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Tuesday, October 1, 2013
HRT Risks May Vary by Type of Estrogen Drug Published: Sep 30, 2013 | Updated: Oct 1, 2013
Conjugated Equine Estrogens (CEE, Premarin, Cenestin) have numerous drawbacks. 1. You need to abuse horses to manufacture the product (horses made pregnant; left in stalls all day/night with a foley catheter to collect urine; antibiotics to prevent infection; and their foals often starve as it isn't cost effective to feed them and raise them as horses). 2. CEE, compared to bioidentical estradiol (which is available as an FDA approved medicine), causes thromboembolic events. This is similar to progestins (Medoxyprogesterone (Provera) causes more cancer, heart attacks and osteoporosis compared to bioidentical progesterone (Prometrium)). 3. CEE often costs more than bioidentical estradiol (Premarin is not AB rated and is not generically substituted, but there are inexpensive generic estradiol creams. Since bioidentical estradiol and progesterone work better (not just less hot flashes, but less insomnia, anxiety, osteoporosis, etc), are less toxic (especially when estrogen is applied topically vs. orally), and less expensive, the case could be made that it would be below the standard of care to prescribe CEE/Medoxyprogesterone before at least attempting a trial of topical estradiol +/- topical/oral progesterone.
As natural progesterone is only available as 100 mg and 200 mg capsules (Prometrium), many patients need compounded forms (e.g. an in-between dose of 150 mg to get benefit without side effects of breast tenderness or excessive sedation, compounded drugs need to be used.
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Conjugated Equine Estrogens (CEE, Premarin, Cenestin) have numerous drawbacks. 1. You need to abuse horses to manufacture the product (horses made pregnant; left in stalls all day/night with a foley catheter to collect urine; antibiotics to prevent infection; and their foals often starve as it isn't cost effective to feed them and raise them as horses). 2. CEE, compared to bioidentical estradiol (which is available as an FDA approved medicine), causes thromboembolic events. This is similar to progestins (Medoxyprogesterone (Provera) causes more cancer, heart attacks and osteoporosis compared to bioidentical progesterone (Prometrium)). 3. CEE often costs more than bioidentical estradiol (Premarin is not AB rated and is not generically substituted, but there are inexpensive generic estradiol creams. Since bioidentical estradiol and progesterone work better (not just less hot flashes, but less insomnia, anxiety, osteoporosis, etc), are less toxic (especially when estrogen is applied topically vs. orally), and less expensive, the case could be made that it would be below the standard of care to prescribe CEE/Medoxyprogesterone before at least attempting a trial of topical estradiol +/- topical/oral progesterone.
As natural progesterone is only available as 100 mg and 200 mg capsules (Prometrium), many patients need compounded forms (e.g. an in-between dose of 150 mg to get benefit without side effects of breast tenderness or excessive sedation, compounded drugs need to be used.
Kenneth Woliner, MD
www.holisticfamilymed.com
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