The pendulum of hormone replacement
therapy (HRT) has been swinging madly during the past several years. It
is no wonder that so many patients are confused, since physicians are
also uncertain about what to recommend for various hormone problems.
Some, especially in the Family Practice and Internal Medicine
specialties have been peremptorily discontinuing HRT with no
regard to the ramifications for their patients.
For those who desire more information, click on this link:
to read the article by Dr. RD Gambrell in The Female Patient from
November 2004.
I won't attempt to solve this dilemma here or to convince anyone
of the benefits of HRT. The purpose of
this little dissertation is to provide information to my own patients
about a form of treatment that is available to them, if they fit into a
fairly narrow category of therapeutic need.
First, menopause is not a disease, but it is
a relative hormone deficiency state. The deficiency of estrogen
(and sometimes androgen), causes numerous manifestations - some
immediately noticeable to the patient, such as hot flushes, and others
that take years to manifest, such as osteoporosis.
It is usually the neuro-psychological problems that cause the
greatest distress to patients. These include hot flushes (incorrectly
called "flashes"), mood swings, depression, headaches, and
diminished libido (sex desire or enjoyment), among others.
Those women who prefer to avoid hormone therapy are invited to try
various over-the-counter preparations (OTC) such as black cohosh, soy
isoflavones, and various proprietary products such as Promensil,
Estroven, etc.
If these "herbal" products do not adequately relieve the
symptoms, it is usually fairly easy to administer small amounts of
estrogen in the form of tablets or patches. Both patients and
physician must be patient and persistent, because, in some cases, it is
necessary to work together over a number of months, to find the optimal
dose and method of administration that will alleviate most of the
problems.
Rarely (less than 1%) of the time, no satisfactory solution is
found. At that point, most general gynecologist throw up their
hands and say there is nothing else they can do. The
physician may even seem irritated or annoyed, and imply that the patient
is doing something wrong, or that she is just depressed.
(Antidepressants are frequently recommended in these cases)
Rest assured - you are not crazy. Your problems
are not in your head. They are just as real as the problem of
insulin deficiency to a diabetic or thyroid deficiency to someone with
an underactive thyroid.
But there is a solution to
your problems. Most general gynecologists are just too busy to
take the time it takes to talk to you and work with you to solve these
problems. Sadly, even many Reproductive Endocrinologists (RE)
may be so busy with lucrative IVF (test tube baby) programs that they
don't have time to waste on hot flushes.
The solution is to provide the hormone in a more natural form,
i.e. a form that mimics the way that the hormone was produced originally
- by your ovaries.
We place tiny pellets of pure crystalline estradiol 17-ß
(estrogen) and/or testosterone (androgen) - both identical to the
natural hormones - under the skin of the abdomen or the hip. Then,
over a period of 3 to 6 months, the pellet slowly dissolves and releases
its hormone directly into the blood stream, completely eliminating
problems of intestinal absorption or rapid inactivation (first pass) by the liver.
For patients who have failed all other therapy and find it
necessary to resort to this route of administration, over 90% find
blessed relief. Many patients tell me that the pellets are like a
miracle sent to them.
The sad truth is that the pellets have been available
for over 60
years, but are still grossly underutilized.
First tested by Bishop (1) in London in 1938,
Greenblatt (2,3) introduced both estradiol and testosterone pellets into
clinical practice in the US in the 1940's. At one time they were "FDA
approved". Now only the testosterone is
"approved" for male problems. However, the estrogen
pellets are available from special "compounding" pharmacies
which use USP
ingredients in very expensive sterile compounding facilities. All
USP medications are manufactured under the aegis of the FDA by authority
of the FDCA
(Food Drug and Cosmetics Act).
1. Bishop PMF: A clinical experiment in oestrin
therapy. Br Med J 1938; 1:939
2. Greenblatt RB, Hair LQ: Testosterone propionate
pellet absorption in the female. J Clin Edocrinol 1942; 2:215
3. Greenblatt RB, Suran RR: Indications for hormone
pellets in the therapy of endocrine and gynecological disorders.
Am J Obstet Gynecol 1949; 57:294
NB: As a medical student I studied briefly with Dr.
Greenblatt, and later as a resident, with Dr. RD Gambrell (see above), arguably the
most distinguished of Dr. Greenblatt's "disciples".
Other Links: (I can't verify each specific claim made
by these sources, but they seem generally reasonable. I am willing to
discuss all issues and answer all questions, as best I can.
http://natureshormone.com/pellettherapy.htm
(They call them SottoPelle™)
http://members.aol.com/gambr999/hormone1.htm
http://www.mesobeauty.com/pellet-therapy_w.html
http://www.usdoctor.com/pellets.htm
This link contains an error: "Most" Medicare carriers will now
reimburse for pellets. Contact your carrier to be sure.
