Nope, not at all the same. These are hormones to replace women's natural estrogen/progestin that decreases w/ menopause.
Why Oprah Likes Bio-identical Hormones
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Nope, not at all the same. These are hormones to replace women's natural estrogen/progestin that decreases w/ menopause.
Really? What CPT and dx codes would you use?
It wouldn't be covered if you coded it properly and interest in BHT was the sole purpose of the visit. And if it was an add on that aspect of the exam would not be covered -- ie, you might be venturing into 99214 and documentation of covered services would only justify a 99212 or 3. A fifteen minute appointment becomes a half hour. Insurance companies do not cover the services because peer reviewed studies have shown no difference in outcome between classic HRT and BHT, and as we all know HRT has been linked to increased incidence of breast cancer and heart disease. No insurance company will cover the therapy because they don't want to repeat the mistakes of HRT by approving it before it can be properly studied and proven not to cause similar side effects.
All insurance coverage is dictated by the standard of care, and BHT is too new to be the standard of care. That doesn't mean it doesn't work, or that the benefits might not outweigh the risks in many cases, but it does mean that it won't be covered. It's the same principle as when an insurance company denies a pelvic ultrasound for one woman if the ICD9 indicates the study was done because of infertility, but pays for the same procedure when the doctor is trying to diagnose a suspected fibroid.
If you consult with your doctor about HRT in general, evaluate your hormone levels (blood tests, etc), cover all your options (and there are many, including Bio HRT), and make a decision with your doctor about which course of HRT would work best for you... insurance does cover all this, at least in my case. plus, much follow up is needed to measure hormone levels, adjust therapies, and minimize any risks associated with HRT.
I have not made the jump to Bio yet so I haven't dealt with insurance on bio testing and prescribing (no doubt that will be at my own cost), but so far all of my HRT doctor visits and testing are covered, and I've learned about all my options in the process. I know that I can make that jump whenever I am ready, and my doctor will support and guide me along the way. As far as insurance, that is not really a concern. and if you are hitting my age or beyond, you'll know what I mean. Primary concerns are finding the right doc and getting the right health care that works for you, balancing health and risk as best you can.
What I have found interesting and challenging is that a woman really has to be willing to do her own work as far as researching her options, with a good doctor's guidance. I am happy that Oprah is bringing this important women's health issue to the forefront (it actually concerns men as well). It is an issue discussed frequently by Dr. Northrup and other leading women's health docs, but not really mainstream unless you live in a very progressive area of the country where anti-aging medicine is all the rage. and an unfortunate association for HRT, because most of us regular folks aren't interested in "anti-aging". I do not want a face life or lipo or poofy lips. okay, I like facials. But, aging is life and it happens.
I have found that this subject is NOT all about menopause and its symptoms. the symptoms tend to make you move your ass to the doctor to check out treatment, but it is really about maintaining optimal physical and mental health as you age. for many women, relief of symptoms is a very nice side effect though - and in some cases a true life saver. I had not realized that many women (and men) experience hormone imbalances (early or later in life) and so much of their health can be effected if not treated. Many of these imbalances go undetected and patients are prescribed anti-depressants or other unnecessary/unrelated drugs.
yes BOBBY J - men can certainly have hormone imbalances (some age related) and also receive various HRTs.
The Oprah Winfrey Show / Jan 29 / Suzanne Somers: The Bioidentical Hormone Follow-Up
Tune In
She's been met with relentless controversy…but to a whole lot of women, she is a savior. Why Suzanne Somers refuses to keep quiet on the hormone debate.
Tune in on 01/29 to watch this show
I have not made the jump to Bio yet so I haven't dealt with insurance on bio testing and prescribing (no doubt that will be at my own cost), but so far all of my HRT doctor visits and testing are covered, and I've learned about all my options in the process. I know that I can make that jump whenever I am ready, and my doctor will support and guide me along the way. As far as insurance, that is not really a concern. and if you are hitting my age or beyond, you'll know what I mean. Primary concerns are finding the right doc and getting the right health care that works for you, balancing health and risk as best you can.
What I have found interesting and challenging is that a woman really has to be willing to do her own work as far as researching her options, with a good doctor's guidance. I am happy that Oprah is bringing this important women's health issue to the forefront (it actually concerns men as well). It is an issue discussed frequently by Dr. Northrup and other leading women's health docs, but not really mainstream unless you live in a very progressive area of the country where anti-aging medicine is all the rage. and an unfortunate association for HRT, because most of us regular folks aren't interested in "anti-aging". I do not want a face life or lipo or poofy lips. okay, I like facials. But, aging is life and it happens.
I have found that this subject is NOT all about menopause and its symptoms. the symptoms tend to make you move your ass to the doctor to check out treatment, but it is really about maintaining optimal physical and mental health as you age. for many women, relief of symptoms is a very nice side effect though - and in some cases a true life saver. I had not realized that many women (and men) experience hormone imbalances (early or later in life) and so much of their health can be effected if not treated. Many of these imbalances go undetected and patients are prescribed anti-depressants or other unnecessary/unrelated drugs.
yes BOBBY J - men can certainly have hormone imbalances (some age related) and also receive various HRTs.
The Oprah Winfrey Show / Jan 29 / Suzanne Somers: The Bioidentical Hormone Follow-Up
Tune In
She's been met with relentless controversy…but to a whole lot of women, she is a savior. Why Suzanne Somers refuses to keep quiet on the hormone debate.
Tune in on 01/29 to watch this show
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HGH can increase a man's testosterone as he ages. I thought there was a correlation.
thank you Dr Bawa!
I enjoyed Dr. Bawa's seminar yesterday. He will be announcing upcoming seminars soon.
btw, I learned that insurance does pay for much in the way of bioidentical HRT: hormone levels evaluation and prescribed treatment/BHRT. filing and amounts covered depend on doctor and insurance.
I enjoyed Dr. Bawa's seminar yesterday. He will be announcing upcoming seminars soon.
btw, I learned that insurance does pay for much in the way of bioidentical HRT: hormone levels evaluation and prescribed treatment/BHRT. filing and amounts covered depend on doctor and insurance.
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Tonight at 9/8c on Oprah.com - Live Your Best Life is a live webcast with Dr. Christiane Northrup. You must register to participate.
the oprah show was very informative - did you catch it?
amazing the controversey surrounding Bios. the ob/gyn speaking out against bios and compounding pharmacies was really uptight I thought (needs HRT). and christian northrup and suzanne were both so gracious (they are on BHRT)
.no doubt there are some real concerns regarding BHRT, including online companies testing and prescribing for women they've never seen in person. plus there are compounding pharmacies not under standard regulatory control, etc.
these problems can and should be avoided with the help of the right doc.
I applaud the doctors and women who have made it their quest to push forward to identify the best and safest methods to preserve women's quality of health and life after age 35. The more I read and watch and listen, the more apparent it seems that balanced hormones is one very important part of the puzzle.
the oprah show was very informative - did you catch it?
amazing the controversey surrounding Bios. the ob/gyn speaking out against bios and compounding pharmacies was really uptight I thought (needs HRT). and christian northrup and suzanne were both so gracious (they are on BHRT)
no doubt there are some real concerns regarding BHRT, including online companies testing and prescribing for women they've never seen in person. plus there are compounding pharmacies not under standard regulatory control, etc.
these problems can and should be avoided with the help of the right doc.
I applaud the doctors and women who have made it their quest to push forward to identify the best and safest methods to preserve women's quality of health and life after age 35. The more I read and watch and listen, the more apparent it seems that balanced hormones is one very important part of the puzzle.
Only the last 10 minutes. I've read a couple of Suzanne Somers' books, and she does cite reputable research and docs in them. I am wary of doctors are see no alternative to synthetic pharmaceuticals. Bio-identical by definition makes much more sense to me. I know from experience that they really do work.
Here is a nice read for those interested in hormone replacement therapy from an unbiased source. 30-A S.A.
Another Look at Using Hormones to Treat Menopausal Symptoms
If your menopausal symptoms are interfering with your life, hormone treatments might be an option; to make an informed decision, discuss your personal situation with your clinician.
Remember the Women?s Health Initiative (WHI)? In that large study of women who used hormones (estrogen and progestin) after menopause, researchers found that hormone therapy for 5 to 7 years generally was more harmful than it was helpful. After this information was released, many clinicians (doctors, nurse practitioners, nurse midwives, and physician assistants) were reluctant to prescribe hormones for women experiencing menopausal symptoms, and women themselves were afraid to take hormones, even if their symptoms interfered with their lives. Knowing a few key terms (defined in Table 1) can help you to understand which information might apply to you.
View this table:
[in a new window]
Table 1. Menopause Terms
WHY RECONSIDER HORMONE THERAPY?
Estrogen is still the most effective treatment for hot flashes and vaginal dryness; therefore, researchers have continued to ask whether hormones are safe for certain women. The WHI revealed some important problems: More women using combination estrogen-progestin experienced heart attacks, blood clots, strokes, and breast cancers; and more women using estrogen alone developed blood clots and strokes than did comparable nonusers. The number of serious problems was small but real.
However, we now recognize that the safety of hormones is related to the age of the user. Most of the women in the WHI entered the study about 10 years after their periods had ended (older menopausal women). In contrast, most women who have severe menopausal symptoms are younger ? and the WHI participants who began HT soon after menopause were not more likely than were nonusers to develop heart disease or to die. In general, participants did not develop problems until they had used hormones for 5 years or longer. Therefore the study results probably do not apply to women who use hormones right around the time their periods stop and who use them for fewer than 5 years.
USING HORMONES TO RELIEVE SYMPTOMS
Although HT does not prevent heart disease or Alzheimer disease, it works very well for the most common symptoms of menopause. Estrogen used alone can cause abnormal changes in the uterine lining, so progestin is combined with estrogen to prevent these changes when the woman has a uterus. For women who have had hysterectomies (surgery to remove the uterus), estrogen can be used alone. Estrogen-progestin combinations and estrogen alone are available by prescription as pills, patches, gels, and sprays, as well as vaginal creams, tablets, and rings. All formulations are effective, and none has any clear advantage over the others for symptom control, so you usually can choose what you prefer. Using the lowest effective dose and continuing for the shortest time possible is recommended. Clinicians typically start by prescribing a low hormone dose and then increase the dose if necessary. For very severe symptoms, you might begin with a higher dose, which can be lowered when symptoms improve.
You might have heard about "bioidentical hormones," which are made up (compounded) for each individual woman. Although the idea might sound appealing, there is no scientific evidence that bioidentical hormones are any safer or more effective than preparations made by drug companies, and they do not have the same safeguards.
If you take estrogen plus progestin, you will probably have some irregular vaginal bleeding. This is an expected side effect and does not mean that anything is wrong. Be aware that hot flashes will probably return when you stop taking hormones, but often they are not as severe and eventually will improve.
If vaginal dryness or painful sex is your main problem, vaginal estrogen is highly effective and is available as tablets that you insert in your vagina twice weekly, a vaginal ring that you insert once every 3 months, or vaginal cream applied several times each week. Relatively little estrogen from these products is absorbed into the bloodstream, so they do not have the same risks as hormone tablets, gels, or patches.
You should not use estrogen if you have liver or heart disease, or if you have had blood clots in your legs or lungs, cancer of the breast or uterus, or a stroke. However, other treatments are available, and you should not hesitate to ask about them.
OTHER TREATMENTS FOR MENOPAUSAL SYMPTOMS
For women who cannot tolerate or prefer not to take hormones, other treatments include some types of antidepressants as well as certain prescription medications usually used for other medical problems.
"Natural remedies" (herbal and botanical products such as soy, black cohosh, red clover, and ginseng) are available without prescription. Few studies have addressed the safety and effectiveness of these products; be cautious about using them. The National Center for Complementary and Alternative Medicine advises against using kava, which can cause liver damage.
A WORD ABOUT DEPRESSION
Women often experience depression around the time of menopause. However, whether this is due to hormonal changes or to other circumstances ? or whether HT is effective for depression ? is unclear. Many good treatments for depression are available; if you are experiencing depression, seek help from your clinician, a community mental health center or hotline, or another healthcare professional as soon as possible.
TALKING WITH YOUR CLINICIAN ABOUT MENOPAUSAL HORMONE USE
If menopausal symptoms interfere with your quality of life, talk with your clinician. To ensure enough time for discussion, consider scheduling a visit separate from your annual check-up, and bring up the issue at the beginning of your appointment. Your clinician should consider your personal likelihood that hormone use might be harmful to you. For example, if you are at high risk for a heart attack or breast cancer because of your health or family history, you and your clinician might decide that estrogen?s possible risks outweigh its benefits. If you feel that hormones would be helpful but your clinician disagrees and cannot adequately explain why, consider a second opinion.
IN SUMMARY
Not all women have menopausal symptoms severe enough to make them consider treatment. If your symptoms are making you miserable, hormone therapy might be an option. Discuss your personal situation with your clinician and make an informed decision about whether hormonal or other treatment ? or no treatment ? makes the most sense for you.
Resources
National Center for Complementary and Alternative Medicine
http://nccam.nih.gov/health/menopauseandcam/
The North American Menopause Society (NAMS)
Hormone Therapy, Menopause | Expert Advice
Hormone Therapy in the Menopausal and Postmenopausal Years: What Should You Do?
(JW Womens Health Sep 5 2002)
What We?ve Learned from the Women?s Health Initiative
(JW Womens Health May 2 2006)
Manson JE with Bassuk SS. Hot Flashes, Hormones & Your Health. New York, NY: McGraw-Hill; 2007. Dr. Manson is coauthor of a Journal Watch Women?s Health feature article on hormone therapy (JW Womens Health Jul 31 2008).
? Diane E. Judge, APN/CNP
Published in Journal Watch Women's Health July 31, 2008
Another Look at Using Hormones to Treat Menopausal Symptoms
If your menopausal symptoms are interfering with your life, hormone treatments might be an option; to make an informed decision, discuss your personal situation with your clinician.
Remember the Women?s Health Initiative (WHI)? In that large study of women who used hormones (estrogen and progestin) after menopause, researchers found that hormone therapy for 5 to 7 years generally was more harmful than it was helpful. After this information was released, many clinicians (doctors, nurse practitioners, nurse midwives, and physician assistants) were reluctant to prescribe hormones for women experiencing menopausal symptoms, and women themselves were afraid to take hormones, even if their symptoms interfered with their lives. Knowing a few key terms (defined in Table 1) can help you to understand which information might apply to you.
View this table:
[in a new window]
Table 1. Menopause Terms
WHY RECONSIDER HORMONE THERAPY?
Estrogen is still the most effective treatment for hot flashes and vaginal dryness; therefore, researchers have continued to ask whether hormones are safe for certain women. The WHI revealed some important problems: More women using combination estrogen-progestin experienced heart attacks, blood clots, strokes, and breast cancers; and more women using estrogen alone developed blood clots and strokes than did comparable nonusers. The number of serious problems was small but real.
However, we now recognize that the safety of hormones is related to the age of the user. Most of the women in the WHI entered the study about 10 years after their periods had ended (older menopausal women). In contrast, most women who have severe menopausal symptoms are younger ? and the WHI participants who began HT soon after menopause were not more likely than were nonusers to develop heart disease or to die. In general, participants did not develop problems until they had used hormones for 5 years or longer. Therefore the study results probably do not apply to women who use hormones right around the time their periods stop and who use them for fewer than 5 years.
USING HORMONES TO RELIEVE SYMPTOMS
Although HT does not prevent heart disease or Alzheimer disease, it works very well for the most common symptoms of menopause. Estrogen used alone can cause abnormal changes in the uterine lining, so progestin is combined with estrogen to prevent these changes when the woman has a uterus. For women who have had hysterectomies (surgery to remove the uterus), estrogen can be used alone. Estrogen-progestin combinations and estrogen alone are available by prescription as pills, patches, gels, and sprays, as well as vaginal creams, tablets, and rings. All formulations are effective, and none has any clear advantage over the others for symptom control, so you usually can choose what you prefer. Using the lowest effective dose and continuing for the shortest time possible is recommended. Clinicians typically start by prescribing a low hormone dose and then increase the dose if necessary. For very severe symptoms, you might begin with a higher dose, which can be lowered when symptoms improve.
You might have heard about "bioidentical hormones," which are made up (compounded) for each individual woman. Although the idea might sound appealing, there is no scientific evidence that bioidentical hormones are any safer or more effective than preparations made by drug companies, and they do not have the same safeguards.
If you take estrogen plus progestin, you will probably have some irregular vaginal bleeding. This is an expected side effect and does not mean that anything is wrong. Be aware that hot flashes will probably return when you stop taking hormones, but often they are not as severe and eventually will improve.
If vaginal dryness or painful sex is your main problem, vaginal estrogen is highly effective and is available as tablets that you insert in your vagina twice weekly, a vaginal ring that you insert once every 3 months, or vaginal cream applied several times each week. Relatively little estrogen from these products is absorbed into the bloodstream, so they do not have the same risks as hormone tablets, gels, or patches.
You should not use estrogen if you have liver or heart disease, or if you have had blood clots in your legs or lungs, cancer of the breast or uterus, or a stroke. However, other treatments are available, and you should not hesitate to ask about them.
OTHER TREATMENTS FOR MENOPAUSAL SYMPTOMS
For women who cannot tolerate or prefer not to take hormones, other treatments include some types of antidepressants as well as certain prescription medications usually used for other medical problems.
"Natural remedies" (herbal and botanical products such as soy, black cohosh, red clover, and ginseng) are available without prescription. Few studies have addressed the safety and effectiveness of these products; be cautious about using them. The National Center for Complementary and Alternative Medicine advises against using kava, which can cause liver damage.
A WORD ABOUT DEPRESSION
Women often experience depression around the time of menopause. However, whether this is due to hormonal changes or to other circumstances ? or whether HT is effective for depression ? is unclear. Many good treatments for depression are available; if you are experiencing depression, seek help from your clinician, a community mental health center or hotline, or another healthcare professional as soon as possible.
TALKING WITH YOUR CLINICIAN ABOUT MENOPAUSAL HORMONE USE
If menopausal symptoms interfere with your quality of life, talk with your clinician. To ensure enough time for discussion, consider scheduling a visit separate from your annual check-up, and bring up the issue at the beginning of your appointment. Your clinician should consider your personal likelihood that hormone use might be harmful to you. For example, if you are at high risk for a heart attack or breast cancer because of your health or family history, you and your clinician might decide that estrogen?s possible risks outweigh its benefits. If you feel that hormones would be helpful but your clinician disagrees and cannot adequately explain why, consider a second opinion.
IN SUMMARY
Not all women have menopausal symptoms severe enough to make them consider treatment. If your symptoms are making you miserable, hormone therapy might be an option. Discuss your personal situation with your clinician and make an informed decision about whether hormonal or other treatment ? or no treatment ? makes the most sense for you.
Resources
National Center for Complementary and Alternative Medicine
http://nccam.nih.gov/health/menopauseandcam/
The North American Menopause Society (NAMS)
Hormone Therapy, Menopause | Expert Advice
Hormone Therapy in the Menopausal and Postmenopausal Years: What Should You Do?
(JW Womens Health Sep 5 2002)
What We?ve Learned from the Women?s Health Initiative
(JW Womens Health May 2 2006)
Manson JE with Bassuk SS. Hot Flashes, Hormones & Your Health. New York, NY: McGraw-Hill; 2007. Dr. Manson is coauthor of a Journal Watch Women?s Health feature article on hormone therapy (JW Womens Health Jul 31 2008).
? Diane E. Judge, APN/CNP
Published in Journal Watch Women's Health July 31, 2008
of course the WHI study provides relevant information, but not the whole story by far. it seems there are still not enough studies to evaluate synthetic HRT, much less BHRT.
HRT is an ongoing experiment. let us hope the medical profession continues to evaluate and refine best practices in HRT for women and men. I find it hard to believe that most women were yanked from HRT all at once, after the results of the study came out. poor women! I'll bet anti-depressant use shot up then and there.
The above article is a good but very brief overview of HRT - but far from telling the whole story.
the article states:
this is basically true. unless you do quite a bit of your own research and find there is far more truth to learn about what's out there, and what may work best for you. its much more complex than this simple statement. the medical profession is slowly but surely starting to ask questions about efficacy, they are prescribing bios more and more - fda approved, and generically formulated hormones made by certified formulating pharmacies - doctors are having to find and evaluate these pharmacies. Regular pharmacies are starting to formulate these hormones as well due to demands. they have no choice - women are making demands in the doctor's office. doctors are responding. its great news!!! Men and women should not face hormone replacement needs without an informed doctor by their side. and they don't have to. so, I find this statement very limited in scope, although its basically true, or at least it tells the truth but leaves out quite a lot of important developments in the field of HRT.
I realize the medical profession moves very slowly, and this is probably a good thing overall. so thank you doctors, scientists and women everywhere. where we want to be is at a place where balanced HRT information is available, individualized choices are given, informed decisions can be made, and quality of health and life can be reached even when hormone levels bite the dust (hormone deficiencies can be age-related, environment, or due to other problems at any age). we're getting there.
HRT is an ongoing experiment. let us hope the medical profession continues to evaluate and refine best practices in HRT for women and men. I find it hard to believe that most women were yanked from HRT all at once, after the results of the study came out. poor women! I'll bet anti-depressant use shot up then and there.
The above article is a good but very brief overview of HRT - but far from telling the whole story.
the article states:
this is basically true. unless you do quite a bit of your own research and find there is far more truth to learn about what's out there, and what may work best for you. its much more complex than this simple statement. the medical profession is slowly but surely starting to ask questions about efficacy, they are prescribing bios more and more - fda approved, and generically formulated hormones made by certified formulating pharmacies - doctors are having to find and evaluate these pharmacies. Regular pharmacies are starting to formulate these hormones as well due to demands. they have no choice - women are making demands in the doctor's office. doctors are responding. its great news!!! Men and women should not face hormone replacement needs without an informed doctor by their side. and they don't have to. so, I find this statement very limited in scope, although its basically true, or at least it tells the truth but leaves out quite a lot of important developments in the field of HRT.
I realize the medical profession moves very slowly, and this is probably a good thing overall. so thank you doctors, scientists and women everywhere. where we want to be is at a place where balanced HRT information is available, individualized choices are given, informed decisions can be made, and quality of health and life can be reached even when hormone levels bite the dust (hormone deficiencies can be age-related, environment, or due to other problems at any age). we're getting there.
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