Understanding Bioidentical Hormones

By Barbara Call Bourassa

Millions of women going through menopause are constantly looking for a panacea—that one cure-all which will eliminate their hot flashes, reduce their fatigue, and eliminate their irritability. As a result, bioidentical hormones have received much attention in the media lately. Bioidentical hormones are “chemically matched” hormones that claim to combat the aging process, eliminate headaches, reduce anxiety, improve your memory, increase your libido, get rid of body odor, and fight fatigue. Could they be what menopausal women have been waiting for?

Unfortunately not. These claims are too good to be true, say medical experts from the Food and Drug Administration (FDA), the North American Menopause Society (www.menopause.org), the American College of Obstetricians and Gynecologists (www.acog.org), and the Endocrine Society (www.endo-society.org). These groups have banded together in an effort to educate consumers, dispel the marketing hype around such hormones, and set the record straight on what's true and what's not when it comes to HRT.

It all began in July 2002, when the results of the Women's Health Initiative study revealed that HRT raised the risk of heart disease, breast cancer, stroke, blood clots, and dementia. As a result, millions of women stopped taking traditional prescription forms of HRT. "Many women made a move [off traditional HRT] because they were concerned about their health, but they have gone into the bioidentical market as guinea pigs," says Dr. Wulf H. Utian, executive director of the North American Menopause Society (NAMS) and professor emeritus of reproductive biology and obstetrics and gynecology at the Case Western Reserve University School of Medicine. "The science-based evidence and the medical community are all on the same page: We have a major concern about the bioidentical hormone movement.”

Why are people drawn to bioidentical hormones? A large reason is that that they’re marketed as "custom mixed" to match an individual woman's hormone levels. A doctor or pharmacist tests the patient's hormone levels using a blood or saliva test, then prescribes a unique mixture of estrogen, progesterone, and other ingredients to fit the woman's profile. The prescription is mixed at a compounding pharmacy. It may sound like the perfect thing, but there are several problems with this scenario, say experts. For starters, women's hormone levels change all the time, making the blood and saliva test results questionable, says Utian. "In a normal reproductive cycle, the blood levels of estrogen change from moment to moment and from day to day," he says. For that reason, it's impossible to accurately gauge a woman's hormone levels. Doctors using traditional HRT prescription medications instead prescribe the lowest dose to help relieve menopausal symptoms.

Second, compounded bioidentical hormones are not overseen by the FDA. As a result, "many bioidentical hormone formulations can be inconsistent in dose and purity," says the Endocrine Society's October 2006 Position Statement.

"Essentially, patients are doing an experiment of one," says Dr. Nanette Santoro, a professor in the department of Obstetrics & Gynecology and Women's Health at the Einstein College of Medicine and Montefiore Medical Center in Bronx, N.Y. Women who take bioidentical hormones "are putting an unknown quantity of unknown ingredients in their body," she says. What's more, although no studies have been done reporting the hazards of bioidentical hormones, "this fact is turned around and presented as if this means they are completely safe," says Santoro.

In fact, bioidentical hormones have exactly the same potential risks and benefits of traditional, FDA-approved medications, says Utian. And the claim that bioidentical hormones are more natural because they are derived from plants is also misleading, he notes. Plant compounds are no more natural to humans than mare urine, which is what some traditional HRT medications are derived from.

According to menopause experts, patients need to proceed with caution when it comes to making decisions about hormone therapy. Be wary of marketing claims, ask your doctor plenty of questions, and read as much as you can to be sure you get the complete story about all types of hormones.

For more information on bioidentical hormones, consult your physician and visit www.endo-society.org/news/press/2006/BHLackEvidenceSafetyEffectiveness.cfm