Bio-Identical Hormones
Should You Use Bioidentical Hormones?Bioidentical hormones have become a popular alternative to standard hormone therapy for menopause. The hormones have even been mentioned on Oprah’s web site. Much of the marketing for these products revolves around the fact that they are derived from plant chemicals rather than synthetic sources. Makers also say that bioidentical hormone replacement therapy offers doses different from those in FDA-approved products (the FDA considers BHRT a marketing term, and doesn’t recognize its use). Finally, BHRT proponents say that the doses can be custom-made for individual women based on a saliva test.However, Mayo Clinic gynecologist and obstetrician Dr. Mary Gallenberg offers several conflicting facts. First, some FDA-approved products like Estrace, Prometrium natural progesterone, and the Climara patch, are also derived from plants, while the bioidentical hormone estriol is not used in any FDA-approved drug. Estriol products are not available as pharmaceutical preparations in Canada or the United States. Another type of bioidentical hormone, progesterone, is approved for oral use in treating endometrial hyperplasia. However, it is also often used transdermally, which has not been reliably proven to have the same effect.Gallenberg also says that compounding pharmacies, which produce bioidentical hormone products, are not subject to the same quality assurance standards as the manufacturers of commercial products. Finally, Gallenberg says that the saliva tests, which claim to determine the appropriate BHRT dosage, do not accurately “reflect the levels in your blood or correspond to menopause symptoms.”One detail which has led to an assumption that BHRT is safer than standard hormone therapy is that FDA-approved products require inserts listing potential side effects and safety information. Compounded bioidentical hormones are not required to have these inserts. However, that does not mean adverse effects have not been discovered. All estrogen products carry with them increased risk of certain types of cancer, stroke, heart attack, blood clots, gallbladder disease, enlargement of benign uterine tumors, melisma, and yeast infections, among other conditions. Estradiol, one of the estrogen types used in BHRT, are only recommended for short periods of use, and have a small chance of affecting the breasts, eyes, and skin, as well as the cardiovascular, gastrointestinal, genitourinary, and central nervous systems. Progesterone, used both orally and transdermally, also has possible adverse effects.A 2010 article in The Medical Letter on Drugs and Therapeutics claimed “There is no acceptable evidence that ‘bioidentical’ hormones are safe or effective. Patients should be discouraged from using them.” Make sure you have all the facts, and understand all the possible risks, if you decide to proceed with bioidentical hormone replacement therapy.