What's HRT? What's the difference between traditional and bioidentical? Why are women so opinionated about the choice?
Hormone Replacement Therapy (HRT) used to be routinely prescribed for women in peri and menopause, but due to emerging information about the potential health risks of hormone therapies, HRT is now being used much less.
But before we get into why, let’s first talk about what HRT is and how it’s used.
What is HRT?
Hormone replacement therapy is a preparation of female hormones that “replaces” the ones that the body no longer produces during and after menopause. The idea behind HRT is that the symptoms of menopause (hot flashes, anxiety, etc.) can be alleviated by replacing these hormones. And while women who use HRT do see relief, there are risks that outweigh the benefits for many women.
Issues with HRT
About ten years ago, the Women’s Health Initiative study, the most comprehensive study of HRT to date, released its results—and they were shocking. The study noted a huge spike in rates of breast cancer, stroke, and heart attacks, debunking the myth that breast cancer and HRT weren’t linked, and that HRT lowered heart attack risk.
As a result of these issues, there has been a lot of publicity surrounding “Bioidentical HRT.” And more studies have been done.
What is Bio-Identical HRT?
Bioidentical hormones are referring to hormones that are advertised as being safer and better than FDA-approved estrogen and progestogens distributed by pharmaceutical companies because they come from natural plant sources.
Here’s what the Harvard Medical School has to say about bioidentical HRT:
“The interest in a more natural approach to hormone therapy has focused attention on bioidentical hormones — hormones that are identical in molecular structure to the hormones women make in their bodies. They’re not found in this form in nature but are made, or synthesized, from a plant chemical extracted from yams and soy. Bioidentical estrogens are 17 beta-estradiol, estrone, and estriol. (Estradiol is the form of estrogen that decreases at menopause.) Bioidentical progesterone is simply progesterone. It’s micronized (finely ground) in the laboratory for better absorption in the body.
Bioidentical hormone therapy is often called “natural hormone therapy” because bioidentical hormones act in the body just like the hormones we produce. But here again, that tricky word natural muddies the waters. Pregnant mares’ urine is natural, but Premarin is not bioidentical, at least not to human estrogen. The same goes for Cenestin, which is made from plants but is not bioidentical.”
Bioidentical hormones are marketed as safer alternatives because they come from natural sources. But the question remains:
Are They Really Safer?
Despite the marketing claims, bioidentical hormones are not any safer—in fact, they may be riskier, without any added benefits. Even though they are derived from plants, they are still processed and packaged commercially. Also, many FDA-recommended hormones are also derived from plants.
Dr. Oz debunks the myth that bioidentical hormones are “identical” to the ones in our bodies.
“Plant-derived estrogen from soybeans is molecularly very similar, but not identical to human hormones. That’s why I prefer the term “bio-mimetic” to “bioidentical.”
Furthermore, he says that there’s no significant difference between bioidentical and commercially produced hormones:
“It’s basically all the same stuff. In fact, many compounding pharmacies mass produce hormone preparations that are copies of those produced commercially.”
So What’s the Bottom Line?
The FDA now recommends using hormone therapy only in low doses for a short time for severe menopausal symptoms, due to increased risk of breast cancer, heart disease, and stroke.
And while marketers may want us to believe that bioidentical hormones are more natural and therefore safer than FDA-approved hormones, the truth is that there’s no significant difference between them. If your doctor recommends hormone therapy, ask for an FDA-approved naturally-derived hormone. And be sure to exercise, since exercise can reduce your risk of stroke and balance out the added risk from the hormones.
Talk to the professionals that are supporting you in dealing with menopausal symptoms. This article is a snapshot of thinking at the current time. It provides context and information that is available publicly, to inform your thinking. Nothing should be a substitute for the counsel of the professionals who know you and your body. HFD doesn’t advocate for a particular treatment. Every woman makes her choice.