Menopause is a state of transition for women and should be embraced as a time of change. No two women experience symptoms of menopause the same and that is why Naturopathic Medicine excels at recognizing which approach to utilize for each individual’s transition. There are many ways to address symptoms of menopause including diet and nutrition, botanical medicine, acupuncture, homeopathy, and hormone replacement therapy.
Bioidentical Hormones are hormones that are derived from plant substances that are an exact chemical duplicate of the hormone made by the human body. This is different than synthetic, or non-bioidentical in that the chemical structure is an analog or “look alike”, compared to the natural one produced in the body. The slightest difference in the molecule or chemical configuration can produce a different response to its counterpart. Because bioidentical hormones are indistinguishable, they produce the same physiologic response as the natural hormone found in the human body. Compounding pharmacies utilize substances such as yams and soybeans to chemically derive the bioidentical hormones like estrogen (estrone, estradiol, estriol), progesterone, testosterone, pregnenolone, and dehydroepiandrosterone (DHEA). Russell Marker, a chemistry professor in the 1930’s, discovered this process. These pharmacies can compound different delivery systems for patients including creams, capsules, troches, and suppositories. Each delivery system changes the dosage and timing of administration due to the amount of hormone you are trying to deliver to the system for optimal results. The benefit to having these formulations compounded is that they can be started with a low dose and titrated up, customizing them for each individuals presenting symptomatology.
Bioidentical Hormones are not only used for menopause but are used for a variety of ailments such as hormone imbalances (PMS, Fibroids, Endometriosis, etc), migraines, osteoporosis, arthritis, threatened miscarriages, low libido, and hypogonadism. A formula is created by a physician for an individual based on lab values and symptomatology. Prescribing physicians take in account those that are not candidates due to family history of estrogen dominant cancers. For those that are not good candidates there are still numerous options for treating symptoms relating to hormone imbalances. Although, various over the counter products are available that include bioidentical hormones, it is important to seek out a physician that can discuss various options and create a formulation that is specific for you and your needs.
Is BHRT Safe?
A question that arises for many: “Is Bioidentical Hormone Replacement Therapy (BHRT) safe and what is the difference between natural verses synthetic?” There are several factors to address when accessing if BHRT is safe for you and that is why a physician skilled in prescribing these compounds is important to include in your treatment plan.
The safety profile of BHRT is complex due to the limited studies available to evaluate individuals utilizing this therapy for long term. In theory, it makes sense that these compounds are safer on the body compared to its counterpart. A meta-analysis was published by Holtorf in 2009 stating, “Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly”. Overall the side effects of bioidentical hormones are less than the synthetic and produce more positive therapeutic outcomes. However, it is still unclear if any potential harm can be produced by the administration of BHRT. It is important to understand that natural does not always mean safe or better.
To understand the difference between natural verses synthetic, it is best to define the following terms:
Natural: existing in or caused by nature; not made or caused by humankind.
Bioidentical: having the same molecular structure as a substance produced in the body.
Synthetic: made by combining different substances; not natural, man made.
When discussing various hormones using these terms it can become confusing. For example, it could be rightfully argued that Premarin (conjugated estrogen), a commonly prescribed non-bioidentical, synthetic estrogen is natural because it comes from pregnant horse urine. However, Premarin’s negative effects in the human body are very different than the effects of bioidentical estrogen due to the difference of molecular structure.
Bioidentical Hormone Replacement Therapy is currently considered a safer alternative to non-bioidentical hormone replacement. That said, there are still some potential risks associated that should be understood. It is best to integrate several strategies when promoting health and longevity, including nutrition, exercise, botanical medicine, nutraceutical supplementation and recognizing the mind-body connection. Remember through each transition in life to embrace the change and find therapies that suite your individualized needs.