What You Must Know and Document Before Prescribing Menopausal Hormones

by Neal Rouzier, MD.

November 2023

BHRT (bioidentical) VS SHRT (synthetic)

IMHO, there is no greater controversy, confusion, disagreement, misunderstanding, or cognitive dissonance in medicine that is as great as and more prevalent than for hormone replacement therapy (HRT). Each and every hormone has been somehow denigrated and maligned more so than any other treatment in medicine. It is amazing that relatively intelligent practitioners will not understand, grasp, embrace, and appreciate HRT. More so, despite all the evidence and literature to the contrary, clinicians will not have the insight that it takes to understand that HRT is not BHRT, apples are not oranges, E2 is not CEE, and P4 is not MPA, no matter how hard we think that they are the same. The medical literature well supports that SHRT is not BHRT. This concept becomes blurred when “experts” claim that there is no difference between SHRT and BHRT, and the harm of BHRT is the same as SHRT. However, these claims that BHRT is no better than SHRT, the risks and harm are the same, and ACOG/NAMS severely denigrate compounded BHRT are all driven by politics and economics. True, compounded BHRT is not FDA-approved and never will be studied or become FDA-approved. Nonetheless, no RCT with BHRT proves any harm or risk compared to SHRT. There are numerous studies, RCTs, and meta-analysis that prove no harm to E2 and P4. This is in contrast to the multiple studies proving harm, side effects, and complications to CEE and MPA. These comparative studies are published in OB/GYN journals but seemingly ignored by most clinicians that have a political or economic bias against the use of compounded BHRT.

Why is Progesterone so Misunderstood?

IMHO, I believe that micronized progesterone (P4) is the most misunderstood hormone of them all. Based on my > 25 years of researching BHRT and SHRT, I feel that the majority of physicians (not NPs or PAs) still think that MPA is P4, there is no difference between the two, they are both harmful when replaced, and both cause significant harm, side effects, complications, and should be avoided. And most problematic is the concept that if a menopausal patient does not have a uterus (from hysterectomy), then they don’t need P4 and thus should not take it, as if it is harmful somehow. It is my endeavor in this webinar series to prove that foregoing is completely wrong, P4 is safe and necessary whereas MPA is not safe and should be avoided at all costs. The best way to accomplish this is via the medial literature and studies. I have been criticized over the last 25 years for prescribing P4 to menopausal women that have had hysterectomies. A recent paper published in “Menopause” stated that most OB/GYN residents are taught little to nothing about hormone replacement during their residencies. So, the one specialty that should know the most about hormones and should be the experts in hormone replacement, are the ones that are taught the least. All hormones have health benefits, and those benefits are lost when the hormones are lost. Every study demonstrates benefit when E2 and P4 are replaced. There are many benefits to replacing P4 other than protecting the uterus.

Educate your Patients

Whenever patients respond that their PMD’s criticize me prescribing P4 for them, I simply respond with a stack of medical literature demonstrating the benefits of replacing P4. In addition, I explain the reason that they sleep so much better, and feel so much better, is due to the P4. I thus advise the patient: If you don’t want to sleep better and feel better, then don’t take P4. If you don’t want to protect against breast cancer, heart disease, or bone loss, then don’t take P4. If you don’t want to protect your brain against cognitive decline and memory loss, then don’t take P4.  And if your doctor does not want to protect you against the foregoing, then you should switch doctors to someone who understands the benefit of replacing and optimizing your hormones. This webinar is a continuation of the many studies demonstrating the protective and beneficial effects of replacing micronized progesterone to all patients.

Respectfully,

Neal