I recently spoke with actress Suzanne Somers about her enthusiastic use of "bioidentical" hormones to combat menopausal hot flashes and the ravages of aging. Bioidentical hormones are products that are chemically identical to what's made in a woman's body.
Some are approved as medications; others are supplements. Many of Somers's best-selling books, including her latest, Breakthrough: Eight Steps to Wellness, strongly encourage women to use bioidentical estrogen and progesterone supplements after they hit menopause. Since these are identical to the hormones made by the human body, Somers reasons, they are safe and even beneficial to take well into old age--whereas, she believes, traditional hormone therapies, with slightly different molecular structures, are harmful. She has a cadre of experts to back up her claims and recently touted the antiaging benefits of bioidenticals on the Oprah Winfrey Show to cheers from Oprah, who herself takes the supplements.
After speaking with Somers, though, I thought I would run some of her statements by a medical expert, Adriane Fugh-Berman, a physician and associate professor in the complementary and alternative medicine master's program at Georgetown University Medical Center. (Fugh-Berman takes no money from pharmaceutical companies.) I inserted Fugh-Berman's comments below Somers's answers. Edited excerpts of our conversation:
What inspired you to write a book about wellness?
It started with my understanding--after speaking with many experts--that no one is well and then connecting the dots as to why. I now realize the dots lead to toxicity in our environment, chemicals in our food, water, air, and household cleaning products, and our overuse of pharmaceutical drugs. All of these things make your body incapable of handling any more toxic sludge, and you get cancer. More and more women are beginning menopause at younger ages, and the reason is the toxicity in the environment, coupled with their diet and stress levels. My eight steps, including good nutrition, adequate sleep and exercise, and taking bioidentical hormones, are key for the prevention of cancer and keeping you well as you age.
Fugh-Berman response: I'm not aware of any evidence that early menopause is becoming more common. And early menopause reduces breast cancer risk. Women who start their periods early or begin menopause later than average have a higher risk of breast cancer.
Why do you believe that it's harmful for women to experience a natural decline in estrogen?
People always like to point to high estrogen as a culprit. If it was a culprit, every young woman would have ovarian or breast cancer, because they ooze estrogen. Things start to really go awry when the decline in estrogen occurs. Think about it. Most women get their breast cancers in perimenopause, as in my case, but it doesn't show up until menopause, so they say it occurs in menopausal women. I was on birth control pills for 22 years because I was told they were safe. I've come to realize that they weren't safe because is it safe to take a chemical every day? And how could it be safe to take something that prevents ovulation? We go against that nature; every time we go against that nature, we mess with things.
Fugh-Berman: We have 40 years of evidence about birth control pills. They don't increase breast cancer risk (except possibly in women who have taken them for decades starting in their teens), and using birth control to halt ovulation reduces ovarian cancer risk.
But isn't it going against nature to prevent the natural state of menopause by taking bioidentical hormones?
Most doctors who say menopause is natural are men. The doctors whom I've interviewed--I'm drawing from their expertise, not my own--recognize the importance of restoring hormones. Our bodies weren't intended to live beyond our reproductive years. Women used to die routinely at 40 or 45, and now they're living to 90 or 100. We've figured out with technology how to keep ourselves alive twice as long as the body wants to be. When we restore our bodies to those optimal hormonal levels at which we reproduce, we keep our insides healthy because our brains are tricked into thinking we can still reproduce and keep us alive to perpetuate the species.
Fugh-Berman: Actually, very little kills people in their 40s, and certainly there's no evidence that declining hormone levels do. And findings from the Women's Health Initiative show that long-term use of postmenopausal hormones leads to more heart disease, strokes, breast cancer, and Alzheimer's. As I point out in my latest paper on the myth that new drugs save lives, life expectancy is calculated as an average, so death rates in younger age groups have the greatest impact. In the 19th century, infant deaths were common, and life expectancy in 1900 was only 49 years. Plunging infant mortality rates and fewer women dying in childbirth have increased life expectancy to 68 years in 1950 and to 75 years in 1990. Thus, women who survived infancy and childbirth in past centuries had an excellent chance of reaching a ripe old age.
So you think every woman who goes through menopause needs to take bioidentical hormones?
Certainly, that's a woman's choice. But I think it's a good idea if you want to stay alive for twice as long as your body intended. Without estrogen, your brain doesn't work as well. That's what all that foggy thinking is about which eventually leads to Alzheimer's. And your bones become brittle and prone to breaks unless you take a nasty bone-building drug like Fosamax or Boniva. Keeping your hormone levels optimal will protect your brain and your bones, and you won't get depression, so you won't need to take Prozac. And you won't need to take painkillers because you won't have the joint pain that's associated with aging. The doctors I interviewed say eliminate all these drugs and put back those natural biologically identical hormones. I use an estrogen cream every day and progesterone cream two weeks a month. That's why, at 62, I don't require any pharmaceutical drugs.
Fugh-Berman: Menopausal hormone therapy DOUBLES the risk of dementia, according to data from the Women's Health Initiative, and increases age-related memory problems, too. We can't assume that bioidentical hormones are any different. While some women do experience accelerated bone loss around menopause, most bone loss is age-related, not menopause-related. And the risks of bone loss have been: The average age of hip fracture is 80. While the Women's Health Initiative study did find that hormones improved mood, it was only in women with hot flashes, and I'm not aware of any evidence that estrogen helps joint pain. What's more, any supplemental hormones, whether bioidentical or not, are exaggerated pharmaceutical drugs.
What if a woman simply wants to follow good lifestyle habits like a good diet, regular exercise, adequate sleep?
Those lifestyle habits are absolutely the recipe for health, and every woman is different. Some women pump out hormones through their 60s and don't have a problem with menopause. Women like myself, though, who choose to work and be wives and mothers and live a high-stress lifestyle, we burn out our hormones really fast. And when estrogen and progesterone plummet, the stress hormone cortisol skyrockets. When your cortisol is high, sleep is impossible. When you're overstressed from declining estrogen and progesterone, cortisol never stops pouring, and we can try to sleep all we want but, without estrogen or progesterone, we won't get that sleep. While I understand women who choose to fight menopause naturally with diet and exercise, they're actually making the aging process harder when they opt not to take bioidentical hormones. They're not able to achieve the kind of health that they would if they had optimal hormone levels. It's hard for me to even understand why people fight it.
Fugh-Berman: Where to begin? First of all, while ovaries, adrenal glands, and fat tissue all make some estrogen after menopause, we know that menopausal symptoms don't correlate well with estrogen levels. Some women have no detectable estrogen and experience no hot flashes, whereas others have nearreproductive age levels and have terrible symptoms. The reasoning on stress burning out our ovaries doesn't have any scientific validity; the real risk factors for early menopause are smoking and heart disease. And the remarks about cortisol are inaccurate. Yes, cortisol can keep you awake, but there's no direct relationship between cortisol and declining estrogen and progesterone. At this point, we really don't know what the optimal hormone levels are, and in response to Somers's inability to understand why all women don't take bioidentical hormones, try: common sense, thrift, and an aversion to potentially increasing one's cancer risk.
Tell me about your own menopause. Did you have severe symptoms?
I had three years where I couldn't sleep; I'd wake up soaking wet throughout the night and would get maybe two or three hours total. I was tired all the time, didn't want sex, and started gaining weight for no reason. My hair was stringy, my nails became brittle, and I was downright miserable. My doctor offered me Premarin, but after hearing all those terrible things about it, I refused to take it. I also refused the menopause cocktail of antidepressants, antianxiety meds, and sleeping pills. Finally, I found an endocrinologist who put me on bioidentical hormones, and I started feeling better within a few days. By the end of a year, I was back to my old self, sleeping normally, feeling great, and in the mood sexually again. I don't sell hormones or supplements; this is simply a passion for me.
What do you say to doctors who criticize you for hyping bioidentical hormones as safer than conventional synthetic hormones, who say that bioidentical hormones haven't been well studied?
It makes my blood boil. There are over 40 studies showing that bioidentical hormones are safe, including a Danish study of 700,000 women comparing bioidentical to synthetic hormone use. European women have been using bioidenticals for over 50 years. Bottom line: Bioidentical hormones have been proven safe. They're approved by the Food and Drug Administration. It's very frustrating when doctors don't pay attention to these studies, but so many of them have been bought by pharmaceutical companies, and there's huge money in menopause. Doctors even get bonuses for prescribing chemotherapy drugs; it's really quite a terrible thing.
Fugh-Berman: I agree that the bioidentical estrogen estriol has been well-studied in Europe and has been shown to be effective for hot flashes. But those same European studies also tell us that it increases the risk of endometrial hyperplasia (abnormal cell growth in the uterus) and cancer. In this country, FDA approval doesn't connote safety; it connotes an advantageous risk-benefit ratio for specific conditions. If there's no benefit (for, example, in a woman with no symptoms), the risk-benefit ratio is unfavorable. And yes, I agree there's big money in menopause, but bioidentical hormone manufacturers and promoters are also getting their share of it.
Speaking of cancer treatments, is your oncologist concerned that you take estrogen after having been diagnosed with breast cancer?
He told me I could die, but here I am eight years later doing just fine. I declined chemotherapy and the drug tamoxifen, which cuts off estrogen, and am sticking with bioidentical hormones. [Somers says that she did recently have a hysterectomy after experiencing uterine bleeding and severe hyperplasia.] Obviously, every woman has to make her own individual choices when it comes to breast cancer treatments, and I just felt that my choices were the best shot I had at survival.
(c) 2009 U.S. News & World Report