BIO-IDENTICAL HORMONE REPLACEMENT

Bio-Identical Hormone Replacement Therapy (BHRT) is the therapeutic use of plant-based hormones that are identical on a molecular level with those created by the human body. Hormone pellets are often the preferred method of delivery and have benefits over other formulations, such as creams or orals. Sustained, consistent release of hormones from pellets over time is considered an advantage over the fluctuations that can occur with other formulations.

Bio-Identical Hormone Replacement Therapy (BHRT) is the therapeutic use of plant-based hormones that are identical on a molecular level with those created by the human body. Hormone pellets are often the preferred method of delivery and have benefits over other formulations, such as creams or orals. Sustained, consistent release of hormones from pellets over time is considered an advantage over the fluctuations that can occur with other formulations.

Optimizing Hormones

The desired effect of BHRT in women includes:

• Decrease vasomotor symptoms, including hot flashes and night sweats, often considered to be the cardinal symptoms of menopause
• Prevent osteoporosis
• Minimize physical symptoms, such as vasomotor symptoms (night sweats, hot flashes and flushes) and vaginal dryness
• Reduce metabolic and structural changes such as bone loss, skin thinning, fatty replacement of the breast, changes in blood lipids, and atrophy of the bladder and urethra

Conventional hormone therapy vs. bioidentical hormone therapy

Compounded bioidentical hormones are advertised as being a safer, more effective, natural and individualized alternative to conventional hormone therapy. However, these claims remain unsupported. Also, the lack of FDA oversight for compounded hormones generates additional risks regarding the purity and safety of compounded bioidentical hormones. Although custom hormone combinations often include blends of the same ingredients found in FDA-approved bioidentical hormones, some include additional hormones. These additional hormones have not had adequate testing and are not included in any FDA-approved products.

Who shouldn't take bioidentical hormones?

Using any type of hormone therapy is a decision made between you and your healthcare provider after carefully weighing the risks and benefits. Bioidentical hormones have been controversial, and many are not FDA-approved, but that doesn't mean your healthcare provider will rule them out as a treatment option.

If you've had or are at high risk for the following conditions, hormone therapy may not be safe:

• Blood clotting disorders.
• Heart or cardiovascular disease.
• Breast cancer.
• Stroke.

Why are bioidentical hormones used?

The levels of certain hormones in your body go down with age. These hormones include estrogen, progesterone and testosterone. Some common effects of low hormones include:

• Hot flashes.
• Night sweats.
• Vaginal dryness.
• Loss of interest in sex or painful intercourse.
• Problems sleeping.
• Loss of energy or fatigue.
• Weight gain.
• Mood changes.
• Memory loss or confusion.

Replacing these lost or low hormones is the goal of bioidentical hormone therapy or conventional hormone therapy. Once hormone levels are increased, most people see their symptoms improve. However, there is not much evidence to support that bioidentical hormones are equal to conventional hormone therapy. Your healthcare provider can discuss your options for hormone replacement with you based on your symptoms and health history.

How common are bioidentical hormones?

One study suggests that approximately 1 to 2.5 million women in the U.S. over age 40 are using compounded bioidentical hormones.

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How are bioidentical hormones given?

Bioidentical hormones come in many forms. These include:

• Pills.
• Patches.
• Creams.
• Gels.
• Shots.
• Implanted pellets.

Your healthcare provider will decide which method is best for you. You may try more than one way before you find one that works well for you.

How does my healthcare provider select my dose?

People on hormone treatment are watched very closely by their healthcare providers. The goal is to relieve symptoms with the lowest dose possible for the shortest amount of time. Depending on your healthcare provider, you might have routine blood, urine or saliva tests to check your hormone levels. Your healthcare provider may adjust your dose based on your changing hormone needs.

The FDA recommends against using hormone levels to guide the dosing of hormone therapy in women, as normal levels fluctuate day to day. In particular, salivary hormone levels are known to fluctuate and have not been shown to be related to menopausal symptoms.

How long does it take for bioidentical hormones to start working?

The amount of time it takes for bioidentical hormones to work varies. Some people may feel mild relief within a few weeks. Most of the time, it takes about three months to feel the full effect of any type of hormone therapy.

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RISKS / BENEFITS

What are the risks of bioidentical hormones?

It has been shown in research studies that there are risks to taking hormones. It can increase the risk of blood clots, stroke, and gallbladder disease. Your risk of heart disease and breast cancer may also increase if you are older or use hormonal therapy for an extended period. Many healthcare providers who use bioidentical hormones claim they are safer than traditional hormone therapy treatments. But there have been no large research studies of bioidentical hormones to show evidence of this.

Are bioidentical hormones safe?

The bioidentical hormones that are approved by the FDA have been tested for safety. They have passed the FDA's strict standards and are safe for people to use. Like all hormone treatments, there are risks involved. You should weigh the pros and cons of even the FDA-approved bioidentical hormones with your healthcare provider.

Are compounded bioidentical hormones bad?

There are risks to taking compounded bioidentical hormones, but in some cases, they may be a better choice. Compounded bioidentical hormones are not FDA-approved. They are not tested for safety or effectiveness. Many major medical groups do not support using them because not enough is known about their safety and long-term side effects.

What are the side effects of bioidentical hormones?

When the FDA approves a drug, the drug company must report any side effects they are told about. These side effects are included in the paperwork you get when you pick your medication up at the pharmacy. Pharmacies that compound hormones do not have to report drug side effects to the FDA or provide paperwork. This contributes to the myth that compounded hormones are safer when healthcare providers don't know all of the possible side effects of these hormones.

Side effects can occur, especially after the first dose. Your body is not used to the new level of hormones. Many side effects get better as the body adjusts to the new level of hormones. In some cases, the dose may need to be changed.

Some common side effects of bioidentical hormones include:

• Weight gain.
• Blurred vision.
• Tiredness.
• Acne.
• Increased facial hair.
• Headaches.
• Breast tenderness.
• Spotting.
• Cramping.
• Bloating.
• Mood swings.

You may itch or get red around the area where you apply your hormones if you use a patch, cream or gel.

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