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Bioidentical Hormones: A Treatment Option

For many years the clinical answer to menopause was simple. Doctors would often recommend hormone replacement therapy (HRT) as a reliable way to replace the diminishing levels of estrogen. When it was discovered that in some women HRT increased the risk of stroke, cancer, and heart disease, treatment for menopause became more complicated.

HFN 032 BioidenticalOptions 1 F3248846After this realization, new ways of administering HRT started emerging, such as limited exposure to estrogen through transdermal patches or vaginal rings and creams and adding synthetic versions of the hormone progesterone to help reduce the risk of cancer. Currently, one form of HRT starting to gain traction is bioidentical hormone replacement therapy, or BHRT.

What is Bioidentical Hormone Replacement Therapy?
Bioidentical HRT differs from conventional HRT in the composition of the medication itself. Bioidentical hormones come from plant-based materials and are chemically identical to the ones that occur naturally in your body. They are usually compounded, or mixed, by a specially trained pharmacist, according to a formula customized for you. Synthetic hormones, which have typically been used in conventional hormone replacement therapy, are often derived from horse products—actually, urine from pregnant mares. Although many women are enthusiastic about improvement in their menopausal symptoms while using BHRT, there are no well-designed studies yet showing this treatment's long-term safety.

The Positives
Proponents of BHRT claim that the use of hormones that are identical to the ones produced by your own body lowers the risk of developing breast cancer (compared to HRT) while treating the symptoms of menopause, especially hot flashes and vaginal symptoms. It is believed that real progesterone opposes the natural increase in breast cell growth caused by estrogen more effectively than synthetic progesterone. Proponents also believe that bioidentical hormones do not increase the risk of clotting, as synthetic hormones have been shown to do in some women.

Another difference is seen not in the drug itself, but in the way it is taken. Synthetic hormones are taken in standardized doses, while bioidentical hormones can be delivered in custom amounts to fit the specific needs of an individual, something BHRT advocates say is a distinct advantage.

Some products can be easily prescribed by your physician and purchased at most pharmacies. For others, if your doctor has prescribed particular combinations, doses, or preparations, you need a pharmacy that specializes in custom compounding. It's recommended you seek a pharmacy accredited for this area of expertise, preferably by the Pharmaceutical Compounding Accreditation Board (PCAB).

Several celebrities, such as Suzanne Somers, Dr. Christiane Northrup, and Oprah, have been associated with discussions about and praises for bioidentical hormones, and there are numerous websites from proponents who prescribe or compound these products.

Andrew Weil, MD, well known and respected by many for his knowledge of and advocacy for integrative medicine, cautions about the use of HRT but has written, "When HRT is necessary, I have always recommended using bioidentical (in the sense of hormones that are similar or identical in molecular structure to the hormones women make in their bodies) estrogen/progesterone for women who need treatment, specifically Estrace and oral micronized progesterone, both FDA-approved prescription drugs."

The Negatives
Conventional HRT was once thought to be the definitive answer to treating the symptoms of menopause. When research started revealing serious risks and HRT was no longer considered to be as safe and effective as it once was, some experts turned to bioidentical hormone therapy as the answer. However, bioidentical therapy simply lacks the same amount of research in the United States as its predecessor. In fact, many bioidentical hormones are not approved by the Food and Drug Administration. This lack of research doesn't necessarily mean that bioidentical hormones are harmful, but it does mean that the risks haven't been ruled out yet. This is one of the reasons why bioidentical HRT is such a controversial method of treatment.

Furthermore, there is no guarantee that a drug prescribed by your doctor and specially compounded at the pharmacy has the same consistency in quality, dosage, safety, or effectiveness from one month's supply to the next. Usually compounded drugs are not covered by your insurance, so check first to avoid surprises.

According to the Mayo Clinic's OB-GYN Mary M. Gallenberg, MD, bioidentical hormones are "custom made for you, based on a test of your saliva to assess your unique hormonal needs. Unfortunately, however, the hormone levels in your saliva don't reflect the levels in your blood or correspond to menopause symptoms." It also has been argued that your hormone levels fluctuate, and one reading, either of your blood or saliva, may not reveal a dependable enough level to determine the compound right for you.

See Your Doctor
As is usually the case with any medical procedure, proper treatment varies from woman to woman, based on individual needs. Speak with your doctor before making any decisions on what type of menopause treatment is appropriate for you. ♀

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