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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Managing Menopause Naturally

Without warning, a sensation of intense warmth spreads from your head to your neck and chest. Beads of sweat begin to form on your face and you feel a little dizzy. This brief episode is over in minutes and leaves you flushed (reddened), perspiring, hot and craving a cold glass of water. Like many women, you are experiencing a hot flash and would like some symptom relief.

In your search for managing your symptoms you may have come across Hormone Replacement Therapy (HRT), but not sure if it is right for you. You have read the testimonial of many women through different media resources who have successfully managed their menopausal symptoms using bioidentical hormones and would like to find out more about the treatment and its risks. You have also heard about nonhormonal ways of dealing with menopause. Whatever your questions, finding the right treatment can be just as overwhelming as the menopause transition itself.

A short history on Hormone Replacement Therapy (HRT)
For many years Premarin or Prempro were the prescription of choice for millions of women in America entering menopause. Premarin, a mixture of estrogens derived from the urine of a pregnant horse, and Prempro, a combination of horse estrogens and synthetic progesterone, serve to replace the hormones that the body is no longer producing in sufficient quantities in the perimenopausal and menopausal stages of a women’s life. These synthetic hormones are prescribed not only to alleviate menopausal symptoms, but also to protect women against heart disease, reduce fracture risk, and as an anti-aging regimen.

In 1991, the effects of hormone replacement therapy were tested in a large clinical trial called the Women’s Health Initiative. More than 16,000 healthy post-menopausal women participated in the study. They were given a placebo or a combination of conjugated equine estrogen and synthetic progesterone in 1 tablet daily for an average of 5.2 years. An important objective of the trial was to examine the effect of estrogen plus progestin on the prevention of heart disease and hip fractures, and any associated change in risk for breast and colon cancer. The study did not address the short-term risks and benefits of hormones for the treatment of menopausal symptoms.

In 2002 the study was stopped short because the health risks (increased risk of heart disease, breast cancer, stroke and pulmonary embolism) to participants outweighed the possible benefits.

While the study found that HRT does reduce the risk for fractures and colorectal cancer, the researchers concluded that the balance of harm versus benefit does not justify any woman beginning or continuing to take estrogen plus progestin exclusively for this purpose. Therefore, non-hormonal therapies and strategies for treatment of osteoporosis and prevention of colorectal cancer should be considered, respectively.

Recently, the 2008 reanalysis of the study concluded that hormone therapy is associated with increased risk of stroke regardless of age at which HRT started.

Although the associated risks were only reported for conjugated equine estrogens and synthetic progestin, many practitioners refrained from prescribing bio-identical and natural forms of the hormones as well.

Bio-identical Hormones
Bioidentical hormones share the exact same molecular structure as the hormones in our body. Since bioidentical hormones are not as profitable as their synthetic 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 natural 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. HRT either conventional or bioidentical is not for everyone. Women who are interested in hormone therapy should discuss their individual risks for breast cancer, heart disease and stroke with their health care provider.

Natural Alternatives
The goals of treating menopause with an alternative approach are to provide symptomatic relief from common menopausal complaints and to prevent conditions such as heart disease and osteoporosis that increase in prevalence as a woman ages. A natural approach to treatment involves the following:

• Dietary recommendations: to help the body adequately metabolize estrogen.
• Exercise regimen (Aerobic and Resistance-Training): The risk of coronary artery disease rises dramatically in postmenopausal women.
• Aerobic exercise provides cardiovascular benefits and reduces menopausal symptoms.
• Resistance-Training protects against osteoporosis and fractures by increasing muscle strength and building bone.
• Stress Management: To help balance the hormone regulating system of the body (hypothalamic-pituitary-adrenal axis).
• Nutritional supplementation: To provide the body with adequate nutrition for prevention of developing heart disease, osteoporosis and cofactors needed for better mental function.
• Botanical therapies: Herbal preparations to help alleviate menopausal symptoms and provide active components for improved hormonal regulation.

Bio-identical hormone therapy should be the last step in the treatment of menopausal symptoms. When diet and lifestyle changes, nutritional supplements and botanical medicine are not enough to significantly effect menopausal symptoms, natural hormone therapy can be utilized. The dose and form of hormones should be determined based on the risk factors and unique needs of each menopausal woman.

It is important to recognize that each individual woman has a unique set of risk factors based on her family history, diet and lifestyle, past medical history, gynecological history, and other current medical conditions for which she is undergoing treatment. The most optimal treatment and prevention plan should be based on a comprehensive health history, physical examination, laboratory testing and assessment of risk factors, as well as a discussion with your healthcare provider about all the options (conventional and alternative) available and which ones are most likely to provide you the most benefit.

To find out about the health plans offered at Ocean Pacific Integrative Health Center, please call our office at 760-944-9300 or visit our website at http://opintegrativecenter.com.

Reference (detailed information available upon request)
NIH; JAMA (Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women); JAMA ( Health Risks and Benefits 3 Years After Stopping Randomized Treatment With Estrogen and Progestin) ; Women’s Encyclopedia of Natural Medicine. (Tori Hudson).