by Ted Griggs

Dr. Christopher Cutter

Women suffering through the hot flashes, night sweats and other symptoms common to menopause may be able to find relief through a hormone cream they rub on their skin.

"If a patient is low on DHEA or testosterone, which might happen if you have a hysterectomy, you can tailor the amount of those hormones to the patient's needs," said Dr. Christopher Cutter, a family practitioner in Mamou. Cutter is one of the few, if not the only, doctors in the area championing the use of hormone replacement creams.

The process is fairly straightforward. Cutter first determines the hormones in which his patients are deficient. He then works with a compounding pharmacist to create a cream that addresses the patient's needs.

The compounding pharmacists can do almost anything, Cutter said. One cream can contain as many as three to five hormones, and the compound can be unique to each patient.

In addition to providing a remedy explicitly designed for each individual, hormone creams offer a number of advantages for the patient, Cutter said.

For one thing, the creams are safer, and they aren't as hard on the patient's body.

The creams deliver the hormones in a more natural fashion, mimicking the way the body produces hormones, Cutter said. The skin acts as a reservoir, allowing the hormones to slowly leach into the capillary system.

Unlike pills, the creams don't place an extra load or unnatural strain on the patient's liver.

"There's pretty good scientific research that shows it doesn't go through the liver," Cutter said. Although all of the blood is eventually filtered through the liver, the hormone cream doesn't dump the entire amount on the liver immediately.

The creams involve lower doses of hormones and are far less expensive than pills. Cutter estimates the cost at $50 to $60 a month for an individually tailored cocktail instead of the $300 a patient would pay for name-brand pills.

The work by Cutter and Mamou area compounding pharmacists could eventually help restore the promise of hormone replacement therapy. Hormone replacement therapy lost much of its luster during the last three years following two studies by the National Institutes of Health's Women's Health Initiative. The first study, published in July 2002, showed that the overall risks of estrogen plus progestin increased the risk of breast cancer, stroke and blood clots. The second study, published in May 2003, showed the use of estrogen and progestin doubled the risk of developing dementia in women 65 and older.

Other studies have shown long-term use of estrogen can increase the risk of endometrial cancer, or cancer of the lining of the uterus, gallbladder cancer and ovarian cancer.

In May, the U.S. Preventive Services Task Force issued a new recommendation against the routine use of estrogen to prevent chronic conditions such as heart disease, stroke and osteoporosis in postmenopausal women who have undergone a hysterectomy. The task force based its recommendation on recent evidence from the Women's Health Initiative clinical trial and other studies. The new Task Force recommendation is being published in the May 17 issue of the Annals of Internal Medicine.

Most of the studies done on the long-term effects of hormone replacement therapy involved pills. But there are other delivery methods, including transdermal patches, gels, vaginal creams and rings.

According to the National Cancer Institute, these forms of estrogen are effective methods of treating the symptoms of menopause. In general, vaginal administration of hormones results in lower levels of circulating hormones, according to the Cancer Institute.

Cutter heard about hormone creams six to eight years ago. "Some people were saying you could make these hormone creams and put them on a patient's skin," Cutter said.

Cutter was intrigued by the idea. After looking into the issue, he discovered there had not been a lot of legitimate science or research done on the creams. Cutter put together a study, testing the product on men who were deficient in testosterone. The study was published in the Journal of the American Board of Family Practice in 2001.

Cutter began attending and speaking at conferences on pharmaceutical compounding. Eventually he expanded his research into women's health issues.

Now he uses the creams primarily for women patients, those going through menopause or with perimenopausal symptoms.

Hormones can help reverse a lot of the symptoms common to women who have had their ovaries removed or whose ovaries have failed, such as hot flashes, night sweats, sleeplessness, and vaginal dryness, Cutter said.