Menopause - The Lowdown on Bioidentical Hormones
Oct. 14, 2019
Menopause: the Lowdown on Bioidentical Hormones
Now that we are promoting Hormone Replacement Therapy (HRT) for women who are suffering from the symptoms of menopause as a safe and effective way to manage them there are questions about alternative therapies. Some women are asking about Bioidentical Hormone Therapy (BHT) and the topic has caused much debate. So what are they and are they safe?
What are Bioidentical Hormones?
Bioidentical hormones are a type of HRT most often used to relieve the symptoms of menopause, mainly hot flushes, night sweats, vaginal dryness and mood changes. Bioidentical hormones are marketed by some practitioners as being "natural" and the assumption is that they are superior to "synthetic" hormone therapy used for managing menopause symptoms. They are meant to be identical to the natural hormones produced by the ovaries, but it is important to realise that all hormones that you can buy are synthesised, including bioidentical hormones. In fact, the main oestrogen used in bioidentical hormone preparations is the same one used in FDA approved hormone treatment. They are active hormones which have been compounded into troches, tablets and creams by compounding pharmacists.
What is in bioidentical hormones?
They usually contain 2 or 3 types of oestrogen and can also have testosterone, DHEA and hydrocortisone. Progesterone in the form of a cream or oral tablet may also be paired with it.
Are they safer than conventional hormone replacement therapy?
Bioidentical hormones are NOT safer than conventional hormone replacement therapy (HRT). There have not been any large research studies looking into the safety of bioidentical hormones. In fact, they have been associated with significant adverse effects in New Zealand and internationally and there is no scientific evidence to show that they are effective.
There are a number of concerns when it comes to bioidentical hormones:
1. They are active hormones and will have both positive and negative effects like all active substances. This means that they also have potential side effects just like conventional HRT
2. They are not regulated. There isn't the same requirement for testing, safety data and side effects as conventional HRT or other medications. It also means that adverse effects don't need to be reported to the relevant authorities. People who use bioidentical hormones may not be properly informed about their potential risks because this information may not be readily available.
3. They are not standardised. The level of hormones in each compounded product is not consistent, even if done by the same pharmacist which might mean that the cream you get today may be different from the cream you get on another day.
So what are the potential harms?
1. There may be increased risk of cancer of the uterus when using bioidentical oestrogens
2. In women using testosterone creams, the levels of testosterone may be too high (levels in the normal male range).
3. There may be increased risk of stroke and blood clots and if used for longer, heart disease and breast cancer.
So what should I do?
If you are suffering from menopausal symptoms that are affecting your life, there are good options available to manage them.
Some basic lifestyle modifications can really help. A healthy diet and exercise is always a good start as well as weight loss if this is appropriate. Other strategies include layering of clothes, use of natural fibres, smoking cessation and relaxation response techniques.
If your symptoms are more severe, conventional HRT may also be used after discussion and evaluation of the benefits and risks. If HRT isn't for you then there are also non-hormonal treatments which include some of the newer antidepressant medications, gabapentin (a medication used for pain relief) and clonidine (an old fashioned blood pressure medication) which can decrease hot flushes. Make an appointment to see your healthcare provider for more information about these options.
This article was written by Angela Sun, a 5th year medical student, who trained at Medplus.