Use your Migraine.com account
Log in with Facebook
Log in with Google
Log in with Yahoo!
I am tired of women patients and medical colleagues claiming that bio-identical hormones are the kind that have to be made at a “compounding pharmacy” and claiming this type of hormone preparation is the best as it is “natural” and the dose can be tailored to just what a woman needs. Often saliva testing is recommended to check the hormone levels both before prescribing and then during therapy to monitor and then make adjustments to the dose.
I say “Give me a break”! Where is the proof that these products are better (or safer) than bio-identical products that are available by pharmaceutical companies? The term bio-identical has been misinterpreted and misused in recent years. Bio-identical simply refers to the fact that what is being taken is the same as what your own body produces. In the case of hormone therapy for women, we are often referring to estrogen and progesterone when we use the term bio-identical.
Estradiol is the most active and often considered the most important estrogen for women when looking at what our own ovaries produce. During times of estrogen lowering such as menses, post-partum, perimenopause, and menopause, the lower level of estradiol is the main trigger for hormonal migraines that often occur during these times. This level can be raised by giving an estradiol patch such as the Vivelle dot or Climara (name brand estradiol products). This treatment approach is often referred to as “add back estrogen” and is especially ideal when contraception Is not needed or not indicated but a hormonal approach still makes sense given the hormonal trigger for these migraines.
Estradiol comes in patches, gels, sprays and lotions; it can also be inserted as a pellet. These products are all bio-identical and DO NOT NEED TO BE COMPOUNDED OR MADE BY A COMPOUNDING PHARMACY. Since they are made by pharmaceutical companies, they are usually covered by insurance and readily available. As a physician, I know exactly what I am prescribing and can adjust the dose to meet a woman’s needs. There is a lot of flexibility in dosages and preparations. Occasionally, I may order an estradiol level to check a woman’s level if we are unsure whether to go up or down on the dose; however, I usually adjust the dose by how she is feeling and what is happening with her migraines. I order testing by blood and not saliva. I do not feel saliva is a valid measurement of hormone levels and is often hard to interpret. I know many may disagree but that is my opinion. I am also tired of women or compounding pharmacies ordering the saliva testing and then wanting my help in interpreting these results! If a woman or pharmacist orders saliva testing, then let them interpret and figure it out!
Progesterone, also produced by a woman’s own ovaries, is available in a bio-identical product called Prometrium (micronized natural progesterone). It is available as a 100 mg and 200 mg dose and is readily available in pharmacies and usually covered by insurance. I do not see a need for most women to have a compounded progesterone product made up for them. Occasionally, I have women who cannot tolerate Prometrium and we may use a compounded pharmacy to make up a progesterone cream. There are many progesterone creams available over the counter.
Do I ever prescribe a product like Triestrogen/Progesterone or Biestrogen/Progesterone for women in my practice with migraine and hormonal issues? Yes and in a few cases, these women truly feel this is the best way for them to take hormones. I am OK with this but feel it is important to offer these women pharmaceutical bio-identical products such as the Vivelle dot and Prometrium as alternatives to compounded hormones.
I am curious: how many of you feel compounded hormone preparations have worked better for you, including for your migraines, than bio-identical estradiol & progesterone pharmaceutical products like Vivelle dot and Prometrium?
Did you enjoy this article?
Read more just like it! Subscribe to the Migraine.com weekly and receive the latest migraine news and headlines, right in your inbox.
Discuss
Comment using either your Migraine.com or Facebook account. Please select the appropriate tab:
"I had my first migraine when I was 12. I thought I was going blind, the spots in my vision all grouped together and everything went black. The pain was intense and felt like my head would crack open above my right eye." 
Do you have migraines or tension-type headaches 15 or more days a month? Get the information and tools you need.
Download the free Migraine.com app for your phone and access your journal, headlines and more.
I looked at the wording in the package insert for Vivelle dot brand name and it described the patch as a “multipolymeric adhesive” and there was no mention of the the word Latex. From my experience, very few women have complained of skin sensitivity to the name brand Vivelle dot patches unlike the generic substitutions. The Gabapentin should be compatible with the other medications you are taking but check with your health care provider or pharmacist to be sure. The most common side-effect of Gabapentin is sedation.
Thanks for the reply Dr Hutchinson. Just some clarifying questions if you don’t mind.
The irritation to the vivelle dot was on a generic, and looked to be related to an emerging allergy to latex. Is the name brand latex free?
I am currently taking the oral estrace once a day, so I will definately ask my doctor about increasing to twice a day.
My doctor had actually enrolled in a Gabapentin study for hot flashes, but when I was diagnosed with uveitis I was disqualified from the study. I am still interested in trying it though, or maybe one of the others you mentioned. I am just not sure how they would mix with my other medications. In addition to the estradiol, I take meloxicam for the auto-immune inflamation and imipramine as a migraine prophylactic. Is there a concern with mixing those with any of the medications you mentioned above?
Here are my comments after reading the 2 experiences that WildZan and Julie have reported: I don’t like Premarin which is made from “pregnant mares” as Wildzan is aware. Oral Estrace is estradiol and “bio-identical” but may be better dosed as twice a day as the once a day dosing may not give an even estrogen level over a 24 hour period; the uneven estrogen level could aggravate migraines. As for irritation from the Vivelle patch, I recommend always asking for name-brand. Getting a generic (often larger size) is often more irritating to the skin than the name brand. Even if mild irritation from a name-brand patch such as Vivelle occurs, then spraying with a steroid spray over the skin surface prior to applying the patch can cut down on skin irritation; for this, I often give my patients some samples of a nasal steroid spray such as Flonase or Nasacort. Alternatives to estrogen to help hot flashes and night sweats include Effexor, Prozac and the beta-blockers such as Inderal. The Clonidine patch and Gabapentin have also been found helpful in reducing hot flashes.
I have heard about these bio-identical hormones made at a compounding pharmacy, and had thought about trying them. I am not a typical post-menopausal, because I had a surgical menopause at 35. For a while I was on the typical Premarin, but I got off of it as quickly as I could for two reasons: 1) I am a horse owner and lover, and have worked with too many rescue organizations that deal with discarded mares and foals from PMU farms. 2) My mother had just completed treatment for an estrogen-fed breast cancer and my doctor felt that having me on HRT for more than a few years could be risky.
The only difficulties I really faced with not being on HRT was hot flashes. Really nasty, severe, miserable hot flashes. The kind that wake you up in the middle of the night dripping sweat, ruin make up in the blink of an eye, and can seriously dampen (literally!) your success at work because it is hard to have your presentation taken seriously when you have sweat rolling down your forehead. I have tried so many different things that people recommended, from black cohosh supplements to phyto-estrogen creams and nothing helped. Which is how I ended up thinking about trying the bio-identicals…
I tried the Vivelle dot, which worked for about a month, but then I started breaking out from the patches. Currently I am taking Estrace, which does help, but doesn’t stop the flashes completely. I do NOT want to have to start taking Premarin again, what other options do I have?
This is a very interesting post to me, as I had saliva testing done by a friend who is a pharmacist whose family owns a compounding pharmacy and has built quite a business in my area specializing in bio-identical HRT. I have been following a treatment plan based on those results for about 6 months. Then just this week I had an appointment with an endocrinologist who felt very similar to you about compounding pharmacies/saliva testing/compounded bio-identical HRT treatments. I will have blood tests in his office next week, after not taking the compounded supplements for a week, so that the endocrinologist can check the accuracy of the saliva tests.
In my case, I was having severe insomnia and disrupted sleep cycle issues along with chronic, debilitating migraines. Part of what was tested and found to be way out of balance with me were my cortisol levels that assist with regulating my internal clock. I do think that the “medications”–I never know what to call them–that I take from the compounding pharmacy have helped me sleep on a more normal schedule, and resting better has helped my migraines. I don’t wake up with as many migraines now. So–take that for what it’s worth. That’s not really dealing with the estrogen/progesterone question you are talking about. I haven’t been retested (by the pharmacy) so I don’t know if the treatments to bring my elevated estrogen levels down were effective and if that also caused decreased migraines, but I primarily attribute waking up with fewer migraines to sleeping so much better.
I find it interesting you posted this this week when I had such an interesting conversation with my doctor about this subject. I will be watching to see if anyone else comes along to post their experiences.