Re: bioidentical hormone replacement therapy

[Guest guest]

I’ve been working with a local

pharmacist for almost a year doing BHRT. I love it! It’s really neat to

realize that there are actually hormone imbalances you can find (saliva

testing) and fix (compounded hormones). Many of my women patients have been

tested and are feeling significantly better on their hormones. I actually give

a talk monthly to the community and we have good attendance every month. Many

come see me (even some people who have other PCP’s…it feels kind of

funny being the consultant!)

Many of my women patients have been

interested, and when I tested them and got them on hormone(s) they feel a lot

better (sleep, anxiety, hot flashes, irritability, libido, etc).

This is one of those areas that

traditional medicine has significant limitations, like the WHI results (30%

increase breast CA, etc). In my opinion, Prempro has caused way more morbidity

and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it.

There are safer hormones and methods of delivery, but no Big Pharma to market

them.

But that’s OK. My patients find out

about it, I get them feeling better, and we’re all happy.

Economically, if I have to drop Medicare,

I’m just going to more aggressively market BHRT. There’s tremendous

interest out there and women are willing to pay for it…that would be my “exit

strategy”.

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From: [mailto: ] On Behalf Of pricklyfinger2007

Sent: Sunday, December 13, 2009

10:59 PM

To:

Subject:

bioidentical hormone replacement therapy

dear all,

who here in this listserve is providing biohrt...

any pros and cons are welcome...

but most importantly, rather than run the other way, i would like to know more

about it and why i should or why i shouldnt... thanks...

grace

[Guest guest]

Gretchen,

Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,

To: Sent: Mon, December 14, 2009 12:52:45 PMSubject: RE: bioidentical hormone replacement therapy

I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the consultant!)

Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc).

This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them.

But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy.

Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategyâ€.

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007Sent: Sunday, December 13, 2009 10:59 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] bioidentical hormone replacement therapy

dear all,who here in this listserve is providing biohrt... any pros and cons are welcome...but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...grace

[Guest guest]

But why do they have to be compound hormones? Isn't Vivelle Dot bioidentical? Isn't Prometrium bioidentical?

(I understand they are not "natural" but Provera is natural but not human bioidentical.)

I feel like maybe I'm missing something here. I do hormone replacement for patients? But I havn't made it a huge deal?

Should I be?

To: Sent: Mon, December 14, 2009 1:37:08 PMSubject: Re: bioidentical hormone replacement therapy

Gretchen,

Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,

From: Gretchen Reis MD <greis@wellspringfam ilymed.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Mon, December 14, 2009 12:52:45 PMSubject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy

I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the consultant!)

Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc).

This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them.

But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy.

Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategyâ€.

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007Sent: Sunday, December 13, 2009 10:59 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] bioidentical hormone replacement therapy

dear all,who here in this listserve is providing biohrt... any pros and cons are welcome...but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...grace

[Guest guest]

You have been doing bioidentical hormone therapy if you have been prescribing Vivelle and Prometrium, and it doesn't have to be a big deal. Many women do not need any hormones at all. Most who do can be treated with standard doses of estradiol and progesterone. Some however do better when they have more "tweaking" done to their doses than that provided by standard doses, have some testosterone thrown in, or have their hormones delivered in a cream/gel/etc - in those cases they need a compounding pharmacy to make it. Sometimes testing (via urine, saliva or blood, depending on what the purpose of testing is) can be helpful. I learned most of this from reading and from the Institute of Functional Medicine course (Applying Functional Medicine to Clinical Practice).LonnaSubject: Re: bioidentical hormone replacement therapyTo: Date: Tuesday, December 15, 2009, 1:46 PM

But why do they have to be compound hormones? Isn't Vivelle Dot bioidentical? Isn't Prometrium bioidentical?

(I understand they are not "natural" but Provera is natural but not human bioidentical. )

I feel like maybe I'm missing something here. I do hormone replacement for patients? But I havn't made it a huge deal?

Should I be?

From: Bleiweiss <hockeyref1yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Mon, December 14, 2009 1:37:08 PMSubject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy

Gretchen,

Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,

From: Gretchen Reis MD <greis@wellspringfam ilymed.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Mon, December 14, 2009 12:52:45 PMSubject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy

I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the consultant!)

Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc).

This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them.

But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy.

Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategyâ€.

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007Sent: Sunday, December 13, 2009 10:59 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] bioidentical hormone replacement therapy

dear all,who here in this listserve is providing biohrt... any pros and cons are welcome...but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...grace

[Guest guest]

lonna, IFM is pretty expensive, i hope they are worth it... seminars that is.

myria, replied to you in some way, it got lost in cyberspace, til later.

grace

>

>

> Subject: Re: bioidentical hormone replacement therapy

> To:

> Date: Tuesday, December 15, 2009, 1:46 PM

>

>

>

>

>

>

>

>  

>

>

>

>

>

>

>

>

>

> But why do they have to be compound hormones?  Isn't Vivelle Dot

bioidentical?  Isn't Prometrium bioidentical?

> (I understand they are not " natural " but Provera is natural but not human

bioidentical. )

> I feel like maybe I'm missing something here.  I do hormone replacement for

patients? But I havn't made it a huge deal?

> Should I be?

>

>

>

>

>

> From: Bleiweiss <hockeyref1yahoo (DOT) com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 1:37:08 PM

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy

>

>  

>

>

>

> Gretchen,

>     Much like so many female providers, my wife has a significantly

biased towards female (good, doc and patients are happy and more comfortable)

patient panel simply by patient selection women wanting a female primary. Where

would she, we read and learn more about this stuff if she were interested in

adding this therapy, treatment to her tool bag for her patients??? Thanks much

and hope to hear from you soon,

>

>

>

>

>

>

> From: Gretchen Reis MD <greis@wellspringfam ilymed.com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 12:52:45 PM

> Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy

>

>  

>

>

>

> I’ve been working with a local pharmacist for almost a year doing BHRT. I

love it! It’s really neat to realize that there are actually hormone

imbalances you can find (saliva testing) and fix (compounded hormones). Many of

my women patients have been tested and are feeling significantly better on their

hormones. I actually give a talk monthly to the community and we have good

attendance every month. Many come see me (even some people who have other

PCP’s…it feels kind of funny being the consultant!)

> Many of my women patients have been interested, and when I tested them and got

them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes,

irritability, libido, etc).

> This is one of those areas that traditional medicine has significant

limitations, like the WHI results (30% increase breast CA, etc). In my opinion,

Prempro has caused way more morbidity and mortality than Vioxx ever did, but

Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of

delivery, but no Big Pharma to market them.

> But that’s OK. My patients find out about it, I get them feeling better, and

we’re all happy.

> Economically, if I have to drop Medicare, I’m just going to more

aggressively market BHRT. There’s tremendous interest out there and women are

willing to pay for it…that would be my “exit strategyâ€.

>  

>

> Gretchen Reis MD

> Wellspring Family Medicine

> Circleville, OH

>  

>

>

>

>

> From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement

1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> Sent: Sunday, December 13, 2009 10:59 PM

> To: Practiceimprovement 1yahoogroups (DOT) com

> Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy

>  

>  

>

>

>

> dear all,

>

> who here in this listserve is providing biohrt...

> any pros and cons are welcome...

>

> but most importantly, rather than run the other way, i would like to know more

about it and why i should or why i shouldnt... thanks...

>

> grace

>

[Guest guest]

I learned to do the creams on the job with another MD, who was really pretty crazy, only stayed about 2 months, then left. Recently started advertising the spa on American Health, and Beauty, a website that tracks all the beauty treatments, and lists local doctors. In the form about what we offered here, it asked about bio-identical HRT, which I haven't made a big deal about. I checked yes. I am getting 2-3 patients a month from this for the last 3 months. I think it must have been on Oprah again. Anyway, I decided I wanted more training, I just googled it, and up popped some seminars, some had CD's of last years or 2 yr ago seminars for 300-500$. I didn't book mark it, but this is way cheaper than flying somewhere, always available, and you can skip over what you already know. I think it was A4M seminars, not IFM. My 2 cents.

Cote'

MD COTE, Medical, Laser, and Spa

lonna, IFM is pretty expensive, i hope they are worth it... seminars that is.myria, replied to you in some way, it got lost in cyberspace, til later.grace> > > Subject: Re: bioidentical hormone replacement therapy> To: > Date: Tuesday, December 15, 2009, 1:46 PM> > > > > > > >  > > > > > > > > > > But why do they have to be compound hormones? Isn't Vivelle Dot bioidentical?  Isn't Prometrium bioidentical?> (I understand they are not "natural" but Provera is natural but not human bioidentical. )> I feel like maybe I'm missing something here. I do hormone replacement for patients? But I havn't made it a huge deal? > Should I be?> > > > > > From: Bleiweiss <hockeyref1yahoo (DOT) com>> To: Practiceimprovement 1yahoogroups (DOT) com> Sent: Mon, December 14, 2009 1:37:08 PM> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy> >  > > > > Gretchen,>    Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,> > > > > > > From: Gretchen Reis MD <greis@wellspringfam ilymed.com>> To: Practiceimprovement 1yahoogroups (DOT) com> Sent: Mon, December 14, 2009 12:52:45 PM> Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy> >  > > > > I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the consultant!) > Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc). > This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them. > But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy. > Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategy�. >  > > Gretchen Reis MD> Wellspring Family Medicine> Circleville, OH >  > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007> Sent: Sunday, December 13, 2009 10:59 PM> To: Practiceimprovement 1yahoogroups (DOT) com> Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy>  >  > > > > dear all,> > who here in this listserve is providing biohrt... > any pros and cons are welcome...> > but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...> > grace>

[Guest guest]

I pinched and saved for years. But it has been/is very valuable to me!LonnaSubject: Re: bioidentical hormone replacement therapyTo: Date: Tuesday, December 15, 2009, 3:33 PM

lonna, IFM is pretty expensive, i hope they are worth it... seminars that is.

myria, replied to you in some way, it got lost in cyberspace, til later.

grace

>

> From: Myria <myriaemeny@ ...>

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy

> To: Practiceimprovement 1yahoogroups (DOT) com

> Date: Tuesday, December 15, 2009, 1:46 PM

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> But why do they have to be compound hormones? Isn't Vivelle Dot bioidentical? Isn't Prometrium bioidentical?

> (I understand they are not "natural" but Provera is natural but not human bioidentical. )

> I feel like maybe I'm missing something here. I do hormone replacement for patients? But I havn't made it a huge deal?

> Should I be?

>

>

>

>

>

> From: Bleiweiss <hockeyref1@ yahoo. com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 1:37:08 PM

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy

>

>

>

>

>

> Gretchen,

> Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,

>

>

>

>

>

>

> From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 12:52:45 PM

> Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy

>

>

>

>

>

> I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the consultant!)

> Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc).

> This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them.

> But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy.

> Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategyâ€.

>

>

> Gretchen Reis MD

> Wellspring Family Medicine

> Circleville, OH

>

>

>

>

>

> From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> Sent: Sunday, December 13, 2009 10:59 PM

> To: Practiceimprovement 1yahoogroups (DOT) com

> Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy

>

>

>

>

>

> dear all,

>

> who here in this listserve is providing biohrt...

> any pros and cons are welcome...

>

> but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...

>

> grace

>

[Guest guest]

I am going to throw the evidence-based monkey wrench into the works

here...

I've got nothing against BHRT, and I thank you all for starting this

discussion; I too would like to find a clear reference to understand

how others are deducing what and how to prescribe.

BUT: please tell me this: where is the evidence that BHRT is any

different than equine estrogens in adverse long-term outcomes? It took 

long, very large, likely-not-to-be-repeated studies to clearly

demonstrate the adverse effects of HRT on breast cancer and CAD risk.

Until those studies came out, many many women took traditional HRT and

felt well. Aren't hormones hormones - does the breast tissue really

know the source of the estrogenic stimulation it receives? Where in

this discussion is 'first do not harm', since we have clear evidence of

adverse outcomes with long-term HRT? Do those of you who prescribe BHRT

discuss potential adverse long term risks, and document this in some

way?

Thanks,

Steve Hersch MD

Ashland, OR

Lonna Larsh wrote:

 

I pinched and saved for years.  But it has been/is very

valuable to me!

Lonna

From: pricklyfinger2007 <tagabanawa>

Subject: Re: bioidentical hormone

replacement therapy

To:

Date: Tuesday, December 15, 2009, 3:33 PM

 

lonna, IFM is pretty expensive, i hope they are worth

it... seminars that is.

myria, replied to you in some way, it got lost in cyberspace, til later.

grace

>

> From: Myria <myriaemeny@ ...>

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

> To: Practiceimprovement

1yahoogroups (DOT) com

> Date: Tuesday, December 15, 2009, 1:46 PM

>

>

>

>

>

>

>

>  

>

>

>

>

>

>

>

>

>

> But why do they have to be compound hormones?  Isn't Vivelle Dot

bioidentical?  Isn't Prometrium bioidentical?

> (I understand they are not "natural" but Provera is natural but

not human bioidentical. )

> I feel like maybe I'm missing something here.  I do hormone

replacement for patients? But I havn't made it a huge deal?

> Should I be?

>

>

>

>

>

> From: Bleiweiss <hockeyref1@ yahoo. com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 1:37:08 PM

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

>

>  

>

>

>

> Gretchen,

>     Much like so many female providers, my wife has a

significantly biased towards female (good, doc and patients are happy

and more comfortable) patient panel simply by patient selection women

wanting a female primary. Where would she, we read and learn more about

this stuff if she were interested in adding this therapy, treatment to

her tool bag for her patients??? Thanks much and hope to hear from you

soon,

>

>

>

>

>

>

> From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 12:52:45 PM

> Subject: RE: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

>

>  

>

>

>

> I’ve been working with a local pharmacist for almost a year doing

BHRT. I love it! It’s really neat to realize that there are actually

hormone imbalances you can find (saliva testing) and fix (compounded

hormones). Many of my women patients have been tested and are feeling

significantly better on their hormones. I actually give a talk monthly

to the community and we have good attendance every month. Many come see

me (even some people who have other PCP’s…it feels kind of funny being

the consultant!)

> Many of my women patients have been interested, and when I tested

them and got them on hormone(s) they feel a lot better (sleep, anxiety,

hot flashes, irritability, libido, etc).

> This is one of those areas that traditional medicine has

significant limitations, like the WHI results (30% increase breast CA,

etc). In my opinion, Prempro has caused way more morbidity and

mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling

it. There are safer hormones and methods of delivery, but no Big Pharma

to market them.

> But that’s OK. My patients find out about it, I get them feeling

better, and we’re all happy.

> Economically, if I have to drop Medicare, I’m just going to more

aggressively market BHRT. There’s tremendous interest out there and

women are willing to pay for it…that would be my “exit strategyâ€.

>  

>

> Gretchen Reis MD

> Wellspring Family Medicine

> Circleville, OH

>  

>

>

>

>

> From: Practiceimprovement 1yahoogroups (DOT) com [mailto:

Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> Sent: Sunday, December 13, 2009 10:59 PM

> To: Practiceimprovement 1yahoogroups (DOT) com

> Subject: [Practiceimprovemen t1] bioidentical hormone replacement

therapy

>  

>  

>

>

>

> dear all,

>

> who here in this listserve is providing biohrt...

> any pros and cons are welcome...

>

> but most importantly, rather than run the other way, i would like

to know more about it and why i should or why i shouldnt... thanks...

>

> grace

>

[Guest guest]

I agree. Hormone therapy has risks associated with it and of course I always discuss this with my patients and document the discussion in the chart. Many women are willing to accept the risks associated to relieve their symptoms. All drugs have risks, as do herbs and other supplements and in fact everything we do at every minute. Some practitioners claim that bioidenticals offer protection from breast CA, but there isn't any decent literature to support this claim. Lonna

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>

Subject: [Practiceimprovemen t1] Re: bioidentical hormone

replacement therapy

To: Practiceimprovement 1yahoogroups (DOT) com

Date: Tuesday, December 15, 2009, 3:33 PM

lonna, IFM is pretty expensive, i hope they are worth

it... seminars that is.

myria, replied to you in some way, it got lost in cyberspace, til later.

grace

>

> From: Myria <myriaemeny@ ...>

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

> To: Practiceimprovement

1yahoogroups (DOT) com

> Date: Tuesday, December 15, 2009, 1:46 PM

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> But why do they have to be compound hormones? Isn't Vivelle Dot

bioidentical? Isn't Prometrium bioidentical?

> (I understand they are not "natural" but Provera is natural but

not human bioidentical. )

> I feel like maybe I'm missing something here. I do hormone

replacement for patients? But I havn't made it a huge deal?

> Should I be?

>

>

>

>

>

> From: Bleiweiss <hockeyref1@ yahoo. com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 1:37:08 PM

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

>

>

>

>

>

> Gretchen,

> Much like so many female providers, my wife has a

significantly biased towards female (good, doc and patients are happy

and more comfortable) patient panel simply by patient selection women

wanting a female primary. Where would she, we read and learn more about

this stuff if she were interested in adding this therapy, treatment to

her tool bag for her patients??? Thanks much and hope to hear from you

soon,

>

>

>

>

>

>

> From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 12:52:45 PM

> Subject: RE: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

>

>

>

>

>

> I’ve been working with a local pharmacist for almost a year doing

BHRT. I love it! It’s really neat to realize that there are actually

hormone imbalances you can find (saliva testing) and fix (compounded

hormones). Many of my women patients have been tested and are feeling

significantly better on their hormones. I actually give a talk monthly

to the community and we have good attendance every month. Many come see

me (even some people who have other PCP’s…it feels kind of funny being

the consultant!)

> Many of my women patients have been interested, and when I tested

them and got them on hormone(s) they feel a lot better (sleep, anxiety,

hot flashes, irritability, libido, etc).

> This is one of those areas that traditional medicine has

significant limitations, like the WHI results (30% increase breast CA,

etc). In my opinion, Prempro has caused way more morbidity and

mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling

it. There are safer hormones and methods of delivery, but no Big Pharma

to market them.

> But that’s OK. My patients find out about it, I get them feeling

better, and we’re all happy.

> Economically, if I have to drop Medicare, I’m just going to more

aggressively market BHRT. There’s tremendous interest out there and

women are willing to pay for it…that would be my “exit strategyâ€.

>

>

> Gretchen Reis MD

> Wellspring Family Medicine

> Circleville, OH

>

>

>

>

>

> From: Practiceimprovement 1yahoogroups (DOT) com [mailto:

Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> Sent: Sunday, December 13, 2009 10:59 PM

> To: Practiceimprovement 1yahoogroups (DOT) com

> Subject: [Practiceimprovemen t1] bioidentical hormone replacement

therapy

>

>

>

>

>

> dear all,

>

> who here in this listserve is providing biohrt...

> any pros and cons are welcome...

>

> but most importantly, rather than run the other way, i would like

to know more about it and why i should or why i shouldnt... thanks...

>

> grace

>

[Guest guest]

This is generally a half hour discussion, on the risks of HRT in general, then more discussion in particular on the WHI study. The study is somewhat flawed against estrogen/progestrone anyway as the average age of the women particiapitng was 60, and everyone who had been on HRT or estrogen was exclued. We know the arteries change gradually during menopuaseto become more stiff, less forgiving, that is part of why women have later heart attacks. So we took older women with stiff arteries, and gave them a blood clotting agent, what did we expect? The study was pulled for clotting risk, not d/t breast cancer although it got all the press. I don't push people to bio-identical, but I prefer Estradiol pills to prempro, the Naturopath's would have us believe the European literatures supports less risk from Estradiol or triest, I haven't evaluated, I don't know. I do say, we use less cream, because of first pass, this should be less risky, but we DONT KNOW. We don't have, nor are we likely to get a 50,000 person study on Triest or Biest. The OCP patches, actually were formulated to give less drug, but paradoxically still give about 20% more, so higher risk of clot. Some people do great on typical big pharma bio-identical pills, other's don't, so want to try topical. Other's have their mind made up about it and just want topical. They have all read Suzanne Sommer's books. I haven't and point out, she has no medical training, and I don't do what she does. If they want that, go to a Naturopath. Many people try the creams, and although they work for them, it's just a mess or too expensive and end up switching to the pills. So this is much of my speil, and you of course get to make your own, and your own opinion.

Cote' MD

[Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > dear all,> > who here in this listserve is providing biohrt... > any pros and cons are welcome...> > but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...> > grace>

[Guest guest]

A great thing about being an IMP is having the time to do this. Lonna

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>Subject: [Practiceimprovemen t1] Re: bioidentical hormone replacement therapyTo: Practiceimprovement 1yahoogroups (DOT) comDate: Tuesday, December 15, 2009, 3:33 PM

lonna, IFM is pretty expensive, i hope they are worth it... seminars that is.myria, replied to you in some way, it got lost in cyberspace, til later.grace> > From: Myria <myriaemeny@ ...>> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy> To: Practiceimprovement 1yahoogroups (DOT) com> Date: Tuesday, December 15, 2009, 1:46 PM> > > > > > > > > > > > > > > > > > But why do they have to be compound hormones? Isn't Vivelle Dot bioidentical? Isn't Prometrium bioidentical?> (I understand they are not "natural" but Provera is natural but not human bioidentical. )> I feel like maybe I'm missing something here. I do

hormone replacement for patients? But I havn't made it a huge deal? > Should I be?> > > > > > From: Bleiweiss <hockeyref1@ yahoo. com>> To: Practiceimprovement 1yahoogroups (DOT) com> Sent: Mon, December 14, 2009 1:37:08 PM> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > Gretchen,> Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,> > > > > > > From:

Gretchen Reis MD <greis@wellspringfa m ilymed.com>> To: Practiceimprovement 1yahoogroups (DOT) com> Sent: Mon, December 14, 2009 12:52:45 PM> Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the

consultant!) > Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc). > This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them. > But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy. > Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategyâ€. > > > Gretchen Reis MD> Wellspring Family

Medicine> Circleville, OH > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007> Sent: Sunday, December 13, 2009 10:59 PM> To: Practiceimprovement 1yahoogroups (DOT) com> Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > dear all,> > who here in this listserve is providing biohrt... > any pros and cons are welcome...> > but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...> > grace>

[Guest guest]

if anyone could have told me that the risks for biohrt are nil compared to

usual... id have started doing it yesterday..

like hcg for weight loss... well thats another story.

but i do get patients who are breast cancer survivors who say, they would rather

have a mastectomy four times over rather than not sleep for years... now what

can we say to that?

g

> >

> > From: Myria <myriaemeny@ ...>

> > Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement

therapy

> > To: Practiceimprovement 1yahoogroups (DOT) com

> > Date: Tuesday, December 15, 2009, 1:46 PM

> >

> >

> >

> >

> >

> >

> >

> >  

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > But why do they have to be compound hormones?  Isn't Vivelle Dot

bioidentical?  Isn't Prometrium bioidentical?

> > (I understand they are not " natural " but Provera is natural but not human

bioidentical. )

> > I feel like maybe I'm missing something here.  I do hormone replacement for

patients? But I havn't made it a huge deal?

> > Should I be?

> >

> >

> >

> >

> >

> > From: Bleiweiss <hockeyref1@ yahoo. com>

> > To: Practiceimprovement 1yahoogroups (DOT) com

> > Sent: Mon, December 14, 2009 1:37:08 PM

> > Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement

therapy

> >

> >  

> >

> >

> >

> > Gretchen,

> >     Much like so many female providers, my wife has a significantly

biased towards female (good, doc and patients are happy and more comfortable)

patient panel simply by patient selection women wanting a female primary. Where

would she, we read and learn more about this stuff if she were interested in

adding this therapy, treatment to her tool bag for her patients??? Thanks much

and hope to hear from you soon,

> >

> >

> >

> >

> >

> >

> > From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> > To: Practiceimprovement 1yahoogroups (DOT) com

> > Sent: Mon, December 14, 2009 12:52:45 PM

> > Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement

therapy

> >

> >  

> >

> >

> >

> > I’ve been working with a local pharmacist for almost a year doing BHRT. I

love it! It’s really neat to realize that there are actually hormone

imbalances you can find (saliva testing) and fix (compounded hormones). Many of

my women patients have been tested and are feeling significantly better on their

hormones. I actually give a talk monthly to the community and we have good

attendance every month. Many come see me (even some people who have other

PCP’s…it feels kind of funny being the consultant!)

> > Many of my women patients have been interested, and when I tested them and

got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes,

irritability, libido, etc).

> > This is one of those areas that traditional medicine has significant

limitations, like the WHI results (30% increase breast CA, etc). In my opinion,

Prempro has caused way more morbidity and mortality than Vioxx ever did, but

Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of

delivery, but no Big Pharma to market them.

> > But that’s OK. My patients find out about it, I get them feeling better,

and we’re all happy.

> > Economically, if I have to drop Medicare, I’m just going to more

aggressively market BHRT. There’s tremendous interest out there and women are

willing to pay for it…that would be my “exit strategyâ€.

> >  

> >

> > Gretchen Reis MD

> > Wellspring Family Medicine

> > Circleville, OH

> >  

> >

> >

> >

> >

> > From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement

1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> > Sent: Sunday, December 13, 2009 10:59 PM

> > To: Practiceimprovement 1yahoogroups (DOT) com

> > Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy

> >  

> >  

> >

> >

> >

> > dear all,

> >

> > who here in this listserve is providing biohrt...

> > any pros and cons are welcome...

> >

> > but most importantly, rather than run the other way, i would like to know

more about it and why i should or why i shouldnt... thanks...

> >

> > grace

> >

>

[Guest guest]

I have not done this yet but I have offered pt who start HRT w bioidenticals the Genova or metametrix urine test to check how they metabolize the exogenous estrogen. (Now I hope I remember this correctly) Are they making the - 2-OH metabolite  is the " protective one " vs the 16- OH the bad one? Premarin makes the 4-OH which is the DNA damaging one.

 

 

if anyone could have told me that the risks for biohrt are nil compared to usual... id have started doing it yesterday..like hcg for weight loss... well thats another story.but i do get patients who are breast cancer survivors who say, they would rather have a mastectomy four times over rather than not sleep for years... now what can we say to that?

g > > > > From: Myria <myriaemeny@ ...>> > Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy

> > To: Practiceimprovement 1yahoogroups (DOT) com> > Date: Tuesday, December 15, 2009, 1:46 PM> > > > > > > > > > > > > > > >  

> > > > > > > > > > > > > > > > > > > > But why do they have to be compound hormones?  Isn't Vivelle Dot bioidentical?  Isn't Prometrium bioidentical? > > (I understand they are not " natural " but Provera is natural but not human bioidentical. )> > I feel like maybe I'm missing something here.  I do hormone replacement for patients? But I havn't made it a huge deal?

> > Should I be?> > > > > > > > > > > > From: Bleiweiss <hockeyref1@ yahoo. com>> > To: Practiceimprovement 1yahoogroups (DOT) com

> > Sent: Mon, December 14, 2009 1:37:08 PM> > Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > >   > > > > > >

> > Gretchen,> >     Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon, > > > > > > > > > > > > > > From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> > To: Practiceimprovement 1yahoogroups (DOT) com> > Sent: Mon, December 14, 2009 12:52:45 PM> > Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy> >

> >   > > > > > > > > I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the consultant!)

> > Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc). > > This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them.

> > But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy. > > Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategy†.

> >  > >

> > Gretchen Reis MD> > Wellspring Family Medicine> > Circleville, OH > >   > > > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007> > Sent: Sunday, December 13, 2009 10:59 PM

> > To: Practiceimprovement 1yahoogroups (DOT) com> > Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy> >  > >  

> > > > > > > > dear all,> > > > who here in this listserve is providing biohrt... > > any pros and cons are welcome...> > > > but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...

> > > > grace> >>

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

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[Guest guest]

I treat for symptoms. Period. The failure of the WHI is that they 1. started women after menopause 2. starte women who were not symptomatic. I have plenty of patients who stopped their HRT after WHI and just didn't have a quality of life. Many women have been sent to psychiatrist for homonal issues as per the author of Screaming to be Heard (what women know and doctors refuse to listen). I don't think there is a study nor will they fund a study to prove bioidentical hormones are safer. But I have had less side effects with bioidentical hormones than with Premerin in those woman I took off replacement after the WHI and were miserable and I put them back on bioidenticals. I treat for symptoms and try to gradually taper. But most of my

patients have been on much longer than 5 years due to symptoms that are unbearable from insomnia, to arthritis, to lack of concentration or hot flashes, etc. So this is quality of life issues. Absolutely I discuss the risks and document as well as mandate that if I'm prescribing they will get yearly mammograms.

To: Sent: Wed, December 16, 2009 12:34:51 PMSubject: Re: Re: bioidentical hormone replacement therapy

I am going to throw the evidence-based monkey wrench into the works here...I've got nothing against BHRT, and I thank you all for starting this discussion; I too would like to find a clear reference to understand how others are deducing what and how to prescribe. BUT: please tell me this: where is the evidence that BHRT is any different than equine estrogens in adverse long-term outcomes? It took long, very large, likely-not-to- be-repeated studies to clearly demonstrate the adverse effects of HRT on breast cancer and CAD risk. Until those studies came out, many many women took traditional HRT and felt well. Aren't hormones hormones - does the breast tissue really know the source of the estrogenic stimulation it receives? Where in this discussion is 'first do not harm', since we have clear evidence of adverse outcomes with long-term HRT? Do those of you who prescribe BHRT discuss potential adverse long term risks, and document

this in some way? Thanks,Steve Hersch MDAshland, ORLonna Larsh wrote:

I pinched and saved for years. But it has been/is very valuable to me!Lonna

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>Subject: [Practiceimprovemen t1] Re: bioidentical hormone replacement therapyTo: Practiceimprovement 1yahoogroups (DOT) comDate: Tuesday, December 15, 2009, 3:33 PM

lonna, IFM is pretty expensive, i hope they are worth it... seminars that is.myria, replied to you in some way, it got lost in cyberspace, til later.grace> > From: Myria <myriaemeny@ ...>> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy> To: Practiceimprovement 1yahoogroups (DOT) com> Date: Tuesday, December 15, 2009, 1:46 PM> > > > > > > > > > > > > > > > > > But why do they have to be compound hormones? Isn't Vivelle Dot bioidentical? Isn't Prometrium bioidentical?> (I understand they are not "natural" but Provera is natural but not human bioidentical. )> I feel like maybe I'm missing something here. I do

hormone replacement for patients? But I havn't made it a huge deal? > Should I be?> > > > > > From: Bleiweiss <hockeyref1@ yahoo. com>> To: Practiceimprovement 1yahoogroups (DOT) com> Sent: Mon, December 14, 2009 1:37:08 PM> Subject: Re: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > Gretchen,> Much like so many female providers, my wife has a significantly biased towards female (good, doc and patients are happy and more comfortable) patient panel simply by patient selection women wanting a female primary. Where would she, we read and learn more about this stuff if she were interested in adding this therapy, treatment to her tool bag for her patients??? Thanks much and hope to hear from you soon,> > > > > > > From:

Gretchen Reis MD <greis@wellspringfa m ilymed.com>> To: Practiceimprovement 1yahoogroups (DOT) com> Sent: Mon, December 14, 2009 12:52:45 PM> Subject: RE: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > I’ve been working with a local pharmacist for almost a year doing BHRT. I love it! It’s really neat to realize that there are actually hormone imbalances you can find (saliva testing) and fix (compounded hormones). Many of my women patients have been tested and are feeling significantly better on their hormones. I actually give a talk monthly to the community and we have good attendance every month. Many come see me (even some people who have other PCP’s…it feels kind of funny being the

consultant!) > Many of my women patients have been interested, and when I tested them and got them on hormone(s) they feel a lot better (sleep, anxiety, hot flashes, irritability, libido, etc). > This is one of those areas that traditional medicine has significant limitations, like the WHI results (30% increase breast CA, etc). In my opinion, Prempro has caused way more morbidity and mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling it. There are safer hormones and methods of delivery, but no Big Pharma to market them. > But that’s OK. My patients find out about it, I get them feeling better, and we’re all happy. > Economically, if I have to drop Medicare, I’m just going to more aggressively market BHRT. There’s tremendous interest out there and women are willing to pay for it…that would be my “exit strategyâ€. > > > Gretchen Reis MD> Wellspring Family

Medicine> Circleville, OH > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007> Sent: Sunday, December 13, 2009 10:59 PM> To: Practiceimprovement 1yahoogroups (DOT) com> Subject: [Practiceimprovemen t1] bioidentical hormone replacement therapy> > > > > > dear all,> > who here in this listserve is providing biohrt... > any pros and cons are welcome...> > but most importantly, rather than run the other way, i would like to know more about it and why i should or why i shouldnt... thanks...> > grace>

[Guest guest]

My understanding of the WHI and many other studies is that medroxyprogesterone has been implicated in the increase in breast cancer risk much more so than conjugated equine estrogen. The ball park hazard ratios I remember for breast cancer from the WHI are 1.26 for Premarin and Provera in relation to breast cancer (just barely statistically significant) and 0.8 or 0.77 for Premarin alone (not quite statistically significant in the smaller study but consistent with other studies). This is why many are recommending use of estrogen alone without medroxyprogesterone. An alternative would be to use micronized progesterone (brand name Prometrium vs compounded micronized progesterone) but there is not enough research to clearly indicate this is better in relation to breast

health. The PEPI study in 95 suggested micronized progesterone was a better choice in relation to cardiovascular health but since PremPro was introduced about then, Prometrium never really took off (Wyeth had the upper hand in advert dollars and who can beat an "all in one" pill cost-wise or convenience-wise?). The basic lessons from WHI that were no surprise are 1) use transdermal estrogens to avoid clot risks; 2) start hormone therapy in the peri-menopause and early menopause time rather than much later when cardiovascular disease has become well established; 3) monitor for risks (mammograms, cardiovascular markers etc) and 4) educate on lifestyle factors to reduce various risks including alcohol and exercise for breast cancer risk reduction. Way too many women have compromised quality of life and and no ability to deal with stress effectively or to exercise when hormones are in transition- this too often leads to

habits that increase their risk more than the use of judicious HRT or ERT. One does not have to use compounded hormones to provide bio-identical hormones to women. I have prescribed bio-identical hormones for over 10 years and have moved away from saliva testing (happy to discuss why off list) and use compounded hormones only rarely now. I prescribe various transdermal estradiol products and use Prometrium frequently. My patients are thrilled with results. There is way too much confusion about hormone therapy and not enough quality research. The WHI clearly had the fatal flaw of not including adequate numbers of younger women. They were actively recruiting 70 year old women to begin HRT- no wonder their quality of life scores were so low. HERS was done after the WHI began which was unfortunate - if we had had that data, I think the WHI would have been designed much

differently.The caveat of first do no harm is certainly relative- aspirin does harm, statins can do harm and so can hormones. NOT using ASA, statins and HRT can do harm. What is one supposed to recommend to the woman that is having insomnia, night sweats, hot flashes, irritability and brain fog to the point that her marriage, job and role of mother is compromised? Ambien, SSRIs, Lithium (yes- it has been used for the brain fog!)?? When I prescribe I spend enormous amounts of time discussing the research and the risks vs benefits. Do women understand- unfortunately, no. They come with pre-conceived notions about "natural" hormones and end up trusting my judgement. I discuss the alternatives for their symptoms- they are not interested. I discuss the challenge of measuring hormone levels in women who still have ovaries, the pitfalls of saliva and urine testing and how symptoms are a better guide in general- particularly when

using branded HRT that have data to tell us where the average level is on a certain dose ie: Vivelle Dot dosage range (0.025 - 0.1) results in levels of 35 - 100 pg/ml Cavg. Stopping now... I tend to go overboard on the topic of hormones. Upshot in my opinion is that BHRT is not proven more safe than traditional CEE and medroxyprogesterone but transdermal estrogen has been proven safer than oral estrogen in relation to clot risk as well as a few other factors that are important. What impact a bio-identical progesterone has needs more research but holds promise. The general understanding of what the research has shown is too often confused and "estrogen" is blamed for harmful effects that may be more accurately attributed to the synthetic progestin. Carla Gibson FNPMissoula, MTTo: Sent: Wed, December 16, 2009 10:34:51 AMSubject: Re: Re: bioidentical hormone replacement therapy

I am going to throw the evidence-based monkey wrench into the works

here...

I've got nothing against BHRT, and I thank you all for starting this

discussion; I too would like to find a clear reference to understand

how others are deducing what and how to prescribe.

BUT: please tell me this: where is the evidence that BHRT is any

different than equine estrogens in adverse long-term outcomes? It took

long, very large, likely-not-to- be-repeated studies to clearly

demonstrate the adverse effects of HRT on breast cancer and CAD risk.

Until those studies came out, many many women took traditional HRT and

felt well. Aren't hormones hormones - does the breast tissue really

know the source of the estrogenic stimulation it receives? Where in

this discussion is 'first do not harm', since we have clear evidence of

adverse outcomes with long-term HRT? Do those of you who prescribe BHRT

discuss potential adverse long term risks, and document this in some

way?

Thanks,

Steve Hersch MD

Ashland, OR

Lonna Larsh wrote:

I pinched and saved for years. But it has been/is very

valuable to me!

Lonna

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>

Subject: [Practiceimprovemen t1] Re: bioidentical hormone

replacement therapy

To: Practiceimprovement 1yahoogroups (DOT) com

Date: Tuesday, December 15, 2009, 3:33 PM

lonna, IFM is pretty expensive, i hope they are worth

it... seminars that is.

myria, replied to you in some way, it got lost in cyberspace, til later.

grace

>

> From: Myria <myriaemeny@ ...>

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

> To: Practiceimprovement

1yahoogroups (DOT) com

> Date: Tuesday, December 15, 2009, 1:46 PM

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> But why do they have to be compound hormones? Isn't Vivelle Dot

bioidentical? Isn't Prometrium bioidentical?

> (I understand they are not "natural" but Provera is natural but

not human bioidentical. )

> I feel like maybe I'm missing something here. I do hormone

replacement for patients? But I havn't made it a huge deal?

> Should I be?

>

>

>

>

>

> From: Bleiweiss <hockeyref1@ yahoo. com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 1:37:08 PM

> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

>

>

>

>

>

> Gretchen,

> Much like so many female providers, my wife has a

significantly biased towards female (good, doc and patients are happy

and more comfortable) patient panel simply by patient selection women

wanting a female primary. Where would she, we read and learn more about

this stuff if she were interested in adding this therapy, treatment to

her tool bag for her patients??? Thanks much and hope to hear from you

soon,

>

>

>

>

>

>

> From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> To: Practiceimprovement 1yahoogroups (DOT) com

> Sent: Mon, December 14, 2009 12:52:45 PM

> Subject: RE: [Practiceimprovemen t1] bioidentical hormone

replacement therapy

>

>

>

>

>

> I’ve been working with a local pharmacist for almost a year doing

BHRT. I love it! It’s really neat to realize that there are actually

hormone imbalances you can find (saliva testing) and fix (compounded

hormones). Many of my women patients have been tested and are feeling

significantly better on their hormones. I actually give a talk monthly

to the community and we have good attendance every month. Many come see

me (even some people who have other PCP’s…it feels kind of funny being

the consultant!)

> Many of my women patients have been interested, and when I tested

them and got them on hormone(s) they feel a lot better (sleep, anxiety,

hot flashes, irritability, libido, etc).

> This is one of those areas that traditional medicine has

significant limitations, like the WHI results (30% increase breast CA,

etc). In my opinion, Prempro has caused way more morbidity and

mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling

it. There are safer hormones and methods of delivery, but no Big Pharma

to market them.

> But that’s OK. My patients find out about it, I get them feeling

better, and we’re all happy.

> Economically, if I have to drop Medicare, I’m just going to more

aggressively market BHRT. There’s tremendous interest out there and

women are willing to pay for it…that would be my “exit strategyâ€.

>

>

> Gretchen Reis MD

> Wellspring Family Medicine

> Circleville, OH

>

>

>

>

>

> From: Practiceimprovement 1yahoogroups (DOT) com [mailto:

Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> Sent: Sunday, December 13, 2009 10:59 PM

> To: Practiceimprovement 1yahoogroups (DOT) com

> Subject: [Practiceimprovemen t1] bioidentical hormone replacement

therapy

>

>

>

>

>

> dear all,

>

> who here in this listserve is providing biohrt...

> any pros and cons are welcome...

>

> but most importantly, rather than run the other way, i would like

to know more about it and why i should or why i shouldnt... thanks...

>

> grace

>

[Guest guest]

I like your summary, Carla.

1. You show that if we we " first do no harm " then we shouldn't be doctors.

Everything we do or don't do has potential for harm and hopefully benefit.

2. Treat patients, not labs.

3. Maintaining a healthy life style is more important than most of what medicine

can do. The original studies showed less MIs on HRT apparently b/c they were

healthier. Healthy lifestyle overpowered the thrombogenic effects of HRT.

4. Quality of life matters.

Re DVT and transdermal estradiol, it is likely that there is less risk but I

don't think we can say with certainty yet. From UpToDate:

" Route of estrogen — Transdermal estrogen, which has little effect on

hemostasis, may be associated with a lower VTE risk. This was illustrated in a

multicenter case-control study in postmenopausal women that included 271 cases

of VTE and 610 controls matched for age, center, and admission date [78]. The

odds ratios for VTE in current users of oral or transdermal estrogen compared to

nonusers were 4.2 (95% CI 1.5-11.6) and 0.9 (95% CI 0.4-2.1), respectively [78].

There are no clinical trial data comparing the effect of transdermal and oral

estrogen preparations on VTE risk. In a meta-analysis that included this

observational study [78], as well as three others, no excess risk of venous

thromboembolism was observed in women taking transdermal estrogen (OR 1.2 [95%

CI 0.1-1.7]), even in those with prothrombotic mutations or high body mass

index. These results should be interpreted with caution because of the small

number of events, and the lack of clinical trial data [79].

" This observational study also reported that neither medroxyprogesterone acetate

nor micronized progesterone appeared to be associated with VTE risk, while

nonpregnane progestins (nomegesetrol acetate and promegestrone) were associated

with excess risk. "

> >>>>>

> >>>>> From: Myria <myriaemeny@ ...>

> >>>>> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

> >>replacement therapy

> >>>>> To: Practiceimprovement

> >>1yahoogroups (DOT) com

> >>>>> Date: Tuesday, December 15, 2009, 1:46 PM

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> But why do they have to be compound hormones? Isn't Vivelle Dot

> >>bioidentical? Isn't Prometrium bioidentical?

> >>>>> (I understand they are not " natural " but Provera is natural but

> >>not human bioidentical. )

> >>>>> I feel like maybe I'm missing something here. I do hormone

> >>replacement for patients? But I havn't made it a huge deal?

> >>>>> Should I be?

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> From: Bleiweiss <hockeyref1@ yahoo. com>

> >>>>> To: Practiceimprovement 1yahoogroups (DOT) com

> >>>>> Sent: Mon, December 14, 2009 1:37:08 PM

> >>>>> Subject: Re: [Practiceimprovemen t1] bioidentical hormone

> >>replacement therapy

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> Gretchen,

> >>>>> Much like so many female providers, my wife has a

> >>significantly biased towards female (good, doc and patients are happy

> >>and more comfortable) patient panel simply by patient selection women

> >>wanting a female primary. Where would she, we read and learn more about

> >>this stuff if she were interested in adding this therapy, treatment to

> >>her tool bag for her patients??? Thanks much and hope to hear from you

> >>soon,

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> From: Gretchen Reis MD <greis@wellspringfa m ilymed.com>

> >>>>> To: Practiceimprovement 1yahoogroups (DOT) com

> >>>>> Sent: Mon, December 14, 2009 12:52:45 PM

> >>>>> Subject: RE: [Practiceimprovemen t1] bioidentical hormone

> >>replacement therapy

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> I’ve been working with a local pharmacist for almost a year doing

> >>BHRT. I love it! It’s really neat to realize that there are actually

> >>hormone imbalances you can find (saliva testing) and fix (compounded

> >>hormones). Many of my women patients have been tested and are feeling

> >>significantly better on their hormones. I actually give a talk monthly

> >>to the community and we have good attendance every month. Many come see

> >>me (even some people who have other PCP’s…it feels kind of funny being

> >>the consultant!)

> >>>>> Many of my women patients have been interested, and when I tested

> >>them and got them on hormone(s) they feel a lot better (sleep, anxiety,

> >>hot flashes, irritability, libido, etc).

> >>>>> This is one of those areas that traditional medicine has

> >>significant limitations, like the WHI results (30% increase breast CA,

> >>etc). In my opinion, Prempro has caused way more morbidity and

> >>mortality than Vioxx ever did, but Wyeth (Pfizer) still keeps selling

> >>it. There are safer hormones and methods of delivery, but no Big Pharma

> >>to market them.

> >>>>> But that’s OK. My patients find out about it, I get them feeling

> >>better, and we’re all happy.

> >>>>> Economically, if I have to drop Medicare, I’m just going to more

> >>aggressively market BHRT. There’s tremendous interest out there and

> >>women are willing to pay for it…that would be my “exit strategyâ€.

> >>>>>

> >>>>>

> >>>>> Gretchen Reis MD

> >>>>> Wellspring Family Medicine

> >>>>> Circleville, OH

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> From: Practiceimprovement 1yahoogroups (DOT) com [mailto:

> >>Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of pricklyfinger2007

> >>>>> Sent: Sunday, December 13, 2009 10:59 PM

> >>>>> To: Practiceimprovement 1yahoogroups (DOT) com

> >>>>> Subject: [Practiceimprovemen t1] bioidentical hormone replacement

> >>therapy

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> dear all,

> >>>>>

> >>>>> who here in this listserve is providing biohrt...

> >>>>> any pros and cons are welcome...

> >>>>>

> >>>>> but most importantly, rather than run the other way, i would like

> >>to know more about it and why i should or why i shouldnt... thanks...

> >>>>>

> >>>>> grace

> >>>>>

> >>

> >>

> >

>

[Guest guest]

I " m not sure it is quite right to say that progesterone is more the

cause of incr breast cancer than estrogen. I don't think we know that.

The date on estrogen alone came from women s/p hysterectomy so they were

only on estrogen. Cancers that are ER+ are definitely going to respond

to HRT with/without progesterone. There are PR+ tumors also. IT is

tempting to say just give women estrogen but I'm not sure it is quite

that simple. But I don't think treating only with estrogen for a while

is necessarily bad. The risk of unopposed estrogen is for uterine cancer

and pts can have an endometrial bx every yr or so as one pt of mine has

opted to do because she couldn't tolerate progesterone(unclear why).

Ellen

PS--I do agree with what you have said about the bio-identical issue.

Estradiol is bio-I. The issue of " natural " is thorny---many pts/people

just don't get it. I once asked at a Naturopathic meeting on women's

issues the difference between cow adrenal preps and horse estrogen.

Everyone laughed but no one answered my question. People believe what

they want to believe, even well educated people with fancy degrees.

Compounded stuff is also expensive--Prometrium is often NOT covered by

insurance, an issue for many.

magnetdoctor@... wrote:

>

> Here, here, I agree with everything you said.

>

> Cote' MD

> [Practiceimprovemen t1] bioidentical hormone

> replacement therapy

> >

> >

> >

> >

> >

> > dear all,

> >

> > who here in this listserve is providing biohrt...

> > any pros and cons are welcome...

> >

> > but most importantly, rather than run the other way, i would

> like to know more about it and why i should or why i

> shouldnt... thanks...

> >

> > grace

> >

>

>

>

Attachment: vcard [not shown]

[Guest guest]

WHI did find that treating older women with HRT lead to an incr in

CAD/events. Starting a 70 yo on HRT would not be reasonable and seems a

very unlikely thing to do.

magnetdoctor@... wrote:

>

> Here, here, I agree with everything you said.

>

> Cote' MD

> [Practiceimprovemen t1] bioidentical hormone

> replacement therapy

> >

> >

> >

> >

> >

> > dear all,

> >

> > who here in this listserve is providing biohrt...

> > any pros and cons are welcome...

> >

> > but most importantly, rather than run the other way, i would

> like to know more about it and why i should or why i

> shouldnt... thanks...

> >

> > grace

> >

>

>

>

Attachment: vcard [not shown]

[Guest guest]

I don't know  nuthin " bout bioidenticalsbut the endometrail hyperplasia  issue is of interest to me SOme articles  actually say  to get an u/s in any woman over like age 40 to assess endometrial stripe thickness  But why would I do that  as the majority of women in the age group with irregular menses a re havign menopause? it is very difficult to sort out   who could have endometrial ca I think. I have a low threshold for getting an u/s but I cannot see that we  use  technology on everyone for a rare disease BEcasue my patietns are older and I have seen a few cases of this  this is on my mind alot( I have like under 3 patietn who care about hot flashes and HRT) and  I can do  bx easily enough but to select who get s  it   is very hard.

I do not undertand the mirena IUD thing either in this setting?GYN here says u/s reasonable  do invasive testing only if equivocal results/clinical suspicionLAst case I had was  relatively  young woman who told me a typical menopause story  CAme back with story of slighlty more misbehaving bleeding but had belly pain  on pelvic had  very distubing anatomy hence to u/s and on  She died with some  horrible aggressive version of things  but anyway still I really puzzle over endometrail ca and how to be on thelookout without u/s everyone.

Jean

 

Although I haven’t attended a lecture on this in over a year,

last I heard, U/S is still not good at predicting which women has a problem and

which women doesn’t.  Apparently, the thickness of the endometrial lining is

just not a good predictor of who has atypia or dyspasia and who doesn’t.  I

think the saline histogram help identify polyps better but from what I have

heard from women, it’s as bad if not worse than the bx. 

 

 

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

 

 

 

From:

[mailto: ] On Behalf Of Ellen

son

Sent: Friday, December 18, 2009 2:36 AM

To:

Subject: Re: Re: bioidentical hormone replacement

therapy

 

 

Marina IUD has Progesterone in it, no Estrogen. Why would you do that in

a post-menopausal woman? I've seen it used to manage peri-menopausal

bleeding to good effect but why else?

US may be a better option these days than endo bx.

dannielle harwood wrote:

>

> So my understanding in terms of estrogen and breast ca is as

> follows...estrogen does not cause breast cancer however it likely

> " fertilizes " or stimulates the growth of the cancers.....this is

(

> perhaps) why women who do get breast ca while on HRT have cancers that

> are lower grade and actually do better overall.

> If you are going to use estrogen unopposed I believe an US q 6months

> is what is being used for following the uterus by most gyns. I believe

> if after a certain number of US there is no hyperstim of the

> endometrium that you can go to less frequent screenings. Do not know

> the financial difference or safety of endo bx vs, US, but I am

> curious. Another option is to use a Mirena IUD. and follow with US.

> Dannielle Harwood, M.D.

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the sole use

> of the intended recipient(s) and contains confidential information.

> Unauthorized use or disclosure is prohibited. If you are not the

> intended recipient, you may not use, disclose, copy or disseminate

> this information. If you are not the intended recipient, please

> contact the sender immediately by reply email and destroy all copies

> of the original message, including attachments.

>

> [Practiceimprovemen t1] bioidentical hormone

> > replacement therapy

> > >

> > >

> > >

> > >

> > >

> > > dear all,

> > >

> > > who here in this listserve is providing biohrt...

> > > any pros and cons are welcome...

> > >

> > > but most importantly, rather than run the other way, i would

> > like to know more about it and why i should or why i

> > shouldnt... thanks...

> > >

> > > grace

> > >

> >

> >

> >

>

>

-- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical  record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and  brief  questions

Email replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .     MD         ph   fax

impcenter.org

[Guest guest]

I meant use the mirena to offer some endometrial protection while giving estrogen.

Dannielle Harwood, M.D.-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.

[Practiceimprovemen t1] bioidentical hormone> > replacement therapy> > >> > >> > >> > >> > >> > > dear all,> > >> > > who here in this listserve is providing biohrt...> > > any pros and cons are welcome...> > >> > > but most importantly, rather than run the other way, i would> > like to know more about it and why i should or why i> > shouldnt... thanks...> > >> > > grace> > >> >> >> >>>

[Guest guest]

ah.

 

I meant use the mirena to offer some endometrial protection while giving estrogen.

Dannielle Harwood, M.D.-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.

[Practiceimprovemen t1] bioidentical hormone> > replacement therapy> > >> > >> > >> > >> > >> > > dear all,> > >> > > who here in this listserve is providing biohrt...> > > any pros and cons are welcome...> > >> > > but most importantly, rather than run the other way, i would> > like to know more about it and why i should or why i> > shouldnt... thanks...> > >> > > grace> > >> >> >> >>>

-- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical  record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and  brief  questions

Email replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .     MD         ph   fax

impcenter.org

[Guest guest]

This OBGYN's site is of interest in helping to understand the WHI data: http://www.drtimdelivers.com/statswhi052504/statsofwhi052504.shtml He raises what I think are valid questions re: the interpretation of the WHI results... though he may be a bit fanatical on some of his pages, I understand his frustration in the blind acceptance of the WHI results as information that should be applied to women of all ages without consideration of the hormone delivery mechanism and other factors such as severity of symptoms on QOL.Graphs below are visually helpful. We could keep an entire separate listserv on this topic

busy...CarlaFrom http://courses.washington.edu/bonephys/opestrogen.html which is a course on osteoporosis:Overall effects in women aged 50 - 59 who took estrogen alone:The above graph shows the results from the estrogen-only study in a subset of the women who were age 50-59. None of the differences between placebo and estrogen were considered statistically significant. Overall, therefore, estrogen in young women does not have the same risks as estrogen in older women!This graph demonstrates the major findings of the Women's Health Initiative. There were two parallel studies, one using progestin and estrogen in 16,000 women, the other in 10,000 women who had a hysterectomy, using estrogen alone. The first trial was terminated after 5 years due to increased risk of breast cancer. The second was terminated after 7 years due to increased risk of stroke. From the graph you can see that in both studies the death rate was the same in estrogen users

and placebo users, the rate of fractures was lower in the estrogen groups, and the number of strokes and blood clots was higher in the estrogen groups. The women who took estrogen and progestin had higher risks of heart disease and breast cancer than placebo, but this was not seen when women took estrogen alone.To: Sent: Fri, December 18, 2009 5:44:43 PMSubject: Re: bioidentical hormone replacement therapy

I'm not sure how many copywrite laws I just broke, but here's the data summarized from WHI with NNT/NNH. This helps me explain the data to patients. I show them the areas of slight benefit and slight harm and help them decide what is important to them. I could post this Word doc as an attachment but I'm not sure how legal it is. If there is a desire to have the .doc version attached and someone who knows (?) thinks it is okay, I'll put it in the attachments. craig

Table 1. Summary of Results from Health Initiative over~5.2-year Study Period

Outcomes

CEE + MPA %

Placebo %

RR %

AR %

NNT; NNH

*CHD: early increase in risk

1.93

1.5

29

0.43

232

Stroke: increase after > 1 yr

1.49

1.05

42

0.44

227

DVT

1.35

0.64

111

0.71

140

PE: early increase in risk

0.82

0.38

116

0.44

227

Total CVD

8.16

6.74

21

1.42

70

*Breast Ca, invasive: increase in risk after~4 yrs

1.95

1.53

27

0.42

238

Colorectal Ca: benefit after~3 yrs

0.53

0.83

36

0.3

333

Hip Fracture

0.52

0.77

33

0.25

400

All Fracture

7.64

9.73

22

2.09

48

Global Index†

8.82

7.69

14

1.13

88

AR = absolute risk; Ca = cancer; CEE = conjugated equine estrogen; CHD = coronary heart disease; CVD = cardiovascular disease; DVT = deep vein thrombosis; MPA = medroxyprogesterone ; NNT = number needed to treat to benefit one patient; NNH = num­ber needed to harm one patient; PE = pulmonary embolism; RR = relative risk.*Primary outcomes of study †Global Index = summarized balance of risks & benefits Note: Only statistically significant outcomes included in table. For breast cancer the confi­dence interval (Nominal 95% CI = 1.00-1.59) had just reached significance.

Reprinted with permission from Saskatoon City Hospital and the British Columbia Community Drug Utilization Program. HRT alternatives in light of the WH1. University of Saskatchewan , 2002. > >> > > >> >> > > > From: Myria <myriaemeny@ ...>> >> > > > Subject: Re: [Practiceimprovemen t1] bioidentical hormone> >> > > replacement therapy> >> > > > To: Practiceimprovement 1yahoogroups (DOT)

com> >> > > > Date: Tuesday, December 15, 2009, 1:46 PM> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > But why do they have to be compound hormones? Isn't Vivelle> >> > > Dot bioidentical? Isn't Prometrium bioidentical?> >> > > > (I understand they are not "natural" but Provera is natural> >> > > but not human bioidentical. )> >> > >

> I feel like maybe I'm missing something here. I do hormone> >> > > replacement for patients? But I havn't made it a huge deal?> >> > > > Should I be?> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > From: Bleiweiss <hockeyref1@ yahoo. com>> >> > > > To: Practiceimprovement 1yahoogroups (DOT) com> >> > > > Sent: Mon, December 14, 2009 1:37:08 PM> >> > > > Subject: Re: [Practiceimprovemen t1] bioidentical hormone> >> > > replacement therapy> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > Gretchen,> >> > > > Much like

so many female providers, my wife has a> >> > > significantly biased towards female (good, doc and patients> >> > > are happy and more comfortable) patient panel simply by> >> > > patient selection women wanting a female primary. Where would> >> > > she, we read and learn more about this stuff if she were> >> > > interested in adding this therapy, treatment to her tool bag> >> > > for her patients??? Thanks much and hope to hear from you soon,> >> > > > > >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > From: Gretchen Reis MD greis@wellspringfa m ilymed.com>> >> > > > To: Practiceimprovement 1yahoogroups (DOT) com> >> > > >

Sent: Mon, December 14, 2009 12:52:45 PM> >> > > > Subject: RE: [Practiceimprovemen t1] bioidentical hormone> >> > > replacement therapy> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > I’ve been working with a local pharmacist for almost a> >> > > year doing BHRT. I love it! It’s really neat to realize that> >> > > there are actually hormone imbalances you can find (saliva> >> > > testing) and fix (compounded hormones). Many of my women> >> > > patients have been tested and are feeling significantly better> >> > > on their hormones. I actually give a talk monthly to the> >> > > community and we have good attendance every month. Many come>

>> > > see me (even some people who have other PCP’s…it feels> >> > > kind of funny being the consultant!)> >> > > > Many of my women patients have been interested, and when I> >> > > tested them and got them on hormone(s) they feel a lot better> >> > > (sleep, anxiety, hot flashes, irritability, libido, etc).> >> > > > This is one of those areas that traditional medicine has> >> > > significant limitations, like the WHI results (30% increase> >> > > breast CA, etc). In my opinion, Prempro has caused way more> >> > > morbidity and mortality than Vioxx ever did, but Wyeth> >> > > (Pfizer) still keeps selling it. There are safer hormones and> >> > > methods of delivery, but no Big Pharma to market them.> >> > > > But

that’s OK. My patients find out about it, I get them> >> > > feeling better, and we’re all happy.> >> > > > Economically, if I have to drop Medicare, I’m just going> >> > > to more aggressively market BHRT. There’s tremendous> >> > > interest out there and women are willing to pay for it…that> >> > > would be my “exit strategy†.> >> > > >> >> > > >> >> > > > Gretchen Reis MD> >> > > > Wellspring Family Medicine> >> > > > Circleville, OH> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:> >> > >

Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of> >> > > pricklyfinger2007> >> > > > Sent: Sunday, December 13, 2009 10:59 PM> >> > > > To: Practiceimprovement 1yahoogroups (DOT) com> >> > > > Subject: [Practiceimprovemen t1] bioidentical hormone> >> > > replacement therapy> >> > > >> >> > > >> >> > > >> >> > > >> >> > > >> >> > > > dear all,> >> > > >> >> > > > who here in this listserve is providing biohrt...> >> > > > any pros and cons are welcome...> >> > > >> >> > > > but most importantly, rather than run the other way, i would> >> > > like to know more about it and why i should or why

i> >> > > shouldnt... thanks...> >> > > >> >> > > > grace> >> > > >> >> > >> >> > >> >> > >> >> >> >> >> >>> >>> >> >> > --> > PATIENTS,please remember email may not be entirely secure and that Email is> > part of the medical record and is placed into the chart ( be careful what> > you say!)> > Email is best used for appointment making and brief questions> > Email replies can be expected within 24 hours-Please CALL if the matter> > is more urgent .> >> >> > MD> > > > > > ph fax > > impcenter.org> >>

>> > > >> > > > -- > Sharon McCoy MD> > Renaissance Family Medicine> www.SharonMD. com>

[Guest guest]

The only thing I know is to do an endometrial biopsy yrly to ensure

there is no cancer.

Ellen

Myria wrote:

> Is there anything to protect from uterine cancer when patient will

> only take the Estorgen because doesn't tolerate any form of Progesterone?

> When I was at the clinic 3 Chinese women were getting their estrogen

> from China and absolutely refused any progesterone after having side

> effects. Just curious if this comes up again.

>

> ------------------------------------------------------------------------

> *From:*

> *To:*

> *Sent:* Fri, December 18, 2009 9:11:06 AM

> *Subject:* Re: Re: bioidentical hormone

> replacement therapy

>

>

> ah.

>

> On Fri, Dec 18, 2009 at 8:42 AM, dannielle harwood <dharwood100@

> sbcglobal. net > wrote:

>

> I meant use the mirena to offer some endometrial protection while

> giving estrogen.

> Dannielle Harwood, M.D.

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the sole

> use of the intended recipient(s) and contains confidential

> information. Unauthorized use or disclosure is prohibited. If you

> are not the intended recipient, you may not use, disclose, copy or

> disseminate this information. If you are not the intended

> recipient, please contact the sender immediately by reply email

> and destroy all copies of the original message, including attachments.

>

> [Practiceimprovemen t1] bioidentical hormone

> > > replacement therapy

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > dear all,

> > > >

> > > > who here in this listserve is providing biohrt...

> > > > any pros and cons are welcome...

> > > >

> > > > but most importantly, rather than run the other way, i would

> > > like to know more about it and why i should or why i

> > > shouldnt... thanks...

> > > >

> > > > grace

> > > >

> > >

> > >

> > >

> >

> >

>

>

>

>

> --

> PATIENTS,please remember email may not be entirely secure and that

> Email is part of the medical record and is placed into the chart ( be

> careful what you say!)

> Email is best used for appointment making and brief questions

> Email replies can be expected within 24 hours-Please CALL if the

> matter is more urgent .

>

>

> MD

>

>

> ph fax

> impcenter.org <http://impcenter.org/>

>

>

Attachment: vcard [not shown]

[Guest guest]

Recent article this wk shows that the rise in chol/LDL may very well

occur at the end of a yr of no periods, ie the start of menopause. Good

that they may have identified this.

WHI certainly showed that started elderly woman on HRT is not a good

idea but starting it early, late peri-/early menopause before the incr

risk of CVD occurs, we still don't know.

But it might be. An individual decision for sure.

Ellen

Dr. Sharon McCoy wrote:

> sorry for the delay on this one, I had written this response but

> wanted to research more before posting; now I will throw it out and

> hope someone else researches or I will add more later...

> ,

> I agree with your take on the WHI study. I don't see the CAD evidence

> for women perimenopausal/just into menopause taking HRT for 4-5 years.

> We know it decreases osteoporosis and related deaths from hip

> fractures, etc. Starting estrogen probably makes breast cancers that

> are already there grow and become apparent.....

> I also don't know that we know (or I guess I know that we don't know)

> what happens death rate wise/morbidity/quality of life-wise to women

> who start HRT at menopause andt then stay on continuously. We do know

> that CAD jumps in women after menopause.

> My take on the WHI always was, if a woman feels great and because of

> family hx or personal health fears breast cancer more than

> osteoporosis, no reason to even think about taking HRT. But if she

> isn't feeling well, not sleeping, etc., she may want to consider HRT.

> I wish there was some good algorithm to help sort the evidence for

> individuals better.....

> Sharon

>

>

> On Fri, Dec 18, 2009 at 11:23 AM, Myria <myriaemeny@...

> > wrote:

>

> Is there anything to protect from uterine cancer when patient will

> only take the Estorgen because doesn't tolerate any form of

> Progesterone?

> When I was at the clinic 3 Chinese women were getting their

> estrogen from China and absolutely refused any progesterone after

> having side effects. Just curious if this comes up again.

>

> ------------------------------------------------------------------------

> *From:* <jnantonucci@...

> >

> *To:*

> <mailto: >

> *Sent:* Fri, December 18, 2009 9:11:06 AM

>

> *Subject:* Re: Re: bioidentical hormone

> replacement therapy

>

>

> ah.

>

> On Fri, Dec 18, 2009 at 8:42 AM, dannielle harwood <dharwood100@

> sbcglobal. net > wrote:

>

> I meant use the mirena to offer some endometrial protection

> while giving estrogen.

> Dannielle Harwood, M.D.

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the

> sole use of the intended recipient(s) and contains

> confidential information. Unauthorized use or disclosure is

> prohibited. If you are not the intended recipient, you may not

> use, disclose, copy or disseminate this information. If you

> are not the intended recipient, please contact the sender

> immediately by reply email and destroy all copies of the

> original message, including attachments.

>

> [Practiceimprovemen t1] bioidentical hormone

> > > replacement therapy

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > dear all,

> > > >

> > > > who here in this listserve is providing biohrt...

> > > > any pros and cons are welcome...

> > > >

> > > > but most importantly, rather than run the other way,

> i would

> > > like to know more about it and why i should or why i

> > > shouldnt... thanks...

> > > >

> > > > grace

> > > >

> > >

> > >

> > >

> >

> >

>

>

>

>

> --

> PATIENTS,please remember email may not be entirely secure and that

> Email is part of the medical record and is placed into the chart (

> be careful what you say!)

> Email is best used for appointment making and brief questions

> Email replies can be expected within 24 hours-Please CALL if the

> matter is more urgent .

>

>

> MD

>

>

> ph fax

> impcenter.org <http://impcenter.org/>

>

>

>

>

> --

> Sharon McCoy MD

>

> Renaissance Family Medicine

> www.SharonMD.com <http://www.SharonMD.com>

>

>

Attachment: vcard [not shown]

[Guest guest]

I wish I could pull the study up from the conference where I

learned this years ago, but endothelial cell function responds positively to

estrogen by making them less inflamed and friable and form better protective

caps over lipid deposits.  This correlates with lower vascular age and thinner intima

media thickness on carotid IMT scans.  This estrogen effect seems to be lost

after about a consecutive year absence of estrogen, and may be the major reason

why ERT/HRT started too far into menopause doesn’t seem to be as

cardiovascularly beneficial as when it is started earlier. 

Regarding the WHI study, a local female cardiologist thinks it

has been misinterpreted and is a strong supporter of ERT/HRT.

Interesting how much we know, and yet how much we still don’t

know about the human body.

Eads, MD

Pinnacle

Family Medicine

Colorado

Springs, Colorado

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Ellen

son

Sent: Sunday, December 20, 2009 5:29 PM

To:

Subject: Re: Re: bioidentical hormone replacement

therapy

Recent article this wk shows that the rise in chol/LDL may very well

occur at the end of a yr of no periods, ie the start of menopause. Good

that they may have identified this.

WHI certainly showed that started elderly woman on HRT is not a good

idea but starting it early, late peri-/early menopause before the incr

risk of CVD occurs, we still don't know.

But it might be. An individual decision for sure.

Ellen

Dr. Sharon McCoy wrote:

> sorry for the delay on this one, I had written this response but

> wanted to research more before posting; now I will throw it out and

> hope someone else researches or I will add more later...

> ,

> I agree with your take on the WHI study. I don't see the CAD evidence

> for women perimenopausal/just into menopause taking HRT for 4-5 years.

> We know it decreases osteoporosis and related deaths from hip

> fractures, etc. Starting estrogen probably makes breast cancers that

> are already there grow and become apparent.....

> I also don't know that we know (or I guess I know that we don't know)

> what happens death rate wise/morbidity/quality of life-wise to women

> who start HRT at menopause andt then stay on continuously. We do know

> that CAD jumps in women after menopause.

> My take on the WHI always was, if a woman feels great and because of

> family hx or personal health fears breast cancer more than

> osteoporosis, no reason to even think about taking HRT. But if she

> isn't feeling well, not sleeping, etc., she may want to consider HRT.

> I wish there was some good algorithm to help sort the evidence for

> individuals better.....

> Sharon

>

>

> On Fri, Dec 18, 2009 at 11:23 AM, Myria <myriaemeny@...

> >

wrote:

>

> Is there anything to protect from uterine cancer when patient will

> only take the Estorgen because doesn't tolerate any form of

> Progesterone?

> When I was at the clinic 3 Chinese women were getting their

> estrogen from China and absolutely refused any progesterone after

> having side effects. Just curious if this comes up again.

>

> ----------------------------------------------------------

> *From:* <jnantonucci@...

> >

> *To:*

> <mailto: >

> *Sent:* Fri, December 18, 2009 9:11:06 AM

>

> *Subject:* Re: Re: bioidentical hormone

> replacement therapy

>

>

> ah.

>

> On Fri, Dec 18, 2009 at 8:42 AM, dannielle harwood <dharwood100@

> sbcglobal. net >

wrote:

>

> I meant use the mirena to offer some endometrial protection

> while giving estrogen.

> Dannielle Harwood, M.D.

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the

> sole use of the intended recipient(s) and contains

> confidential information. Unauthorized use or disclosure is

> prohibited. If you are not the intended recipient, you may not

> use, disclose, copy or disseminate this information. If you

> are not the intended recipient, please contact the sender

> immediately by reply email and destroy all copies of the

> original message, including attachments.

>

> [Practiceimprovemen t1] bioidentical hormone

> > > replacement therapy

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > dear all,

> > > >

> > > > who here in this listserve is providing biohrt...

> > > > any pros and cons are welcome...

> > > >

> > > > but most importantly, rather than run the other way,

> i would

> > > like to know more about it and why i should or why i

> > > shouldnt... thanks...

> > > >

> > > > grace

> > > >

> > >

> > >

> > >

> >

> >

>

>

>

>

> --

> PATIENTS,please remember email may not be entirely secure and that

> Email is part of the medical record and is placed into the chart (

> be careful what you say!)

> Email is best used for appointment making and brief questions

> Email replies can be expected within 24 hours-Please CALL if the

> matter is more urgent .

>

>

> MD

>

>

> ph fax

> impcenter.org <http://impcenter.org/>

>

>

>

>

> --

> Sharon McCoy MD

>

> Renaissance Family Medicine

> www.SharonMD.com <http://www.SharonMD.com>

>

>