Hormonal Optimization

WHI is the largest clinical trial in the US.
The multi-million dollar, 20+ year project sponsored by NIH, originally enrolled around 162,000 women 50-79 y/o between 1993-1998. Trial components: Hormonal therapy (HT), diabetes mellitus (DM), Calcium and Vitamin D (CaD)
Follow ups in 2005-2010, 2010-2015, continue through 2020
A doctor writing on paper while sitting at desk.
During the WHI project, women were divided into 4 groups, two mains branched on either CEE or combination of CEE and MPA as study groups along with two placebo groups for each branch. We do not use CEE or MPA due to numerous side effects, we use bio- identical Hormones: Estradiol and Progesterone.
The result of this study cannot be generalized into our practices at this point.
The term ” Bio-Identical Hormonal Replacement Therapy (BHRT)
is what I, myself and other like- minded physicians use to differentiate this type of hormonal management from the conventional medicine and WHI study.
CEE (conjugated Equine Estrogen) from the horse’s urine, contains conjugated estrogen which has to become activated by converting to Estrone (E1) by the action of sulfatase enzyme. E1 is the form of Estrogen with the highest risk for breast cancer. We do not want to use this form in HRT.
Sample of brochure for oral contraceptive from the pharmaceutical company:
“Distribution Etonogestrel: Etonogestrel is approximately 32% bound to sex hormone- binding globulin (SHBG) and approximately 66% bound to albumin in blood. Ethinyl estradiol: Ethinyl estradiol is highly but not specifically bound to serum albumin (98.5%) and induces an increase in the serum concentrations of SHBG. Metabolism In vitro data shows that both etonogestrel and ethinyl estradiol are metabolized in liver microsomes by the cytochrome P450 3A4 isoenzyme. Ethinyl estradiol is primarily metabolized by aromatic hydroxylation, but a wide variety of hydroxylated and methylated metabolites are formed. These are present as free metabolites and as sulfate and glucuronide conjugates. The hydroxylated ethinyl estradiol metabolites have weak estrogenic activity. The biological activity of etonogestrel metabolites is unknown.
Etonogestrel and ethinyl estradiol are primarily eliminated in urine, bile and feces”. So, let’s see: FDA approves a medicine that its harmful effect is proven, on every brochure listed and it clearly says: the biological activity … is unknown! And why should we take it and prefer it over bio-identical hormones that is shown less harm and more benefit?! Something is wrong with this picture, don’t you agree?
And, on this website which is supposed to be a credible source of information for women, it says: www.womenshealth.org January 2019 “ Oral contraceptives for perimenopausal women: Many women experience irregular periods, intensified PMS, and irritability before they meet the clinical requirement for starting hormone replacement therapy. For these women, the newest treatment is birth control pills. These pills can alleviate annoying symptoms while offering protection from unwanted pregnancy”.
What is in oral contraceptives?
Ethinyl Estradiol as Estrogen and progestin: Drospirenone, Levonorgestrel or Norethinrone acetate, cyproterone, Ethynodiol diacetate…
I encourage you to watch my videos regarding this topic. If you need to dig into it and read the reference articles, here they are:
References for women hormonal optimization:
Hormonal Contributors: Evaluation and Interventions – Ann Hathaway, MD
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40. Stein DG. Progesterone exerts neuroprotective effects after brain injury. Brain Res Rev. 2008;57(2):386-397. doi:10.1016/j.brainresrev. 2007.06.012.
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44. Toran-Allerand CD, Miranda RC, Bentham WD, et al. Estrogen receptors colocalize with low-affinity nerve growth factor receptors in cholinergic neurons of the basal forebrain. Proc Natl Acad Sci USA. 1992;89(10): 4668-4672.
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52. Menopause, Vol. 24, No. 7, 2017: Position statement of the North American Menopause Society
53. International Menopause Society April 25, 2016 : 2016 Recommendations on women’s midlife health and menopause hormone therapy

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