Woodward says his patients "just feel better" on bioidentical hormones. One of his patients, Connie Hibbs, a 67-year-old artist living in Dallas, has been taking Woodward's estradiol pellets for more than 30 years. "I don't feel any different now than I did when I was 35," she says with a youthful laugh. She started taking hormones in her 30s because she was worried about her bones. "Everyone on my mother's side of the family crumpled from osteoporosis," she says. "Now my bone scans are perfect."
But even Woodward sees a downside to the bioidentical industry. "A lot of people out there don't know what they're doing," he says. For example, he says, many prescribers base their doses on saliva tests that supposedly measure their patient's hormone levels. But in his opinion — and the opinion of groups such as the Endocrine Society — such tests are unreliable and potentially misleading. He also notes that many prescribers are "naturopaths" or self-described anti-aging specialists, not board-certified endocrinologists or ob-gyns.
The unknowns surrounding compounded bioidentical hormones make them potentially riskier than standard treatments, Stuenkel says. "At least with FDA-approved hormones, you know what's in the stuff," she says. "They have to follow manufacturing standards." Because compounded hormones are made up on the spot, there's a lot more room for error, adds Santoro. "The dosing isn't that predictable from person to person," she says. Santoro cautions that even if a woman feels terrific with her treatment, she may be getting more hormones than she really needs. That's a problem, she explains, because too much estrogen can lead to uterine cancer. Conversely, a women who is getting shortchanged on hormones could be losing bone mass and missing out on the relief that hormones can bring.
Piera Graven, a 58-year-old operations manager in a New York City medical clinic, tried compounded bioidentical hormones last year to ease her hot flashes. "I thought it would be better to try something natural," she says. But the treatments didn't work, so she turned to Santoro who was still in New York at the time. A combination of Prometrium (a prescription version of progesterone) and a Vivelle Dot estrogen patch did the trick. "I still get hot flashes, but they're nothing like what they were," she says.
Santoro says that the results of the WHI study forced doctors everywhere to take a step back and rethink their approach to hormones. She tries to find the lowest doses that will bring relief, and she'll go through as much trial and error as it takes to find the right approach for each patient. There's no buzzword for her approach, but, she says her patients don't seem to mind.
Chris Woolston is a freelance health writer whose work has appeared in the Los Angeles Times and Reader's Digest.