Since the publication of the book The Sexy Years in 2004, which introduced bioidentical hormones to the public as an alternative form of hormone therapy to manage the symptoms of perimenopause and beyond, questions about effectiveness and safety have multiplied. In addition, the controversy between those who advocate the bioidenticals versus those who promote the traditional route of hormone replacement or no hormone therapy at all has raged into a storm. Although the public in general had previously been pretty unaware of the bioidentical form of hormones, the products have actually been prescribed by medical professionals for better than 50 years, especially in the Western states. I have used them in my menopause practice in Minnesota for the past 20 years. The debate really escalated after the outcomes of the Women Health Initiative were made public and women, along with their providers, began to question what we had been doing and where we might find more acceptable, and possibly safer, alternatives. So, what are these bioidentical hormones and why should you care?
Bio-identical hormones have the same chemical structure as hormones that are made by the human body. The key is the molecular structure of the hormone. In order for a replacement hormone to actually mimic the function of the hormones which were naturally produced and present in women's bodies, the chemical structure must exactly match. Herein lies the difference. The so-called synthetic or substitute hormones which are much more commonly prescribed in medical offices bear no resemblance to a woman's naturally-occurring hormones. They will treat certain symptoms (ex., hot flashes) and reduce the risk of some long-term health concerns (ex., osteoporosis). However, researchers have long held that there are significant differences between hormones that are natural to humans and these synthetic (including animal-derived) preparations. It is believed that the structural differences that exist may account for side effects that are commonly experienced when non-bio-identical hormones are used for replacement therapy.
Women in the menopausal years suffer with symptoms as a direct consequence of their loss of hormones. According to Dr. Erika Schwartz who has treated menopausal women for over 35 years, "Over the past 25 years, hundreds of scientific studies reported in conventional medical journals have demonstrated that bioidentical hormones are safe and efficacious and address the core reason for the hot flashes, night sweats, insomnia, mood disturbances, loss of libido, weight gain and other symptoms plaguing women in menopause. These studies have also demonstrated efficacy and safety in the effects of these hormones on the heart, blood vessels, brain and other organs." The goal of any form of hormone therapy should be to provide an adequate supply of the deficient hormone in a form that is as close as possible to that which the body originally produced in order to result in normal physiologic effects. Every woman is unique, and each requires individual attention and dosing that fits her medical history, current symptoms and long-term health issues.
There are two what I will call varieties of bioidentical hormones. One is produced by pharmaceutical companies; the other is compounded, or individually made, by a compounding pharmacy. Compounding medications preceded the mass production by big companies by hundreds of years. Examples of the commercially made hormones include the patches, Vivelle dot and Climara (estrogen), and Prometium (progesterone) capsules. The compounded hormones include estradiol, progesterone and testosterone. Whether compounded or commercially-available hormones are better for a particular patient is a decision to be made between her and her care provider. I have many patients on both with excellent results. Purists might argue with defining both forms as bioidentical since they do not both start from a plant base. It is true that compounding is the best way to get hormones individually tailored in whatever dose is required and it can offer a variety of forms: creams/gels, lozenges, sublingual drops. However, the critical factor is the molecule that results, regardless of the process. In each case, the molecule is estradiol, progesterone or testosterone and biochemically identical to a woman's own.
The most recent research on the effects and safety of hormone therapy has focused on the critical aspect of timing, when women start on hormones. Many women will have significant symptoms long before their last period and will need to start replacement then. Others may not need hormones for troubling symptoms but choose to take them for maintaining good health as they age. These women may not start until the last period or reasonably soon thereafter. What the research is showing is that women who start hormones either before their last period or within several years of that time gain the most in long-term health maintenance, especially with regard to the heart, bones, brain, bladder, vagina and colon. For the majority of menopausal women, it can be argued that the benefits far outweigh the risks.
Whether or not to take hormones is an individual decision for every woman. It's not as simple as saying menopause is natural and, therefore, we should be able to brace through it without help. The fact is that in this day and age, we outlive our hormone supply. Not so very long ago, women died in their 40s and 50s as a part of the natural course, so menopause was actually an end of life event. Modern medicine has changed all that, and we now live 30 to 50 years beyond menopause. How can we expect the body to function optimally when deprived of basic ingredients of operation?
Published On: October 14, 2008