Hormone replacement therapy, or hormone therapy, can help ease the symptoms of menopause, including hot flashes, vaginal dryness, and mood swings.
It can also lower the risk of brittle bones and heart disease.
However, in 2002, the Women's Health Initiative
Since this safety warning came out against the use of traditional hormone therapy, alternative methods, such as bioidentical hormone therapy, have been developed.
In this article, we examine what bioidential hormones are, how they are used, and what the benefits and risks of using them might be.
Bioidentical hormones are hormones that are chemically the same as those that the body produces.
Although they are made in a laboratory, bioidentical hormones mimic the hormones the human body produces naturally.
As a result, the body should not be able to tell the difference between the hormones it produces and the bioidentical ones.
Bioidentical hormones can be made from a variety of sources that span plant and animal products.
Bioidentical hormones include the following:
- 17 beta-estradiols, which include drugs, such as Estrace, Estradil, and Estring
- estradiol acetate, including Femring
- estradiol hemihydrate, including Vagifem
- micronized progesterone USP, such as Prometrium and Prochieve
Some big pharmaceutical companies manufacture certain bioidentical hormones, which are regulated by the United States Food and Drug Administration (FDA).
However, special kinds of pharmacies, which are known as compounding pharmacies, mix their own formulas of bioidentical hormones. Hormones made by these compounding pharmacies are not regulated by the FDA.
Bioidentical hormones versus synthetic hormones
Bioidentical hormones have the exact chemical and molecular structure as the human body's hormones while other types of lab-made hormones do not. As these other synthetic hormones are made differently than the hormones in the body, the body reacts to them.
For example, Premarin is a replacement estrogen that is made with the help of urine from pregnant horses. It binds to human estrogen receptors very tightly and makes them more reactive.
As with all medications that act as estrogen replacement therapies, this reaction may increase a person's risk of cancer if the medication is taken for a long time.
Bioidentical hormones can be used to treat symptoms of menopause in women, resulting in potential benefits, including:
- reduced fatigue
- increased sex drive
- less hair thinning
- reduced hot flashes
- less dry skin
- improved sleep
- reduced bloating
- better thinking and memory
Although people often refer to the symptoms women experience as being those of menopause, they are, in fact, symptoms of perimenopause.
Menopause refers to the time when a woman stops having periods every month. Perimenopause is the time leading up to menopause when the ovaries start to produce less estrogen.
Who needs bioidentical hormones?
Due to the controversy still surrounding the safety of bioidentical hormones, most women going through perimenopause may want to consider other treatment options first.
Not all women respond well to traditional treatments, however. In these cases, women may consider bioidentical hormones as potential alternatives.
Also, women who have tried other medications may want to consider changes in their lifestyles before starting bioidentical hormone therapy. Some additional measures to try can include:
Bioidentical hormones come in a variety of forms, depending on exactly what symptoms they are targeting.
Types of bioidentical hormones include:
The application of a treatment is supposed to restore the natural hormones that younger women have, but that reduce as they age.
When under a doctor's care, a woman will be tested for hormone levels, typically by sampling saliva or blood. The doctor will determine what hormones the woman needs and a pharmacist will mix a treatment of supposedly natural ingredients.
During her treatment, a woman will have her hormone levels assessed several times to check for balance.
Custom-compounded hormones are hormones that have been custom-made into a pill, spray, cream, or suppository form by a compounding pharmacy. These hormones are blended in a particular combination for each woman.
Compounded hormones may have the benefit of being made without certain allergens. However, compounded hormones are not regulated by the FDA, and their efficacy has not been proven in large trials.
When most people talk about bioidentical hormones, they are usually talking about these un-FDA-regulated custom-compounded formulations
The American College of Obstetricians and Gynecologists, the Endocrine Society, and the North American Menopause Society have also issued statements against custom-compounded hormones.
Some women may mistakenly believe that custom-compounded hormones are safer than other commercially available bioidentical hormone therapies since they have warning literature. However, the literature is because the FDA do not regulate compounded hormones.
While they may be safer for women who have an allergy to an additive in commercially available hormones, custom-compounded hormone therapy carries similar risks to bioidentical hormone therapy.
According to the North American Menopause Society, custom-compounded hormones are no safer than the hormone therapies that are FDA-approved.
Bioidentical hormones are broadly categorized, as either tested and reviewed by the FDA or not.
Products approved by the FDA have undergone extensive testing and quality control. Products not approved by the FDA have either failed testing or have never been evaluated.
Companies that did not seek or failed to get FDA-approval can still sell their products, however. This results in a marketplace mixed with well-tested bioidentical hormones and ones where the risks of use are unknown.
Also, there are currently no long-term studies or tests available that have looked at the use of bioidentical hormones. This means that the potential consequences of the prolonged or minimal use of bioidentical hormones cannot be accurately known.
Another problem with the use of bioidentical hormones is that the therapy might prevent a doctor from diagnosing a more serious illness, such as an autoimmune disease if it is present.
In this respect, some reported side effects include:
- increase risk for blood clots
- gallbladder disease
- skin changes
- mood swings
- vision changes
- heart disease or breast cancer
There is not enough conclusive evidence to suggest that bioidentical hormone therapies are effective or safe. Consequently, women looking for relief from menopause symptoms are probably best advised to consider other routes, including some basic lifestyle changes.
If more research into bioidentical hormones is carried out in the future, they may prove to be safe enough for people to use.