Similarly, Liz, a year-old high school teacher, describes the central roles played by her clinicians and compounding pharmacist in assuaging her concerns about hormones and addressing the symptoms she associates with menopause. My mom had [cancer and] a mastectomy. After a consultation with a compounding pharmacist, Liz refused estrogen but decided to try compounded bioidentical progesterone. In the end, however, it is the clinical experience in this case, with several providers that matters.
In a follow-up conversation, Liz reported that she had started using CBHT estradiol, estriol, and progesterone soon after our original interview. You cannot function without sleeping. Within two weeks the hot flashes were gone and the sleeping followed.
Central to this point is that women sought clinicians who take time to listen and to develop trust with their patients. Across the broader study, the most satisfied women regardless of treatment type were those that felt that they had a trusting relationship with a clinician who they felt was personally invested in their well-being. This is a lesson for all clinicians. Although they generally perceive the benefits of CBHT to outweigh the risks, they have no interest in extending their exposure beyond what is necessary.
As we discussed above, nearly half 10; The former users tried CBHT for the same push and pull reasons discussed above. What is different about the former users is that they generally described menopause symptoms in less distressing terms than the current users, and many only used CBHT for a short period when symptoms became more disruptive to their lives.
The motivations that women described for discontinuing CBHT were largely same reasons women in the overall study gave for discontinuing conventional HT: the treatment was ineffective or had too many side effects, they were concerned about the risks of HT, or their symptoms abated and did not return. The most common reasons women gave for discontinuing CBHT were that they were either ineffective or that the side effects of treatment did not outweigh the benefits.
For example, having prescribed CBHT for her patients, Karen, a year-old naturopathic physician, tried CBHT when she noticed her mild hot flashes increasing in frequency and intensity. She also started having night sweats. Karen tried a compounded bi-estrogen estradiol and estriol and progesterone for only three weeks before discontinuing the therapy due to the side effects she was experiencing. The hot flashes disappeared; the light-headedness came. At the time of our interview, minor hot flashes had resumed, and she was trying to manage them through dietary changes and stress management techniques.
Joan, a year-old behavioral health counselor, started using CBHT in to be proactive about her sexual health and osteopenia; she quit two years later, along with a wave of women who discontinued hormone therapy when the risks were in the news. Finally, several women described passively discontinuing CBHT simply by not refilling their prescription, only to find that their symptoms were bearable without treatment.
This kind of experimentation, which we saw among women using CBHT as well as those using conventional HT, is similar to the trend we previously identified among dietary supplement users [ 82 ], in which individuals become attentive to, and then privilege, their own embodied experience with treatment over professional and clinical prescriptions. Recent data suggests that over one-third of U. Analyzing interview and focus group data collected with current and former users of CBHT, we identified motivations that drive women away from conventional approaches to managing menopause, and those that attract women to CBHT in particular.
When explaining their decision to use CBHT, our participants referenced ongoing medical uncertainty about the potential risks of HT—in particular, the risk for cancer [ 84 — 87 ]—as a key reason they sought to avoid conventional HT. They also emphasized a strong distaste for and desire to avoid CE sometimes called conjugated equine estrogens , with many identifying these products by brand name and using emotional language to index their equine-source. This may reflect the effectiveness of decades of public awareness campaigns against these products e. Women in this study also voiced frustration with a medical system that they perceive to be dismissive of their concerns and overly reliant on pharmaceuticals in place of clinical attention.
They were even more critical of a pharmaceutical industry that they feel has tirelessly promoted HT to generations of women [ 3 , 12 , 90 , 91 ] despite legitimate concerns about its safety [ 1 , 9 — 11 , 92 ]. This should be understood within the broader context of a number of high-profile scandals [ 93 — 96 ] that have undermined public confidence in the pharmaceutical industry [ 97 ] and in biomedicine more broadly [ 98 ].
In contrast, our participants were attracted to CBHT because—as a form of HT—they viewed it as effective for managing the symptoms of menopause and thus for supporting their quality of life.
The importance of this point cannot be overstated. It is the efficacy of HT that has allowed it to weather multiple crises of confidence. Clinicians continue to prescribe HT, and women continue to use HT because it is the most effective way to manage the vasomotor symptoms of menopause [ 99 , ]. Thus, for women who vehemently wish to avoid conventional HT despite facing severe symptoms they associate with menopause, CBHT becomes an attractive alternative.
Although some clinicians and researchers have posited that CBHT may have some safety advantages over conventional HT [ 26 , ], several professional medical organizations have raised concerns about the lack of FDA oversight and quality control of compounded products [ 20 — 22 ]. The literature on CBHT similarly rejects both saliva and blood serum testing as inconsistent and ineffective for determining hormone dose, instead recommending that hormone doses should be as low as possible to effectively manage symptoms [ 20 , 22 , 99 ]; nevertheless, women in this study held varied perspectives on the value of blood and saliva testing—often reflecting on conflicting ideas picked up through the media, or from their clinicians.
Finally, perhaps the most significant appeal of CBHT may not be the pharmaceutical itself, but the kind of clinical care that surrounds it. Research has demonstrated the interpersonal value of clinical care for patient wellness and satisfaction [ — ]. Many of the CBHT users in this study described clinicians and compounding pharmacists who were willing spend significant time establishing and building trust with women, listening to them as they describe their symptoms and often intimate experiences with menopause, counseling women around their treatment options, and enlisting them as partners in treatment decisions [ 54 , ].
This is an anomaly in the U. Unsurprisingly, the women in this study viewed this enhanced clinical care in a very positive light—perceiving both a personal connection and a personal investment in their wellbeing. Yet an important take home message of this study is that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care.
This study demonstrates that many women chose CBHT because they want a different kind of clinical experience, in which their experiences of menopause are validated and they are listened to, where their treatment objectives are solicited and prioritized, and where they are invited to play an active role in determining their treatment.
In short, the clinical context of CBHT appears to explicitly invite women to participate shared decision-making in ways the standard clinical context does not [ 54 , ]. We argue that women making menopause treatment decisions of all kinds would benefit from a clinical context in which they are explicitly invited to share their experience of menopause, and voice their treatment preferences and priorities.
Certainly, there are often structural barriers e. As such, these lessons are important for all clinicians attending to menopausal issues, and possibly for all clinicians across medicine. JJT conceived and designed the study, collected the data, participated in data analysis and interpretation, manuscript writing, and final approval of the manuscript. CR participated in the design of the study, data analysis and interpretation, manuscript writing, and final approval of the manuscript.
MN participated in the design of the study, data analysis and interpretation, manuscript writing, and final approval of the manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Institute of Medicine identified patient-centered care as one of six key aims for improving the U. Thus, as recruitment ended and we sought to ensure greater racial and ethnic diversity in our study, we purposively recruited professional women of color, so not to conflate minority status and education or socio-economic status.
- MORE IN LIFE.
- A Companion to François Truffaut (Wiley Blackwell Companions to Film Directors).
- Bioidentical Hormone Replacement Therapy?
Jennifer Jo Thompson, Email: ude. Cheryl Ritenbaugh, Email: ude. Mark Nichter, Email: moc. National Center for Biotechnology Information , U. BMC Womens Health. Published online Oct 2. Author information Article notes Copyright and License information Disclaimer. Corresponding author.
Received Apr 22; Accepted Sep This article has been cited by other articles in PMC. Associated Data Data Availability Statement The dataset generated and analyzed during the current study are not publicly available due to them containing information that could compromise the confidentiality of research participants. Methods We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U. Keywords: Menopause, Hormone therapy, Bioidentical hormones, Compounded hormones, Shared decision-making, Qualitative research.
Compounded bioidentical hormone therapy Compounded hormone therapy is form of bioidentical hormone therapy that is individually formulated for patients by pharmacists. Prevalence of CBHT use Although there is little historical data on the prevalence of CBHT use, it appears that its popularity rose dramatically among women following the halt of the WHI hormone therapy clinical trials, when many women stopped using conventional HT and sought alternative approaches for managing menopausal symptoms [ 13 ].
Open in a separate window. Photo: Jennifer Jo Thompson. Methods Qualitative research serves as an important complement to experimental and observational quantitative research in the health sciences: it lays the groundwork for good quantitative research; it strengthens interpretation of quantitative data; and it allows for the investigation of unfolding social and organizational processes that are difficult to study in any other way [ 55 ].
Results Twenty-one women Table 2 Participant Characteristics. Health food stores. Books Christiane Northrup. Trusted health care provider. Health seminars. Medical journals. Other health care professionals. Health food store. Health care providers. Books Northrup. Ineffective; Switched to herbal Progesterone cream. Books Weed.
Critical reading of medical literature. Medical conferences. Push away from conventional therapies To some degree, every one of the 21 current and former CBHT users in this study expressed distrust and frustration with the mainstream medical approach to managing menopause. Susan, 3 a year-old professor who sought CBHT from her gynecologist for a short period of time when she started experiencing more intense and more frequent hot flashes, put it this way: Nothing was bad enough to want me to go to take HRT [hormone replacement therapy], or even consider [it].
She explained: The healthcare system creates doctors who have an arrogance about them, and so that arrogance translates into patient care. Push away from alternative therapies Widely available over the counter, dietary supplements like soy, red clover, and black cohosh are a convenient alternative for women seeking to avoid conventional HT; nevertheless, for the most part, these products have not proven themselves efficacious in clinical trials [ 79 , 80 ].
She says, I mean, I was depressed for a couple months. For example, when we asked Peg whether the naturopathic physician she found was familiar with compounded HT, she responded: Very familiar with all of this. Sheree good-naturedly makes this point during a focus group, while also indexing her critique of the quality of mainstream medicine and the biological tailoring of CBHT: [Most doctors] essentially give all women the same dosage, which I think is like, what,.
Hormone health: Could testosterone be the new Botox for women?
She explained: The hot flashes disappeared; the light-headedness came. Discussion Recent data suggests that over one-third of U. Acknowledgements The authors thank our research participants for sharing their experiences and insight. Availability of data and materials The dataset generated and analyzed during the current study are not publicly available due to them containing information that could compromise the confidentiality of research participants.
Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Footnotes 1 The U. References 1. Hormone replacement therapy, cancer, controversies, and women's health: historical, epidemiological, biological, clinical, and advocacy perspectives.
J Epidemiol Community Health. Houck JA: The medicalization of menopause in America. In: Controversies in science and technology: From maize to menopause. Wilson RA. Feminine forever. New York: M. Evans and Company, Inc. Cardiovascular mortality and noncontraceptive use of estrogen in women: Results from the Lipid Research Clinics Program Follow-up Study.
Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen.
Stay Young & Sexy with Bio-Identical Hormone Replacement: The Science Explained
Increased risk of endometrial carcinoma among users of conjugated estrogens. Association of exogenous estrogen and endometrial carcinoma. Menopausal estrogens and breast cancer. National use of postmenopausal hormone therapy: Annual trends and response to recent evidence. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial.
Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women's Health Initiative randomized controlled trial. After the Women's Health Initiative: Decision making and trust of women taking hormone therapy. Womens Health Issues.
Evolution of postmenopausal hormone therapy between and Pinkerton JV, Santoro N. Compounded bioidentical hormone therapy: identifying use trends and knowledge gaps among U. ACOG Compounded bioidentical menopausal hormone therapy. Fertil Steril. Use of compounded bioidentical hormone therapy in menopausal women: An opinion statement of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy.
Compounded bioidentical hormones in endocrinology practice: An Endocrine Society scientific statement. J Clin Endocrinol Metab. Cirigliano M. Bioidentical hormone therapy: A review of the evidence. J Womens Health. Bioidentical hormone therapy. Mayo Clin Proc. Davis, J. Accessed 25 Sept Holtorf K. The bioidentical hormone debate: Are bioidentical hormones estradiol, estriol, and progesterone safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med.
Sites CK. Bioidentical hormones for menopausal therapy. Women's Health Lond Engl ; 4 2 — Fugh-Berman A, Bythrow J. Bioidentical hormones for menopausal hormone therapy: variation on a theme. J Gen Intern Med. Current Opinion in Obstetrics and Gynecology , 20 4 — Three cases of endometrial cancer associated with "bioidentical" hormone replacement therapy. Med J Aust. Menopause and Hormones: Common Questions. Risks and effectiveness of compounded bioidentical hormone therapy: A case series. Pinkerton JV. Menopause management — Getting clinical care back on track.
Bioidentical Hormone Replacement Therapy: Benefits and Side Effects
In: O, The Oprah Magazine. February ; Brody JE: Rethinking the use of hormones to ease menopause symptoms. In New York Times Accessed March 7, WBUR Accessed January 23 Compounded non-FDA-approved menopausal hormone therapy prescriptions have increased: Results of a pharmacy survey. Use of menopausal hormone therapy and bioidentical hormone therapy in Australian women 50 to 69 years of age: Results from a national, cross-sectional study. PLoS One. Use of bioidentical compounded hormones for menopausal concerns: Cross-sectional survey in an academic menopause center.
J Women's Health. Richardson MK. Bioidentical hormone therapy: A challenge for the menopause clinician. The public understanding of science. Beyerstein BL. Alternative medicine and common errors of reasoning. Acad Med. Postmodern values, attitudes and the use of complementary medicine. Complement Ther Med.
- Restoring balance with bioidentical hormones.
- related stories!
- Aging skin!
- Bittersweet: Real Talk on Love, Sex, Family, & Transformation!
- Forever Young!
Sturgis P, Allum N. Science in society: Re-evaluating the deficit model of public attitudes. Public Underst Sci. Wynne B: Misunderstood misunderstanding: Social identities and public uptake of science. Public Understanding of Science , 1 3 — Religious beliefs, knowledge about science and attitudes towards medical genetics. Menopausal women's access path to bioidentical hormone replacement therapy: An exploratory study. Int J Pharm Compounding. Compounded progesterone: Why is it acceptable to Australian women? Soc Sci Med.
Br Med J. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. Bernard HR. Research methods in anthropology: Qualitative and quantitative approaches. LeCompte MD: Essential ethnographic methods. Lambert H, McKevitt C. Anthropology in health research: From qualitative methods to multidisciplinarity. Starks H, Trinidad SB. Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory.
Qual Health Res. Accessed August 3, McCartney M: When it comes to menopausal hormone therapy, women are left guessing at the risks. In: The Guardian WebMD: Understanding menopause - Treatment. Office on Women's Health. Menopause and menopause treatments. Mayo Clinic: Menopause. Wathen CN. Health information seeking in context: How women make decisions regarding hormone replacement therapy. J Health Commun. Women's decision-making about their health care: views over the life cycle.
Researching the lived experience. Britten N. Qualitative research: Qualitative interviews in medical research. Spradley JP. The ethnographic interview. Bioidenticals are derived from plants like yams and soybeans and are synthesized to be chemically identical to human hormones. Conventional synthetic hormones are derived from horse urine and are not chemically identical. Even more controversial for Somers and her many followers is that one of the sources interviewed in Ageless, T.
Wiley, is pushing a treatment plan that may include alarmingly high doses of replacement hormones. Wiley does not hold a Ph.
- In search of youth, women turning to hormones!
- Bioidentical versus synthetic hormones?
- Feel Like Your Younger Self Again with BioTE® Bioidentical Hormone Therapy;
- Walking on Eggshells: Caring for a Critically Ill Loved One.
Somers stands by her book, insisting that she has simply written about multiple options for women who suffer from the symptoms of menopause, and that readers should listen to their own doctors and proceed at their own risk. How did you become interested in this subject? When I started experiencing the symptoms of hormone loss, I went from doctor to doctor and was appalled at what was offered to me. Is this the best you have to offer women? I finally found a doctor who discussed bioidentical hormones, which no other doctor—this was an endocrinologist—no gynecologist had ever mentioned to me.
Why do you think it is that, until recently, bioidenticals have not been on the radar? In some of the therapies you describe, a menopausal woman would cycle through hormones, often in heavier doses than in conventional therapies, as if she were fertile—even triggering a menstrual cycle.
Taking Premarin means getting estrogen every day of the month. Prenpro gives you estrogen and progestin every day of the month. It never ever happens like that in nature, never. Can you describe your regimen of hormone replacement? Our hormone needs as women changes daily. I have my cocktail right now just right. And a woman gets to know.
People with diabetes do it all the time. And so if diabetics can learn how to dose themselves, women can certainly learn how to dose themselves with hormones. And I feel fantastic. I eat organic food.