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Re: Bioidentical Hormone Replacement TherapyFrom: Joanne Bulley, MD (islesannie@yahoo.com)Sat May 8 22:45:14 2004
Yes - from Suzanne Somers - sho apparently "consults" with Dr Diana Schwarzbein (endocrinologist form California - wrote The Schwarzbein Principle). I haven't read any of the Somers book - but I have read a good bit of Schwarzbein - and I *think* she isn't meaning just the compoundes stuff. I tell patients that 17B-Estradiol is bioidentical to what the ovary produces ans is Prometrium (and the new Crinone vaginal progesterone). If they want it "delivered" the same way as the ovaries did it - then there is the transdermal or transvaginal approach. They seem relieved that there is currently available the "bioidentical" stuff - and I do tell them that we have no data to make a definitive answer that one type of estrogen is 100% certain to be medically superior that another. Since at the moment most of the hormone therapy is based on gut level responses to "Sound Bite" information - and I firmly believe that as the WHI was a study of older women without symptoms - I still think some for of HT is perfectly fine - if the woman wants it. So I discuss what I know - what I don't know - and usually she ahs already decided whether or not she wants any hormones before the conversation starts - then unless I think her choice is totally off the wall we usually work together and come up with something. An interesting one last week was a woman who had gone off her estrogen a few months before - was adamant she had to have something for vasomotor symptoms - but it couldn't be estrogen! If I recall coreectly we settled on a trial of Efffexor. My understanding is that the placebo effect for vasomotor symptoms is initially about 30% - but wanes as time goes on. Hencs all the folks who applaud all the isoflavones etc - then eventually come in saying they no longer help. Ok - it is late - I am rambling - so I will sign off!
At Sat, 8 May 2004, art fougner, md wrote:
>
-- Joanne Bulley, MD Keene, NH, USA
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