Bioidentical Hormone Therapy Misinformation

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Combatting Bioidentical Hormone Therapy Misinformation

After a couple of decades with a dramatic drop in hormone replacement therapy for menopause management, hormones are once again the topic of conversation. With new research dispelling the findings of the Women’s Health Initiative study and supporting the safety and benefits for many, more women are asking questions, seeking better healthcare, and choosing hormones, specifically bioidentical ones.

As the interest in hormone therapy increases, so do the myths and misinformation. Most doctors aren’t educated in the nuance or have kept up to date with the research. Women may go to their primary care physician or gynecologist, only to be told that bioidentical hormones aren’t real or are unsafe when they could be a viable option.

Today’s article is meant to help clear the confusion about conflicting information related to bioidentical hormones. The topic is not as controversial as it’s portrayed, and understanding this information is vital for women’s health. Let’s dive in as we cover:

• What are bioidentical hormones? And how do they compare to traditional hormones?
• FDA-approved bioidentical hormones
• What are compounded hormones?
• Bioidentical hormone myths
• Essential BHRT action steps

What are Bioidentical Hormones?

First, some background: hormone therapy is the standard of care for menopausal symptoms, which often show up during perimenopause. Using hormone medications to increase hormones in the body is called hormone replacement therapy (HRT) or menopause hormone therapy (MHT). Hormone therapy has risks and benefits, and in many cases, the benefits outweigh the risks for improving symptoms, quality of life, and long-term health.

Bioidentical hormones are a category of hormones used as HRT/MHT. Bioidentical hormone replacement therapy (BHRT) is available as pills, patches, creams, and gels.

Bioidentical hormones are body-identical. In other words, bioidentical hormones have the exact chemical structure as the hormones the body makes. The hormones may start as a natural, plant-based extract, such as from soy or yams, but are converted into bioidentical molecules in a laboratory. Synthetic hormones can still be bioidentical.

When discussing bioidentical hormone replacement therapy for perimenopause, we’re typically talking about replacing the following hormones:

• Estrogen – Primarily estradiol (E2), but you may also see estriol (E3), and estrone (E1)
• Progesterone
• Testosterone
• DHEA

In contrast, “traditional” or non-bioidentical hormones have hormonal actions in the body but are not exactly the same structure as human hormones. Progestins, such as medroxyprogesterone acetate, are not the same as progesterone. Although to confuse matters, they are often called progesterone. Progestins are found in birth control pills, IUDs, and HRT.

Conjugated equine estrogen (CEE) comes from horse urine. In this sense, it’s “natural” because it comes from nature, but it’s not bioidentical to the human estrogens (estradiol, estriol, and estrone). The Women’s Health Initiative study famously used non-bioidentical hormones, which may be associated with increased risks. It’s important to note there were other issues with this study, including the age of participants and timing of HRT initiation.

FDA-Approved Options for Women

The good and often surprising news is that there are many FDA-approved bioidentical hormone preparations. These medications tend to be covered by insurance or more affordable. They are a good choice when you are advocating for care with your healthcare provider.

Bioidentical progesterone is available as micronized progesterone under the brand name Prometrium as a 100 mg or 200 mg oral capsule.

Bioidentical estradiol, the primary estrogen during the reproductive years, is available as 17-beta estradiol in various capsules, patches, creams, and gels. Transdermal delivery as a patch, cream, or gel is the preferred mode of administration as it carries fewer risks than oral options. Brand names for patches include Alora, Climara, Menostar, and Vivelle. Estrace is a brand name for vaginal estradiol cream. There are many options that can help personalize your protocol, so please work with your doctor.

Please note that testosterone isn’t currently FDA-approved for women, so there aren’t standard women’s doses available as there are for estradiol and progesterone. If you need testosterone, you’ll have to work around this with your doctor. Compounding may be one option.

What is Compounding?

A compounding pharmacy makes customized hormone therapy. So, if you need a different dose or delivery, want to combine hormones, or need a formula without an allergen, your doctor can prescribe a compounded formula.

For example, Prometrium (oral micronized progesterone) contains peanut oil and food dyes. If you’re allergic or otherwise want to avoid these ingredients, the pharmacist can make it with olive oil or another option instead.

Compounded hormones offer a tool for personalized medicine, yet they often get a bad rap from conventional practitioners who raise safety concerns. While custom compounded formulas don’t have clinical trials to back them like the FDA-approved standard options, they contain the same bioidentical active ingredients as the standard formulas. Compounded hormones are not typically covered by insurance. It’s important to work closely with your provider and utilize a trusted compounding laboratory.

BHRT Myths

Let’s review some myths and truths about bioidentical hormone replacement therapy (BHRT).

Myth: Bioidentical hormones are natural.

Truth: Bioidentical refers to the hormone structure, which requires manipulation to match the human hormone, even when coming from a natural source like soy or yams.

Myth: Bioidentical hormones are compounded hormones.

Truth: Bioidentical hormones are available as standard, FDA-approved prescriptions or compounded formulas.

Myth: Bioidentical hormones are alternative medicine.

Truth: Bioidentical hormones bridge conventional, integrative, and functional medicine. They are widely available and offered by many types of prescribing practitioners.

Myth: Bioidentical hormones are safe.

Truth: Overall, HRT is much safer than we were led to believe from the Women’s Health Initiative. Still, bioidentical hormones may cause side effects like non-bioidentical hormones and pose risks for certain populations. It’s necessary to discuss the benefits and risks with your healthcare provider.

Hormone Therapy Checklist

If you are ready to start or are starting BHRT, here are some tips:

• Work with a menopause specialist. Not all doctors or even OBGYNs are trained in hormone therapy for perimenopause and menopause. You’ll get less pushback and more actionable information when consulting an expert. Fenske is a certified Menopause Practitioner through The Menopause Society.

• Start sooner vs. later. Perimenopause is the time to begin discussing BHRT with your provider. Starting hormones closer to menopause may offer more benefits than further into the post-menopause years.

• Start low and slow. It may take your body some time to adjust to hormones. Starting at a low dose and slowly increasing may help mitigate any side effects. If you stop hormones, weaning off slowly may also be helpful.

• Monitor labs. Depending on your health goals, you may want to achieve specific hormone levels in the body. Monitor blood labs to see how you respond to BHRT and adjust as necessary. The DUTCH test is helpful for understanding how your body is detoxifying hormones, an essential part of the picture. Note bioidentical hormones will show up on labs because they are, well, bioidentical.

• Don’t skip the foundations. While BHRT might be a game changer for menopausal symptoms and support long-term health, it doesn’t replace the need for solid nutrition, exercise, sleep, stress management, reducing toxins, and self-care. Supplements offer support, too.

When it comes to HRT, BHRT is what we use in our clinic. Bioidentical hormones offer the best safety profile and customizable options so we can create an individualized peri/menopause protocol for each patient. If you’ve heard rumors that bioidentical hormones are not real or dangerous, hopefully, this sets the record straight. You deserve an in-depth conversation about the benefits and risks of hormone therapy for you with an expert in the field. At TārāMD, we provide the expertise and all the support you need to feel good and thrive in midlife.

References

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2. North American Menopause Society (2012). The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause (New York, N.Y.), 19(3), 257–271.
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