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Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones - Re Art's info From: Henry Gregor (henrygregor@yahoo.com) Tue Jan 18 10:27:27 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: 32 week PROM Recent Herpes outbreak =?ISO-8859-1?B?oCBIZWxw MIME-Version: 1.0" Previous message: Henry Gregor: "Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones" In reply to: art fougner, md: "Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones" Nicely said, and one can share such info with patients in a non challenging way. For some, any science references may simply be ignored, others may be intellectually open and honest enough to investigate or consider. It's no sin to thank a patient for the oppor'y to have been involved in her care, but if a point has been reached wherein what she requests of you, contradicts what you as a clincician feel is appropriate to your concept of good medicine ...it's not inappropriate to explain to her how you feel. If she cares to corroborate your view with rererence to materials such as Art has provided or via opinions from other practitioners (and you can suggest some respected consultants or refer her to reliable web portals such as WebMD or acog.org, or PubMed) whose tng, skill and knowledge you respect, terrific. If not, accept there's no further benefit for either of you in a continued relatiosnhip. I'd ask her for the same respect for your viewpoint and prerogatives that you are giving to her ...I've found most patients are approachable that way. I'd point out its possible to agree to disagree in an agreable manner, without recriminations. If not, remember the serenity prayer and accept that which one cannot change and move on. Just a viewpoint. Hope the perspective was of some interest. (I've actually had the experience whereby pts and I have parted under such circumstances, and, lol, they've later referred pts to me 'cause they thought the way the situation had been handled was fair and polite.) Hank "art fougner, md" <evsono@pipeline.com> wrote: Caveat emptor. Menopause. 2004 May-Jun;11(3):356-67. Bioidentical hormone therapy: a review. Boothby LA, Doering PL, Kipersztok S. Columbus Regional Drug Information Center, Columbus, GA, USA. lisa.boothby@crhs.net OBJECTIVE: The terms "natural" or "bioidentical" hormone therapy (NHT) are used to describe hormone treatment with individually compounded recipes of certain steroids in various dosage forms, including dehydroepiandrosterone, pregnenolone, testosterone, progesterone, estrone, estradiol, and estriol. Based on the results of a person's salivary hormone levels, the final composition of the compounded dosage form is individualized to that specific person. Proponents claim that NHT is better tolerated than manufactured products. This paper is intended to review the concept of NHT and to determine whether there is sufficient scientific evidence to support its use. DESIGN: A literature search was performed in Medline using the following MeSH terms and key words: drug combinations; progestational hormones; hormone replacement therapy; endometrium; estrogen replacement therapy; climacteric; menopause; estradiol; estrogens; progesterone; drug monitoring; and drug compounding. Current Contents, International Pharmaceutical Abstracts, Cochrane Database of Systematic Reviews, Lexis Nexis, Google, Medscape, MD Consult, and clinicaltrials.gov were searched with key words. RESULTS: There are a few observational studies and clinical trials comparing conventional hormone therapy with bioidentical hormone therapy. Studies generally lacked adequate study design, including small sample sizes and comparison of inequivalent doses, to prove safety and efficacy. Little evidence was found to support individualized hormone dosing based upon saliva hormone concentrations. CONCLUSION: Evidence suggests that, although individualized hormonal products may decrease some symptoms of menopause, it seems they have no proven advantage over conventional hormone therapies and their use is not supported by evidence regarding pharmacokinetics, safety, and efficacy. art At Mon, 17 Jan 2005, Garry E. Siegel, M.D. wrote: > >Advice on how to handle please: > >23 YO P0 > >Age 16 had unilateral S and O for torsion by good REI in town. > >1.5 years ago presented with an acute abdomen and torsion; ovary very >blue at lapscope and even at laparotomy (even did a frozen section at 5 >AM--infarcted ovarian tissue)--had other ovary and tube removed. > >Now on OCPs for HRT, so to speak. > >I got a nice email this past week asking if she needed to come in and >talk, or talk by phone, or just email about 2 topics. > >1. I have found a doctor who has done research on Bioidentical >hormones. They are better, less side effects, yada yada. She's not on >my insurance, but could you work with me (and her) for blood tests, etc. > >2. I am considering IVF in the future; will you work with Dr Local REI >(to whom I refer frequently, partner of 1st REI) for bloodwork, etc. > >My reply: > >1. What is the doctor's name/specialty--answer--Dr. I don't know of, >General Practitioner. > >So, it is pretty obvious that the patient has found someone who likely >profits from visits/tests and maybe drug sales--who knows. > >Normally, I would really want to have no part with Dr. I don't know GP, >and am happy to do whatever for the REI. > >I've asked her to come in to talk. > >What should I tell her? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- art fougner, md "If you don't know where you are going, you will wind up somewhere else." Lawrence Peter Berra Yahoo! Mail - Easier than ever with enhanced search. Learn more. Next message: Garry E. Siegel, M.D.: "Re: 32 week PROM Recent Herpes outbreak =?ISO-8859-1?B?oCBIZWxw MIME-Version: 1.0" Previous message: Henry Gregor: "Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones" In reply to: art fougner, md: "Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones"

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