Bioidentical Hormone Replacement Therapy After a Hysterectomy

Controversy has surrounded hormone replacement therapy since 2002, when the Women's Health Initiative raised concerns about serious side effects such as stroke and breast cancer. Bioidentical hormones, which have been available for 15 years, are now in the spotlight as a safer alternative to synthetic hormones.

Definition

• Bioidentical hormones are synthesized from plants and are developed to have the same molecular structure as human hormones. They have been labeled as more natural than synthetic hormones. Some bioidentical hormones are available in commercially produced formulas but they are often compounded by a pharmacist so that the amount of each hormone can be customized to the individual patient.

Use After Hysterectomy

• The use of hormones following a hysterectomy depends on the reason for the surgery and the type of hysterectomy performed. Removing the uterus causes the onset of menopause but does not affect the production of hormones. The need for hormone replacement would be determined by the onset and severity of menopausal symptoms. However, if a radical hysterectomy is performed, then the ovaries also are removed. Since they produce estrogen and progesterone, hormone replacement may be necessary. If the hysterectomy was performed to remove cancer, then subsequent hormone treatment depends on the type of cancer and whether it has spread. For example, if endometrial cancer has spread, then hormones may be used to help stop its growth. If hormone replacement is prescribed following a hysterectomy, then the use of a bioidentical hormone---versus a synthetic one---would be discussed between the patient and doctor. Current mainstream medical policies indicate that bioidentical hormones would not be the first choice.

Issues

• The most significant issue related to the use of bioidentical hormones is that there have been no well-controlled clinical trials. The claim that they are natural and therefore safer may seem logical but it has not been proven under the same rigorous standards used for mainstream medications. A study of 50 menopausal women presented at the 2006 meeting of the American Association of Naturopathic Physicians showed that 82 percent of the women's estrogen-related and 74 percent of their progesterone-related symptoms improved when treated with bioidentical hormones. While this illustrates effectiveness, the study was limited in scope and the issue of side effects was not addressed.

Policy Statements

• Over the last four years, researchers at several different university medical centers have reviewed the studies available about bioidentical hormones. In 2006, the Endocrine Society re-issued its policy statement, which was subsequently adopted by the American Medical Association. And in February 2009, the American College of Obstetricians and Gynecologists reiterated its position. Their reports and policy papers all state that there is no scientific evidence supporting the benefits or safety of bioidentical hormones.

Counterpoint

• Dr. C.W. Randolph, Jr., Medical Director of the Natural Hormone Institute has stated that recent medical research and clinical studies have validated the safety and efficacy of bioidentical hormone replacement therapies. In March 2009, the Holtorf Medical Group published a review of medical literature in the Postgraduate Medical Journal. Dr. Holtorf stated that the literature demonstrates that bioidentical hormone replacement therapy is highly effective and carries a reduced, rather than an increased risk, of breast cancer and cardiovascular disease.

Future Trials

• A clinical trial was launched at the Mayo Clinic in March 2009. Their Women's Health Clinic, in collaboration with the Departments of Endocrinology, Complementary Medicine and Laboratory Medicine, will study the safety and efficacy of bioidentical compounded hormone therapy.