Prempro

Many women who quit taking hormones never looked back, but some, like Forbes, found the return of menopausal symptoms intolerable.

They tried soy and herbal remedies, but nothing worked as well as estrogen.

So "natural" and "bioidentical" hormones held great appeal, especially given that the estrogen in "There are quite a few women like me who have not had success with traditional approaches and have looked for something else," says Barb Gomach, 54.

"If they work, you stick with them." Gomach, of Madison, Wis., says she tried vitamin E, black cohosh and finally The first two were no help, and she experienced such side effects as vaginal bleeding on For several years, she has been buying progesterone capsules from Women's International, although she still uses a commercial estradiol patch because, unlike the compounded hormones, her insurance covers it.

'Breakdown in regulation' Although some compounded hormones are identical to FDA-regulated drugs, they don't have to carry a black-box warning.

Compounding pharmacies "fly a little under the radar," says Michelle Curtis, chair of an American College of Obstetricians and Gynecologists' panel that publish...

The physical components of BHRT are different from the components of Wyeth's synthetic hormones that were studied by WHI.

* Furthermore, Wyeth has had its own problems with FDA rules governing advertising.

In a letter from FDA dated January 11, 1999, the FDA said that promotional materials for Premarin were "false or misleading, and promote Premarin for unapproved uses." One year earlier, the company had received a letter saying that a television advertisement for Premarin was "false or misleading." As the Cincinnati Enquirer reported this month, "For some women, hormone replacement therapy is the only thing that eases symptoms.

More women are turning to bioidentical hormones - custom-compounded mixes of estrogens and progesterone that are identical to hormones produced by the body."Continued Mr.

King, "Pharmacy compounding is performed by responsible, trained professionals who have strong relationships with their patients and their patients' physicians.

The successful practice of pharmacy compounding is predicated on full, open and honest communication between these three groups of people.

However, by attacking these communications and the ab...

use customized hormones for menopause symptoms, according to some pharmacies, including customdrugs.com, the Web site for South River Compounding Pharmacy of Midlothian, Va.

Typically, proponents of bio-identical hormones use saliva tests to measure hormone levels and adjust the dose accordingly.

Critics say such tests are unreliable.

There's no scientific research to back up the theory that bio-identical hormones carry fewer risks than hormones made by drug companies.

Advocates say common sense should tell us that they are a better option - and argue that concerns about the lack of controlled studies are raised by turf-protecting drug companies.

"Nobody ever did a double-blind study to see if we need water on grass - we just know that," says Steven F.

Hotze, founder of the Hotze Health and Wellness Center in Houston and owner of a compounding pharmacy that is leading the legal fight against the FDA.

"We know they work because our patients get well.

That is a scientific experiment of one, and it works over and over again." Pharmacy firms say the cost of bio-identical hormones are comparable to or slightly higher than the price of drug makers' hormones, and many, but not all, insurance plans cover the cost.

The top-selling hormone,