning, itching, or irritation of the vagina
vaginal discharge
change in sexual desire
cold symptoms
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

bulging eyes
sore throat, fever, chills, cough, and other signs of infection
pain, swelling, or tenderness in the stomach
loss of appetite
yellowing of the skin or eyes
joint pain
movements that are difficult to control
rash or blisters
swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs
difficulty breathing or swallowing
Estrogen may increase your risk of developing cancer of the ovaries or gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of taking estrogen.

On Tue, Aug 19, 2008 at 2:22 PM, Dan Stradford wrote:
Estrogen in severe mental illness: a potential new treatment approach.
Kulkarni J, de Castella A, Fitzgerald PB, Gurvich CT, Bailey M, Bartholomeusz C, Burger H.
Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychology, Psychiatry, and Psychological Medicine, The Alfred Hospital, Melbourne, Victoria 3004, Australia.

CONTEXT: Accumulating evidence suggests that estrogens may have therapeutic effects in severe mental illnesses, including schizophrenia, via neuromodulatory and neuroprotective activity. OBJECTIVE: To compare the efficacy of adjunctive transdermal estradiol with that of adjunctive placebo in the treatment of acute psychotic symptoms. DESIGN: Randomized, double-blind study. SETTING: Patients were recruited from inpatient acute hospital wards and outpatient clinics of 2 metropolitan Melbourne general hospitals. PARTICIPANTS: One hundred two women of childbearing age with schizophrenia. All participants were in an acute or chronic phase of their illness; 73 participants were outpatients and the rest were inpatients. Intervention Patients were randomized to receive 100 microg of transdermal estradiol (n = 56) or transdermal placebo (n = 46) for 28 days. MAIN OUTCOME MEASURES: Psychopathological symptoms were assessed weekly with the Positive and Negative Syndrome Scale. RESULTS: The addition of 100 microg of transdermal estradiol significantly reduced positive (P < .05) and general psychopathological (P < .05) symptoms during the 28-day trial period compared with women receiving antipsychotic medication alone. CONCLUSION: Estradiol appears to be a useful treatment for women with schizophrenia and may provide a new adjunctive therapeutic option for severe mental illness. TRIAL REGISTRATION: Identifier: NCT00206570.