Dr. Marcia A. Harris, holistic gynecologist at Patients Medical explains why bio-identical hormones are WAY better for you than synthetic hormones and how pellet therapy can provide a more stable and convenient method of delivering the hormones to your body than pills or creams.
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Focus on the root cause
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12. Received MD from Columbia University College of
Physicians and Surgeons
Awarded the Rudin Scholarship
Internship in Internal Medicine at Harlem Hospital Center
Residency in Obstetrics and Gynecology at NY
Hospital, Weill Cornell
Post-Graduate training at the American Academy of Anti-
Aging Medicine (A4M)
37 years’ experience
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16. Progesterone, Estrogen and Testosterone
Have over 400 functions in the body
When lacking, cause previous symptoms and
subsequent disease
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17. 1st uniquely female hormone
Considered the main female
hormone
Xenoestrogens-Man made
estrogen
Phytoestrogens-Plant estrogen
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18. Type of Estrogen Name
E1 Estrone
• Made in fat tissue
• Holds cancer-causing properties
E2 Estradiol
• Made by the ovary
• Active: relieves symptoms
E3 Estriol
• Highest amount in pregnancy
• Weak estrogen
• Not much help with symptoms
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20. Regrowth of menstrual tissue
Growth of follicle into an egg
Growth of breast
Support vaginal tissue
Develop sex characteristics
STORES FAT!
Decreases thyroid hormone
20
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21. Breast tenderness
Depression
Fatigue
Poor concentration
Endometriosis
Fibrocystic breasts
PMS
Fibroids
Water retention and bloating
Fat gain around hips and thighs
Breast and Uterine Cancer
21
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22. 2nd uniquely female hormone
Made by the ovary after
ovulation
Can be made from wild
yam and soy beans
Provera and
Depo Provera - Are not
progesterone
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23. Pro-Gestation
Promote development of the fertilized egg
Natural Diuretic
Uses fat for energy
Natural antidepressant (calming effect)
Restores sex drive
Promotes regular sleep patterns
Protects against cancer
Balances Estrogen (growth)
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24. Breast tenderness
Depression
Fatigue
Poor concentration
Endometriosis
Fibrocystic breasts
PMS
Fibroids
Water retention and bloating
Fat gain around hips and thighs
Breast and Uterine Cancer
24
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27. As you age, the ovaries produce less estrogen
hormones
Puberty Turbulence
The Reproductive Years
Estrogen, progesterone, testosterone are in optimum
balance
High energy
Strong sex drive!
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28. Peri-menopause is associated
with estrogen dominance.
Increased PMS Mood swings
Breast swelling Depression
Headaches Fluid retention
Decreased sex drive Fibroids
Weight gain FCBD
Foggy thinking Migraine headaches
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29. Permanent cessation of menstruation
Caused by decreased production of ovarian
hormones
Most commonly occurs between ages 48-52
It’s not a disease, but a natural transition
from one life cycle to another
Progesterone falls disproportionately greater
This creates estrogen dominance
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30. Mood Swings Decreased Sex Drive
Depression Erectile Dysfunction
Panic Attacks Vaginal Dryness
Irritability Painful Intercourse
Bloating Irregular Cycles
Indigestion Palpitations
Gas Dizzy Spells
Brain Fog Insomnia
Difficulty Focusing Difficulty Sleeping
Osteoporosis Night Sweats
Varicose Veins Hot Flashes
Lower Back Pain Urinary Leakage
Body Aches Crawly Skin
Chronic Fatigue Thinning Hair
Weight Gain Facial Hair (in women)
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31. Menopause is NOT an estrogen deficiency
condition
External estrogen exposure is unchanged
Hot flashes diminish in 2-5 years
Rx with natural progesterone is effective in
60% of menopausal women
Doesn’t have the advantages of exogenous
replacement
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32. In the 1930’s several significant things
happened
Adolph Friedrich Johann Butenandt won the
Nobel Prize for isolating the sex hormone (1939)
Schering Pharmaceuticals (who sponsored his
work) introduced
Progynum (synthetic estrogen)
Prolutum (synthetic progesterone)
Testorion (synthetic testosterone)
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33. 1938: Diethyl Stilbesterol (synthetic Estrogen)
Given to pregnant women to prevent
miscarriage
9 out of 10 daughters of women who took DES
had genetic abnormalities
5 out of 10 were never able to conceive
2 out of 10 had rare Adeno Carcinoma of the
reproductive system and testicular cancer in
males
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34. 1941 Study: Journal of Cancer Research –
Estrogen is a very important factor in Uterine
Carcinogenesis
1942: Ayerst (Now Wyeth) put Premarin on
the market
Pregnant
Mares’ Premarin!
Urine
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36. 1970’s Premarin – Gold Standard
1971: FDA revokes approval of DES
1975: Studies Endometrial Cancer Black Box
Warning
Unopposed estrogen = Cancer
Progestin: to oppose the estrogen
No safer, actually more dangerous but for 20
years they reigned supreme!
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37. 1993-1998 by the NIH
17,000 healthy women
55-79 years old
All had uterus
Prevention of heart disease and hip fracture
Re: Breast and Colon Cancer
Not designed to address benefits for
treatment of menopausal symptoms
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39. Used conjugated equine estrogen (CCE) with
50% E1, E2, no E3 and 40% equine estrogen.
They also used medroxyprogesterone
Acetate (MPA).
The Premarin only arm showed a decreased
risk in hip fracture and colon cancer.
15 JAMA 2004: 291: 1701-1712
15 JAMA 01-2000, 283:485-491
36 Cancer 2003; 97: 1387-1392
J Natl. Cancer Inst. 92 (4): 328-332, 2000
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40. 2002 – stopped study
35% initially enrolled, but dropped out
20% dropped out due to side effects or fear
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41. The Prempro Arm was halted 22% Increase in total CV Disease
July 9, 2002, three years early 26% Increase in Breast Cancer
due to increased breast 29% Increase in Heart Attacks
cancer and cardiovascular 33% Decrease in Hip Fractures
disease in women. 37% Decrease in Colorectal Cancer
41% Increase in Strokes
60% Leg blood clot
JAMA 7/17/2002 Vol. 288, 3
200% Alzheimer’s ,Dementia
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42. 54% Ovarian Cancer with Prempro
43% Ovarian Cancer with Estrogen alone
No improvement in most quality of life issues
Sleep
Hormonal health
Sexual health
Did relieve
Night sweats
Hot flashes
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43. Herbal remedies
Phytoestrogens:
▪ Black Cohash
▪ St. John’s Wort
▪ Dong Quai
▪ Dietary Soy
▪ Evening Primrose
▪ Flax Seed
▪ Wild Yam
Can help relieve symptoms, but do little to fix the problem….
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44. Biochemically, the body is not set up to convert
plant hormones into bio-identical human
molecular structures from raw botanicals
(although natural the body does not recognize
and can’t use these efficiently).
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45. BHRT
Clinically proven
Safe
Effective
Replaces hormone deficiency
Biochemically resolve the problem at the cellular
level
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46. Uses hormones made from soy
and wild yam
Biologically identical in chemical
structure to the hormones
synthesized in our bodies
Overwhelming research that using
bio-identical hormones to treat
menopause and andropause has
fewer side effects than synthetics
and gives the best results!
Perfectly safe!
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47. A molecular structure that occurs in nature
cannot be patented.
The Keys that Fit!
Relative
Binding
Affinity
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48. BHRT: RBA 100%
At a cellular level, the body
Recognizes
Accepts
and Uses
…BHRT just as it would human hormones.
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50. What is synthetic?
“Patented” or “Conventional” or “Artificial”
Usually not found in nature or at least not in
humans
Chemically altered form of human hormone
Not identical in structure or activity to natural
hormones they try to emulate
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51. Dictates how the hormone is
metabolized and what bi-products result
Changes in the position of even one
substituent can lead to inactive isomers
Speroff 2005 pg 28
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52. Are very different in molecular structure and function from
Bio-Identical Estrogens Progesterone and Methyl Testosterone.
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53. Natural Hormones are Bio-
Equivalent, also known as Bio-
Identical.
Patches
Creams
Gels
Sprays
Pellets
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54. Peak and Trough daily has
liver bypass therefore
increasing clotting factors
CEE has higher conversion
to 16OH Estrone which has a
higher conversion rate to
Quinones.
Oral Testosterone is
Methyltestosterone which
can be liver toxic
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55. Can be administered through patches, gels, sprays or creams
No liver bypass so they have the benefit of no increased clotting
factors and therefore decreased CV risk
Gels, Sprays, and Creams peak and trough daily
Patches Peak and Trough bi-weekly or weekly depending on the
preparation
Must remember to rub it in daily
Risk contamination with gym equipment, spouse or kids
Timing: have to wait to get dressed and use after showering only
Gels are alcohol based and lose some of active hormone when
alcohol evaporates (including androgel for men)
Transdermal preparations loose efficacy over time due to
saturation of skin receptors and this usually occurs after about 1
to 3 years N Engl J Med 1997; 336-683-690
J Clin Endocrin Metab 2001; 86:3629-3644
Lancet 2003; 362:428-432
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56. Estradiol levels are better than pills but still
get peak and troughs
Maintains E2-E1 ratio of 1:1
Adhesive problem very common maintains
Need to change 2 times per week or weekly
Transdermal estrogen has no effect on liver
synthesis of proteins or binding proteins and
therefore no effect on clotting factors.
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57. Good symptom relief
Some are toxic
Weekly or monthly Peaks & Troughs….
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58. PELLET THERAPY (Subcutaneous Implants)
Discovered in 1935 In Europe, original studies done in
1939 by Dr. Greenblatt at the University of Georgia on
hysterectomized women.
No liver bypass so no increased clotting factors and
therefore decreased CV risk.
No Peak and Trough effects so delivers daily customized
doses and subsequent significantly different in symptom
relief due to customized dosing.
Downside is breakthrough bleeding in non-
hysterectomized women when progesterone levels are
not physiologic.
www.patientsmedical.com
59. No roller coaster effect (i.e. no peaks and valleys)
Keep E2-E1 ration at 2-1
which is physiologic
24/7 availability of
hormones to the body
(This may last for 3-8
month at a time ).
Adapts to the daily needs
of the body.
The difference in relief of
symptoms is night and day
compared to other form of
BHRT
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60. Rate in 2001 was 7%
WHI Study was halted because they saw an
INCREASE of 8%
So more than doubled your risk!!!
# at 7% = 7/100 → 17,000 (in study) → 1190
8% incr. = 8/100 → 17,000 → 1360
2550
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61. Arizona Study – 976 Women
# at 7% = 7/100 → 976 (in study) → 70
8% incr. = 8/100 → 976 → 80
150
There was only ONE breast cancer in the group!
Similar statistics for Endometrial Cancer.
ALMOST appears to be protective.
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62. Definitely “cardio sparing” (protects the
heart)
“Bone sparing” (protects the bone
Does NOT increase dementia
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63. Bio-identical is misleading (the chemical
structure is not exactly the same)
No BHRT has met federal standards for
approval
Prometrium (approved in 1998)
Estrogel (approved in 2004)
BHRT is unregulated
Made from FDA and USP registered materials
Is regulated by state boards of pharmacy
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64. The day of one size fits all hormone
replacement regimen used in
traditional medicine is over
Bio-identical HRT allows for custom
balancing hormones based on the
individual patient.
No two persons have the same
genetic make up, medical history,
symptom environment or nutrition.
Custom dosing is clearly appropriate
and most advantageous!
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65. Natural decrease in male hormones
Starts as early as late 20’s
Very gradual, so not as dramatic (1-2% per year)
Weight gain (especially belly fat)
Lifestyle-related
Fatigue - can be debilitating
Urinary problems
Depression, brain fog/anxiety
Decrease in physical agility
Decreased libido/erectile dysfunction
May be related to “mid-life” crisis behavior
Must replace testosterone and DHEA
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66. Money: Big pharma
Most MD’s only know what the drug rep tells
them (actual studies in the 80’s)
Managed care environment
Dr. Phil, Oprah, Dr. Oz and Suzanne Somers
Ageless
The Sexy Years
Breakthrough
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73. Stress Incontinence:
Why it Happens and How to Reverse it
Dr. Harris will explain how this uncomfortable and
embarrassing condition can be treated without dangerous
drugs or surgery.
Wednesday, April 3rd at 6:30pm
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74. Spring Cleaning: Easy and Delicious Detox
Dr. Vivian DeNise explains why everyone needs to
detox and healthy chef, Elisa Haggarty will show
you how easy and tasty it can be!
Tuesday, April 9th at 6:30pm
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75. Get Fit for Spring with the HCG Diet
Dr. Harris demystifies the secret of the HCG Diet and why
there is so much buzz around it. Learn how you can safely and
effectively lose the weight and keep it off!
Wednesday, April 10th at 6:30pm
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76. Just for MEN: Boost Your Mojo Naturally
Dr. DeNise and Nutritionist/Personal Trainer, Judy Penta
explain how to improve your focus, physique, libido and
energy without dangerous OTC or prescription drugs.
Tuesday, April 23rd at 6:30pm
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77. Come See Our Holistic Ophthalmologist
Dr. Ayman Matta will be seeing patients on
Friday, March 22nd in the afternoon.
See one of our staff members for details and scheduling.
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78. Dr. Rashmi Gulati, Dr. Kamau Kokayi, Dr. Marcia A. Harris
Dr. Stuart Weg, Dr. Vivan
Medical Director Holistic and Chinese Holistic GYN and
Alternative Pain DeNise, Integrative
Medicine Internal Medicine
Management Internal Medicine and
Peds
Dr. Eileen DiFrancesco Dr. Paul A. Dreschnack Dr. Victor I. Rosenberg
Dr. Gino Bottino Dr. L. Deanna Howard
Psychopharmacology Plastic Surgery Plastic Surgery
Holistic Oncology Holistic GYN
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