Bioidentical Hormones -- Are They A Safer Alternative?

After the results of the Women’s Health Initiative study came out showing the negative effects of conjugated equine estrogen and medroxy progesterone acetate, women have been seeking safer alternatives to hormone replacement therapy (HRT). In recent years, bioidentical hormones have been promoted as a natural and safer form of HRT for the treatment of menopause symptoms without the risks of their conventional counterparts.

Many women assume that bioidentical hormones don’t have the same risks as conventional hormone therapy and come to us requesting “natural hormone therapy” without a full understanding of the difference between conventional and bioidentical hormones and the risks and benefits associated with each type of hormone therapy.

Bioidentical Hormone Therapy vs. Synthetic Hormone Therapy
When it comes to classifying hormones, some confusion exists as to how what makes a hormone ‘natural’ or ‘synthetic.’ The classification of hormones is based on its chemical structure rather than how it is made or what sources it is derived from.

Bioidentical hormones share the exact same molecular structure as the hormones naturally produced in our body and are considered natural hormones for this reason. Synthetic hormones have a slightly different molecular structure than the hormones in our body and are used in conventional hormone therapy.

Both natural and synthetic hormones are manufactured in a lab. Natural hormones are derived from soy or wild yam plants and modified in the lab to mimic the hormones in our body. Synthetic hormones come from plant or animal sources and are synthesized in a lab to be similar to but not exactly the same as our own hormones. Synthetic hormones are intentionally made to be different in order for drug companies to make them patentable and therefore profitable.

Although synthetic hormones are used most often in conventional hormone therapy, they are associated with negative side effects because they are metabolized differently. The elevated risks from synthetic hormone use received widespread attention from the Women’s Health Initiative, which led to an increased demand for safer alternatives to synthetic hormone therapy.

Although the results of the WHI study cannot be extrapolated to other forms of hormone therapy, we also cannot assume that bioidentical hormone therapy (bio-HRT) is completely safe. Since bioidentical hormones are not as profitable as their conventional counterparts, there have been few large, well-designed studies to evaluate the risks and benefits of bio-HRT. More studies like the Women’s Health Initiative are needed to evaluate the safety and possible risks of bio-HRT. Although the exact risks for every woman using bioidentical hormones are not known, the results of studies that have looked at bio-HRT thus far does not appear to show the same side effect profile as conventional HRT — particularly transdermal forms.

So far, what we do know about bioidentical hormones based on the current scientific research is that medroxyprogesterone acetate (MPA), also known as Provera, when combined with estrogen, appears to increase the risk of heart attack and stroke, whereas estrogen and bioidentical progesterone have the opposite effect. The combination of natural estrogen and progesterone have been shown to decrease the risks associated with synthetic hormones and actually protect against certain cancers.

Comments:
HRT either conventional or bioidentical is not for everyone. Women should discuss their individual risks for breast cancer, heart disease and stroke with their health care provider before starting HRT.

-Dr. Kelly Cohn

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