Bioidentical Hormone Therapy

Bioidentical hormone replacement therapy is commonly used to relieve symptoms of menopause. It has gained more attention after high praise by celebrities such as Oprah Winfrey and Suzanne Somers. Advocates of biodentical hormones highlight their "natural" status and hold them up as better and safer than synthetic versions. But being "natural" doesn't mean they are guaranteed to be free from negative effects.

Bioidentical Hormones

• A bioidentical hormone is one that has been created in a laboratory to have the same molecular structure as hormones produced by the body. Because these manufactured hormones are biologically identical to real hormones, they are considered "natural" and easier for the body to assimilate and use. (This makes them different from synthetic hormones, which are not biologically identical to the body's own hormones but are intended to produce the same effects. Synthetic hormones are designed with the intention of being patented.) "Natural," however, does not necessarily mean the hormones are made from natural materials.

  Not all bioidentical hormone products are FDA-approved. It is also important to note that no concrete studies have proved that bioidentical hormones are better or safer than synthetic versions.

Types

• Bioidentical hormone replacement therapy is used by women going through menopause to relieve symptoms such as hot flashes, thinning bones and vaginal dryness. It can be administered via creams and gels, pills and tablets, and even transdermal patches or vaginal rings.

  It is possible to buy FDA-approved forms of bioidentical hormones such as estradiol or Prometrium (progesterone) with a doctor's prescription. These formulations are standardized in design and dosage, and laboratories are required to adhere to strict guidelines to ensure purity and safety. They are tested thoroughly, and patients are also given a list of potential side effects to watch for.

  However, most times when bioidentical hormones are being discussed, it is in reference to "custom-made" formulations created by compounding pharmacies. These pharmacies develop a formulation based on the results of saliva or blood tests that measure a woman's hormone levels. These tests can be flawed because hormone levels vary throughout the day.

Warnings

• Women considering bioidentical hormone therapy using products from a compounding pharmacy should understand that many of these pharmacies are not FDA-approved. When selecting a pharmacy, check it out first through the Pharmaceutical Compounding Accreditation Board.

  Hormone-replacement products from these pharmacies are not standardized, so there is no testing and no requirement to report any adverse side effects. In most cases, a custom product is not necessary unless a woman is allergic to a specific ingredient in the standardized formulations. In such a situation, a doctor would recommend a customized formula and then monitor the patient's response to it.

Misconceptions

• Many claims about the benefits of bioidentical hormone replacement therapy have not been proved. Common promises include dramatic weight loss, increased energy and protection against breast cancer, Alzheimer's disease and heart disease. Some companies claim their products are safer and more natural than synthetic formulations.

  Because few studies have been conducted, there is no research basis for these statements. The FDA has fought manufacturers over such statements because they may lead women to believe bioidentical hormones are perfectly safe with no potential for harmful side effects.

Side Effects

• According to the Endocrine Society, bioidentical hormones have the same benefits as synthetic hormones. They also have the same side effects. Bioidentical hormone replacement has been linked to increased risk of breast cancer in some studies. In Australia, it has been linked to some cases of endometrial cancer. Other potential side effects may include stroke or heart attacks.

  Until more research has been performed, claims of superior performance or safety are unfounded and should be considered anecdotal at best. Women who need hormone replacement therapy should discuss bioidentical hormones with their doctor and follow her guidance. Any form of hormone replacement should be taken in the smallest dose possible for the shortest time possible to minimize the chances of undesirable results.