About Hormones Women Oral vs. Transdermal
Bioidentical HRT is important and transdermal is more so!
Most women take HRT by mouth (orally) in pill form. It's convenient. However, it also changes how the body metabolizes estrogen and that can be harmful. When any substance is consumed, it is absorbed by the intestines. Then the whole dose immediately goes to the liver. This is known as the "first pass effect." That effect is not what occurs naturally as the ovaries release estrogen into the blood stream. Ovaries release estrogens gradually all day and they gradually go to the liver. When a large dose of estrogen hits the liver all at once, the metabolism is required to process the estrogen differently and the following risks can occur:
Increased clotting factors. Warnings on the box say women who smoke and older women may have an increase in blood clots in the veins and legs that may result in a potentially fatal pulmonary embolism.
Inhibited testosterone. Androgens are thought of as male hormones, because of testosterone, but both men's and women's bodies produce these hormones in order to function sexually. Well-known for his ERT research, Dr. Rogerio Lobo says, "The fastest way to make a woman androgen deficient is to put her on oral estrogen replacement therapy." Here's why: An increase in a sex hormone carrier molecule (sex hormone binding globulin) may cause overly tight binding of testosterone. When that happens, women may experience symptoms of a low testosterone level--decreased libido, vaginal dryness, and thinner bones.
Altered body mass. Metabolism of fats and proteins changes causing both increased fat and loss of lean muscle. Although these counteract each other and usually cause no change in weight, they still produce a flabbier, more undesirable body composition.
Increased risk of breast cancer. Research proves that a woman, who drinks the equivalent of even a single glass of wine or other alcohol a day and takes estrogen orally, may increase her level of estrogen 300% over non-drinkers. That level of estrogen is higher than levels ever experienced in a normal menstrual cycle. Because this predominantly happens to women taking oral HRT, it is suspected of being one of the causes of increased risk of breast cancer. We use transdermal estrogen because it results in just a 30% increase in estrogen levels when alcohol is consumed.
Increased incidence of gall stones is common and can lead to the need for gall bladder removal surgery.
Increased triglycerides, a form of cholesterol fat that is a well-known heart disease risk factor.
Increased C-reactive protein that also generates strong risk of CAD (coronary artery disease).
Not one of these "side effects" occurs with transdermal ERT because the daily dose is released into your circulation just like when the ovaries are functioning normally. During transdermal ERT, estrogens are released gradually into your general circulation through your skin. So why don't all women take ERT transdermally?
Three reasons more women don't take transdermal ERT are:
Inertia: Oral (pill) therapy has been available much longer than transdermal HRT. Easy, one-pill-a-day therapy became a habit for physicians and women. Habits and the thought patterns that go with them are hard to break, especially habits of convenience. In addition, most physicians are not trained to calculate and prescribe precision doses of multiple hormones, optimize them via lab test analysis, and modify the dosages. Further, physicians usually learn about treatment options from pharmaceutical sales representatives whose companies have nothing to gain by developing and marketing products they can't patent.
Availability / Convenience: Many, many women don't want to wear hormone patches. They can catch on your clothing, fall off when you sweat, or require an explanation at moments of intimacy. Although the problem is solved by using transdermal creams that deliver excellent absorption and steady estrogen levels, women must not only be monitored and tested regularly for dosages, but also find special pharmacies to get the multiple hormone mixtures they need. These "compounding pharmacies" can and do combine multiple ingredients in customized dosages, but most pharmacies don't. Pharmaceutical companies have yet to develop transdermal creams that combine estrogen and other needed HRT hormones, e.g., progesterone and testosterone.
Oral ERT raises HDL higher than transdermal ERT. HDL is the good cholesterol. Nevertheless, this is one single reason for using oral medications. Above, we've just cited six reasons against it. When asked why they persist in prescribing oral ERT despite overwhelming reasons against it, gynecologists and internists often can only give the raised HDL rationale. Inappropriately, that rationale is flawed in most cases because although HDL is considerably improved with oral therapy, the majority of women's HDLs are in a very good range so increasing them to 80 mg/dl from 60 does not confer enough benefit to outweigh the above risks. That also holds true even when women are not on ERT. What is more, it has been proven that only about 30 to 40 percent of any reduction in heart disease from ERT is due to ensuing changes in cholesterol profiles. That benefit further mitigates the marginal one of raising HDL in women with appropriate baseline levels. Of course, in some cases, such as when a woman's HDL is less than 30 mg/dl, oral therapy can be preferable. It just is certainly not in the vast majority of cases.
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