The answers to the following FAQ’s are generalized for the population-at-large and meant to help educate readers. Please be aware, however, that individualized therapy may dictate different approaches for specific patients that can differ from what is written here. That is why it must be emphasized that consulting with Dr. Altman, or any other expert in the areas of menopause, hormonal therapy or sexual dysfunction, is the only way to receive the appropriate individualized care that each and every patient deserves.
Natural Hormonal Therapy
Do all pharmaceutically produced hormones come from pregnant mare’s urine?
Answer: The answer to this question is absolutely “NO”. The only pharmaceutical, hormonal, post- menopausal products that come from pregnant mare’s urine are the brands of pills called Premarin, and Prempro (which is a combination of Premarin and a synthetic progesterone).
What are other hormonal products made from?
Answer: They come from plant-based material found in soy and yams. We can make natural bioidentical hormones from these sources. That includes estradiol, progesterone, cortisol and testosterone. Since these bioidentical hormones are “made” from these plant sources, we say they are “synthesized” from them. Made= synthesized. Hence, ALL bioidentical hormones are “synthetic” in spite of what you may read in the PR and advertising of natural hormone creams, etc. There is no such thing as “non-synthetic” hormones…at all! They all have to be produced…made…synthesized! You can obtain bioidentical estrogen and progesterone in many pharmaceutically produced products such as skin patches, gels, creams and vaginal rings, that are all FDA approved and usually covered by insurance. You can also get these bioidentical hormones made up by a compounding pharmacist in creams and tablets, but these are NOT FDA approved, so there is no quality control and no assurance that they contain what they claim to contain!
I have been told that natural progesterone cream is the best way to take progesterone.
Answer: Absolutely not. “Natural compounded” bioidentical progesterone cream does not absorb well enough through the skin to protect the lining of the uterus! And, after all, you take progesterone to protect the lining of the uterus from estrogen induced overgrowth that can increase the risk of uterine cancer. Progesterone protects against that increase and actually decreases the normal risk of uterine cancer. This is why, if you want to use natural progesterone, it should be taken by mouth…orally…to achieve uterine protection. That also means that if you don’t have a uterus, ie had a hysterectomy, you do not need to take any progesterone. There are “synthetic progestins” that act like progesterone and do protect the uterus. These progestins, called norethindrone and norgestrel, can be found in FDA approved patches combined with estrogen, but they are somewhat different from natural progesterone. This can be discussed personally in a consultation in far greater depth, but please understand, the bottom line is, progesterone creams rubbed on the skin are inadequate to protect the lining of the uterus.
Do I have to have my levels checked every month or every other month to figure out what my hormone medication should be?
Answer: A resounding no. You do not have to have this done at all! There are many practitioners, who prescribe compounded hormonal creams and base the dosage on blood or saliva levels taken monthly or every other month. This is expensive for the patient, as insurance frequently does not cover these tests…and well they shouldn’t! But it is generally unnecessary because there is NO DATA to say what these “levels” should be in a post menopausal woman. And, another important point; can you imagine all women walking around with the same blood or saliva levels???? That’s not individualized therapy! That’s “Stepford Wives” therapy!!! All women are different and have different hormonal needs. To make all women have the same levels, based on no data at all, is outrageously absurd!!! It’s anti-individualization of therapy. Every woman needs a different amount of hormone for her individual problems. That “niche” is different for each woman. We determine that niche clinically by a patient’s symptoms. We listen to her biology. She tells us what’s going on. And we respond as clinicians by altering the dose in order to modify her symptoms and to get rid of them. And that level is different for every woman. Some patients need just a little while some patients need a whole lot, and most patients need in between. But the canard of believing that every woman has to walk around with the same blood level is just an absurdity and you should not be fooled by this marketing tool!!! That does not mean we never draw any “levels”. Occasionally, these levels are necessary when the current hormonal dose is not having the desired effect and the clinician wants to raise the dose to a much higher level. We can find those patients who don’t absorb estrogen well through the skin and adjust the dosing accordingly.
Are saliva levels better than blood levels to determine what my hormonal needs are?
Salvia levels are marketed as being better than blood levels. The marketers claim that blood levels tell us how the hormones are being transported in the bloodstream, while saliva levels tell us the level of hormone in the tissue. The problem with this marketing logic is that there is no data whatsoever to correlate saliva levels with any other tissue! This means that saliva levels tell us the levels in saliva only! A better way to explain this is; if a salivary progesterone level is drawn, that level will tell us how well the uterus is being protected against uterine cancer only if that patient “spits into her uterus twice a day”!!! The level in the saliva tells us NOTHING about the level in the uterus where the protection is needed. So, please don’t depend on salvia testing.