Who Should Use Bioidentical Hormone Therapy (BHRT)?
The BHRT question is asked of our experts on a regular basis. It is one of the most important decisions people make in their life. There is a great deal of information on-line and it can be very confusing. We recommend you discuss your individual case with your health care practitioner.
The following information and video seminar will prepare you for the discussion.
Dr. Muth Discusses the Impact of Hormones and Cancer
What is the difference between bio-identical hormones and non-bio-identical hormones?
- Bio-identical hormones are chemically identical to the hormones a woman/man naturally produces in her body. They are synthesized by chemically extracting diosgenin (a precursor) from yams and other similar plant products.
- Non-bio-identical hormones (also called synthetic hormones) are derived from other sources, for example the urine of a pregnant mare. They do not have the identical chemical structure as hormones that are naturally produced in the female body.
- There are bioidentical and non-bioidentical versions of estrogen and progesterone, which are the two hormones we use most often to treat menopausal symptoms.
Are natural hormones better than synthetic hormones?
- We at Serenity Health Care Center believe that bio-identical hormones are superior and a better supplement than synthetic hormones. Some women will have an allergic response to hormones, so then special treatment is needed in order to tolerate hormone therapy.
Is one more "natural"? I often hear bioidentical (BHRT) referred to as "natural."
- "Natural" is a commonly used marketing term - NOT a scientific term. Natural is often substituted for the term bioidentical but it is not an accurate description of bio-identical hormones.
Why is there so much confusion around hormone therapy?
- I think the big confusion is between bioidentical hormone therapy and synthetic hormone therapy. There are plant derived bioidentical hormones made by the pharmaceutical industry but the dose is limited. The biggest difference is between compounded hormone therapy and pharmaceutical hormone therapy.
What exactly is compounding hormone therapy?
- Compounding pharmacies mix together different formulations of hormones in different quantities, as directed by a practitioner. A good compounding pharmacy will have accreditation, which will regulate its quality, grade and consistency of the medications that are produced. Patients may have to pay out of pocket because insurance may not cover it. But the cost is significantly lower than the out of pocket costs for a prescription.
Why do people choose compounding pharmacies?
- Practitioners chose compounding therapy for the ability to individualize a treatment protocol and because they believe it is the best therapy for a person. We prepare the formulations based on salivary or blood testing to assess your hormone levels and compare this with your symptoms prior to choosing a proper dose. It is well known that Suzanne Somers is the most well know celebrity using bioidentical compounded hormone therapy.
Are there any serious risks to using the compounding hormone therapy?
- No. Compounding pharmacists prepare hormone therapy and if it is prescribed at the proper dose there should not be any increase risks compared to using synthetic hormone therapy.
The Women’s Health Initiative study famously found a link between hormone replacement therapy and breast cancer. It scared a lot of women away from using hormones. Did that study use bio-identical or non-bio-identical hormones?
- The hormones used in this study were non-bio-identical-also known as a combined conjugated equine estrogen (in part made from horse urine) plus progestin. In women without a uterus, treated with estrogen only was prescribed, despite years of knowing this causes uterine cancer. The group that saw the highest risk of breast cancer was seen in women who were given combined estrogen and progestin therapy.
Is it fair to say, then, that the risks found in the Women’s Health Initiative study may not be the same for bio-identical hormones?
- The risks are still there. Any hormone therapy--which stimulates cell growth, can increase the risk of breast cancer. Studies from France actually show a reduced risk of breast cancer in women who use hormone therapy for over 10 years. Proper balance between the hormones helps to reduce this risk factor. Any estrogen used orally can increase the risk for stroke or cardiovascular disease.
Have there been any similar long-term studies done with bio-identical hormones (BHRT)?
- Yes. There have been long-term studies comparing the bio-identical patch to the oral hormone therapy. Long-term studies in France have shown decreased risks of stroke, breast cancer, and heart disease.
So despite the risks, you still recommend hormone therapy?
- Yes! We say hormones are helpful at reducing the age related dis-ease that is caused by the fall of hormones. However, we recommend against using oral estrogen therapy and promote topical forms. Not every woman is a candidate for hormone therapy and a knowledgeable health care provider should screen one. There’s no reason to suffer hot flashes, sexual dysfunction, etc. A good health care provider should monitor a woman, so her quality of life can be improved with bioidentical hormone therapy.
With so many people calling themselves "women’s health experts," how do you know if you have a "good provider"? How do you know whom to trust?
- Well, if your provider understands bioidentical hormone therapy and has been trained by a credible group such as A4M, Labrix, or European Menopause Society is just a few of the qualified agencies.