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What is bioidentical hormone replacement therapy and its possible pros and cons?

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Posted by Alex Daly on Aug. 5, 2019

In recent years, bioidentical hormone replacement therapy (BHRT) has received a lot of attention, marketed as a more “natural” and potentially safer treatment option during menopause than the previously popular “hormone replacement therapy” (HRT), which was found to increase the risk for breast cancer and heart disease. 

Bioidentical hormone replacement therapy is a manufactured medical treatment typically used to treat perimenopause (early menopause) and menopause symptoms in women. “Bioidentical” means the hormones in the product are designed to be chemically the same as hormones your body produces. 

Research has shown that BHRT can be effective in treating some symptoms, such as hot flashes and night sweats. 

But many women’s health experts point out that not all BHRT is the same, and the term “natural” is confusing in the world of menopause treatments. 

Read on to learn about the potential benefits and risks of bioidentical hormone replacement therapy, and whether this treatment may be right for you.

What are bioidentical hormones?

Bioidentical hormones are medications that are chemically and structurally identical to the hormones that a woman produces naturally in her body.

There are two types of bioidentical hormones available to consumers: 

  • Pharmaceutical bioidentical hormone products. These medications have been approved by the Food and Drug Administration (FDA), which regulates the quality and safety of these medications.
  • Custom-made or custom-compounded bioidentical hormone products. These medications (sometimes referred to as the compounded version) are mixed at a pharmacy based on a doctor’s instructions. While the individual ingredients in each compound are approved by a doctor and the FDA, the final compound is not FDA-approved. There are no studies that have determined the efficacy, safety, or adverse effects of these medications. 

Why would a doctor prescribe bioidentical hormones? 

Doctors may prescribe bioidentical hormones for patients who are experiencing a hormone imbalance and disruptive menopause symptoms. This hormone imbalance, and the symptoms that follow, is common during menopause. Bioidentical hormones are similar to the hormones produced by the human body, such as estrogen and progesterone. By prescribing bioidentical hormones, doctors can treat the hormonal imbalance and help prevent and treat uncomfortable symptoms. 

When women enter menopause, their hormone levels fluctuate, which can cause uncomfortable symptoms. These symptoms differ for each woman but can include:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Decreased sexual interest
  • Painful sex
  • Trouble sleeping
  • Fatigue
  • Weight gain
  • Brain fog
  • Changes in mood

Studies show that bioidentical hormone replacement therapy can be used to normalize hormone levels in the body and help avoid and alleviate some of these uncomfortable symptoms. 

The North American Menopause Society says that hormone therapy is the most effective treatment for hot flashes and vaginal dryness, but says that if women are suffering specifically from vaginal dryness or painful intercourse, the preferred treatment is a low dose of vaginal estrogen.

How are bioidentical hormones given?

Bioidentical hormones come in a variety of forms including:

  • Oral capsules or pills
  • Patches
  • Creams/gels
  • Shots

If your doctor says BHRT is right for you, you can work together to decide which method is best for you. In terms of dosing, doctors monitor those who are taking hormones very closely as hormone levels fluctuate daily in women’s bodies. Monitoring of this type might mean having to take a blood, urine, or saliva test to check on your levels. Typically, the dosage is kept to a minimum. 

Are bioidentical hormones safe?

The FDA-approved bioidentical hormones have been tested for effectiveness and safety, but compounded hormones have not gone through FDA testing. Little is known about their long-term side effects; the pharmacies that compound hormones are not required to report side effects. 

As is the case with any drug, bioidentical hormones come with their own side effects. Adjusting the dosage or a hormone in the mixture might help minimize the effects of the medication if they are an issue.The most commonly reported side effects with bioidentical hormone replacement therapy are:

  • Weight gain
  • Breast tenderness 
  • Bloating 
  • Mood swings

The FDA says that you should not take any hormone therapy if you: 

  • Have problems with vaginal bleeding
  • Have or have had certain cancers such as breast cancer or uterine cancer
  • Have or have had a blood clot, stroke or heart attack
  • Have a bleeding disorder
  • Have liver disease
  • Have allergic reactions to hormone medicine

Read up on FDA-approved hormone medications for menopause

What are some alternatives to bioidentical hormone replacement therapy? 

While bioidentical hormone replacement therapy may be right for some patients, lower-dose and locally-applied treatments, such as vaginal estrogen, may have several advantages. 

By applying estrogen only where it is needed, in the vaginal area for instance, the impact is minimized throughout the rest of the body. Estrogen cream is particularly effective for atrophic vaginitis, which is common in postmenopausal women and is caused by a drop in estrogen levels. It can cause a number of uncomfortable symptoms, such as vaginal dryness, itching, painful intercourse, as well as urinary and vaginal infections. 

By applying estrogen directly to the vagina, the overall dose can be lower, and circulating blood levels of the hormone aren't raised significantly, minimizing the risk of certain cancers.

If you are experiencing menopause symptoms, doctors and pharmacists are available online to discuss your symptoms, offer advice and, if necessary, send a prescription to your nearby pharmacy. A medical professional will be able to tell you which type of treatment may be right for you. 

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