You’ve seen her on TV, making the talk-show rounds and touting her books, Ageless: The Naked Truth About Bioidentical Hormones (New York, N.Y: Crown Publishing, 2006) and The Sexy Years (New York, N.Y.: Three Rivers Press, 2005). I’m talking, of course, about Suzanne Somers, the 60-year-old blonde bombshell and star of numerous B movies who is also a self-declared expert on all things menopausal. Somers—whose latest campaign is for so-called bioidentical hormones—joins a growing list of people who promote these products in magazines and on TV. Bioidenticals were also a hot topic at this year’s North American Menopause Society convention, and if your female patients haven’t done so already, they will surely start asking about bioidenticals soon. What, exactly, are bioidenticals? Health-care providers have long referred to bioidentical hormones as those normally produced by a woman’s body, mainly estrogen and progesterone. Somers, however, defines bioidenticals as hormones chemically compounded from wild yams and soy and then individually customized for each woman. In the introduction to Ageless, Somers makes bold claims for bioidenticals. “A better life, a healthier life…comes from embracing anti-aging medicine, and bioidentical hormone replacement is a big component,” she writes. “This new approach to health gives you back your lean body, shining hair, and thick skin.
…This new medicine allows your brain to work perfectly and offers the greatest defense against cancer, heart attack, and Alzheimer’s disease. Don’t you want that?”Of course you do! The problem is that none of these claims is supported by solid scientific data. Last April, during a talk titled, “Bio-Identical Hormones: Sound Science or Bad Medicine?” Steven Galson, MD, MPH, director of the FDA’s Center for Drug Evaluation and Research, reported to the Senate Special Committee on Aging: “FDA is unaware of any credible scientific evidence supporting the assertions that…bioidentical compounded products are a safe or effective alternative to FDA-approved drugs containing hormones. Equally concerning are claims…that [bioidenticals] can be used to prevent serious illnesses.…”
As to whether bioidenticals effectively ease menopausal symptoms, it’s hard to say. Some women who take them say they do, but so do many who take FDA-approved hormones. The fact that custom-compounded bioidenticals commonly contain estriol, the weakest estrogen, makes me doubt that they could be effective against hot flushes and night sweats. In my opinion, some patients who believe the hype surrounding bioidenticals may be experiencing a placebo effect.
So, what’s a physician assistant or a nurse practitioner to do if patients ask whether they should take bioidenticals? Our job is to educate and support women in making informed decisions about their health care. This means providing up-to-date, evidence-based information. We also have an obligation to discuss the safety and efficacy of all drugs, including traditional and custom bioidentical hormones.
After learning the facts, if a woman still insists on trying bioidenticals, we should make sure she gets the same careful monitoring all our patients get, including physical exams, Pap tests, pelvic exams, and mammograms. If a patient’s risk for heart disease or endometrial or breast cancer changes, reassessment of any hormonal regimen is in order. Finally, although we may not agree with every choice our patients make, we need to assure them that we will always be there to answer questions and discuss matters further.