Personalizing your approach to menopause is the safest way to use hormone replacement therapy. It allows you to use the least amount of HRT in the safest way possible based on your unique needs, genetics, and body systems. Taking a naturopathic functional medicine approach allows you to not just focus on symptom relief but strategizes long-term with the goal in mind to reduce your risk of chronic disease and thrive into menopause.
In Part 1, we explore what bioidentical hormones are and how they differ from standard hormone therapy. In Part 2, we explore personalized medicine’s approach to hormone therapy.
Differences Between Standard Hormone Replacement Therapy (HRT) and Bioidentical or Natural Hormone Replacement Therapy (BiHRT)
Standard hormone replacement therapy (HRT) refers to a variety of pharmaceutical chemicals designed to act like human estrogen, progesterone, or testosterone in the body and prescribed to help women with symptoms of menopause. Some of these synthetic replacement hormones are quite different from a woman’s hormones, for example, Premarin (pregnant mare urine), while some are designed to be more similar. To be a patentable prescription, however, these medications have to be chemically and structurally different from the natural hormones found in the human body to some degree. As a result, they are not metabolized the same way as a woman’s own hormones and therefore can be detrimental to the body or cause unwanted side effects. In addition to this, no one knows whether they signal the same intricate chemical messages throughout the body as our own hormones do.
Bioidentical hormones, also referred to as natural hormones, are chemicals that are made to be identical to the hormones produced naturally in a woman’s body. Though these originate from natural ingredients like yam or soy, they have to be processed to become a chemical that is indistinguishable from estrogen, progesterone, or testosterone produced in a woman’s body. They are, in essence, biochemically identical to female hormones; thus, they are given the name ‘bioidentical.’ There are two types of natural hormones available to women:
- Prescription Bioidentical Hormones: Some pharmaceutical companies have made a patent out of the delivery system of these natural hormones, and thus they are a prescription medication that will often get covered by insurance. For example, they can patent the adhesive on a patch and make it a unique patentable medication. These are much more favorable than the synthetic hormones, but they are limited in some respects to the types of estrogen in them, the dosing options available, and there is no way to combine estrogen, progesterone, and testosterone. Therefore, if a woman is seeking to replace all these hormones, it will require 3 different prescriptions.
- Compounded Bioidentical Hormones: Available through compounding pharmacies and can be blended into any custom formulation based on the individual needs of each woman. They offer the ability to mix the two most common types of estrogens in different ratios and can incorporate progesterone, testosterone, and DHEA all in one formula if needed. There are also several different ways to administer them based on the comfort, absorbability, symptoms, and health concerns of each woman. Some do better with topical creams, vaginal gels, troches, sublingual drops, capsules, or pellets. The compounded bioidentical hormones overall allow for a more individualized approach as a custom blend can be made up for each woman based on her unique needs.
Benefits of Bioidentical Hormones Over Synthetic Hormones
- Bioidentical hormones are believed to be safer than synthetic HRT: Bioidentical hormones are believed to be safer, but there are no studies comparing bioidentical hormones to synthetic HRT. It is unlikely that there ever will be because natural hormones are chemicals that exist in nature and can’t be patented. No companies are willing to invest millions of dollars researching something they can’t patent or exclusively profit from. However, since these hormones are identical to those produced in a woman’s body, it is believed that they exert the same biochemical effect and, if prescribed correctly, have fewer side effects and are therefore safer than synthetic HRT.
- BiHRT dosing can be personalized: Unlike synthetic hormones, bioidentical hormones are available in any dose or combination. Pharmacists can blend up any mixture or dosage to create personalized formulations, allowing women to find the most effective and safest combination to meet their needs.
- BiHRT is available in a variety of forms that can be prescribed based on a woman’s preference or used to augment specific treatment goals or mitigate disease risks: They are available as creams, gels, suppositories, troches, lozenges, drops, pellets, and capsules.
Is Bioidentical Hormone Therapy Safe?
As mentioned before, there are no large-scale studies on the safety of bioidentical hormones because no pharmaceutical company will fund research for something they can’t own outright or patent. There are several smaller studies on natural hormones showing their effectiveness and safety; however, there are no comprehensive studies that adequately assess disease risk so that we can say with certainty they are without risk. To answer those questions on the safety of natural hormones, we have to examine the research on standard HRT and then explore how relevant this is to bioidentical hormone therapy.
What We Know About the Safety of Synthetic HRT
The study that has had the most impact to date on how physicians prescribe synthetic HRT is the WHI study (Women’s Health Initiative). This is the largest comprehensive study on HRT and was designed to examine the long-term risks and benefits of women taking Premarin (horse estrogen alone) or Prempro (horse estrogen with synthetic progesterone). The study was supposed to last 7 years, but at year 5 in 2002, the women in the Prempro group began to show an increase in heart disease and breast cancer. As a result, this group discontinued the study.
The airways exploded with this news, “HRT Causes Heart Disease and Breast Cancer,” and panic ensued in women and physicians alike. The information no one knew at this point, however, was that this small increased risk of heart disease and breast cancer would eventually be found to only occur in women who initiated HRT after having not had a menstrual cycle for more than 10 years. This preliminary data, however, reported to the public out of context, instilled so much fear that over 50% of women on HRT threw their hormones away regardless of their age or what type of HRT they were on and never looked back. In fact, no one has ever really looked back. This unleashed a generalized mistrust of all hormone therapy that still remains today despite the fact that the final data published concluded that HRT can actually be beneficial for women under 60 and beneficial long-term if initiated early.
The Facts of the Women’s Health Initiative Study
- What made the headlines: “Study on HRT discontinued due to an increased risk of breast cancer and heart disease in a group of women taking Prempro.”
- What women heard: “All hormones cause breast cancer and heart disease in all women.”
- What actually was observed: Women who initiated Prempro HRT (estrogen from pregnant mares combined with synthetic progesterone) over the age of 60 or who were more than 10 years out from their last period were at a slight increased risk of developing heart disease and breast cancer. The women in the estrogen-only group did not have an increased risk.
- What was the increased risk: There was a 0.08 percent increased risk of developing breast cancer (out of 10,000 women, 8 more developed breast cancer), 0.07 percent increased risk of developing heart disease (out of 10,000 women, 7 more got diagnosed with heart disease), 0.08 percent more would have a stroke (8 more cases out of 10,000 women), and 0.08 percent more would develop blood clots. There would also be 5 fewer hip fractures (0.05 percent decreased risk) and 6 fewer colorectal cancers (0.05 percent decreased risk) in 10,000 women.
What hasn’t yet been communicated to the public: What the WHI study actually revealed when completed.
The investigators of WHI continued to monitor the health of these women for another 18 years. They published a final analysis of the research data after the study was completed stating the following:
- The risks for certain safety aspects were overestimated originally in 2002.
- The study showed a benefit in the use of HRT in women in the 50-59 age group and women less than 10 years past menopause. There was a lowered risk of heart disease, a lower risk of death from any cause, and no clear increased risk from stroke while using HRT.
- Those women starting HRT over 60 or who are over 10 years into menopause don’t accrue these same benefits and could be at certain increased risks for other diseases like heart disease and breast cancer.
Other large studies from Europe on HRT also support the same observations that the age of women initiating HRT results in significant differences in disease risk.
Unfortunately, this final data didn’t make the cut for worthy news reporting, and not many women or even physicians are aware of the final results of the WHI study. As a result, a vital piece of information sits shelved away in a journal on our medical library shelves. Most decisions about whether to consider HRT and many standard prescribing protocols are still influenced by the original premature data reported in 2002.
How Relevant Is This Research to Bioidentical Hormone Therapy?
There are differing opinions on how relevant this particular research on synthetic HRT is to bioidentical hormone therapy and how it should be applied. Most argue that you are comparing apples to oranges when you try to compare any synthetic chemical that is foreign to the body to a chemical that is naturally produced in the body. Synthetic hormones are medications and they do not get metabolized the same way as our own hormones do. They can break down into more dangerous chemicals and affect the tissues in the body differently
So, as a result, many clinicians are divided in how they interpret and apply this particular research to BiHRT prescribing. Many believe the research on synthetic hormones doesn’t apply to BiHRT while others prescribe with caution based on the WHI study.
As a Naturopathic physician focusing on women’s medicine, I believe it’s important to be aware of this research and take into account each woman’s health history, family history, risk factors and quality of life when designing her plan for menopause whether we are using diet, lifestyle factors herbs or considering hormone replacement.
Since you as a woman spend 1/3 of your life in menopause it is vital not to be short sighted and focus solely on making symptoms go away. It’s vital to find a practitioner that is able to personalize your treatment plan with a strategy to focus on long term disease prevention so you can thrive into menopause.
Conclusion
Navigating menopause with a personalized approach to hormone replacement therapy (HRT) ensures that you receive the safest and most effective treatment tailored to your unique needs. Bioidentical Hormone Replacement Therapy (BiHRT) offers a more natural and individualized option compared to standard synthetic HRT, focusing not only on symptom relief but also on long-term health and disease prevention. By working with a knowledgeable practitioner who considers your overall health and personal history, you can thrive during menopause and beyond, reducing your risk of chronic conditions and enhancing your quality of life.
