Common Questions on Bioidentical Hormone Replacement Therapy

Finding reliable information on healthcare treatments is increasingly difficult. How can you determine which information is reliable, and who can you trust? Often, the best way to get answers to your most important questions is to ask the medical professionals you already interact with on a regular basis — your doctor, your specialists, and your pharmacist. For patients recently diagnosed with hormone conditions, the prospect of taking bioidentical hormone replacement therapy (BHRT) spurs on many questions. You want to know whether your treatment is likely to be effective, whether it will cause side effects, and how exactly it aids your condition in the first place. We’ve created this short guide to answer a handful of the most common questions about BHRT.

Bioidentical Hormones and Synthetic Hormones – What’s The Difference?

Bioidentical hormones more closely match the molecular structure of human endogenous hormones (e.g. hormones produced within the body), whereas synthetics contain slight structural differences that influence how your body metabolizes and uses the substance. BHRT may be easier for the body to utilize and recognize, leading to better treatment outcomes.

Whether or not synthetics or bioidenticals work best for you depends on a few things, including:

• your condition
• how you respond to your treatment
• your overall treatment goals

Often, a period of trial-and-error is required to get treatment “just right.” Achieving the right balance often takes several weeks.

What Does the Research Say About Effectiveness?

To answer this question, we looked at multiple studies into the effectiveness of bioidentical hormones, both alone and compared to synthetics. Here’s what we found:

• This study concluded that “bioidentical progesterone does not have a negative effect on blood lipids or vasculature” in the same way as synthetic progesterone sometimes does. Ergo, the author believed there was sufficient evidence to support using bioidenticals over synthetics.
• This study from the Mayo Clinic identified a significant benefit to women going through menopause through compounded BHRT because they “provide practitioners the option to prescribe HT for women who cannot tolerate FDA-approved products.”
• This study supported that women given BHRT for symptoms of menopause (specifically, irritability) did, in fact, experience a reduction of symptoms within six months of initial treatment
• This study indicated a potential connection between endogenous estradiol (produced by the human body) and a reduction in breast cancer cells. Because BHRT more closely matches endogenous hormones, this could potentially open up the floor to future breast cancer treatments. Researchers continue to investigate the protective effects of endogenous estradiol.

It is important to note that hormone treatments of any kind are not without risk. Though current research does support the use of BHRT, especially in special situations where non-commercial doses or formulations are required, you should always speak with your pharmacist or physician before initiating treatment.

What Are Bioidentical Hormones Made Of?

The exact definition of bioidentical hormones can be confusing, mostly because some patients refer to these products as “natural,” and “natural” can be interpreted in many ways. Though most BHRT supplements do come from nature, not every naturally-sourced hormone qualifies as BHRT.

The main difference between BHRT and synthetic HRT, as mentioned previously, lies in molecular structure. Synthetics aren’t an exact match for your own endogenous hormones, while bioidenticals are an exact match. Research shows the human body may better metabolize, recognize, and utilize bioidenticals, especially for conditions like menopause.

Nearly all bioidential hormones comes from two primary sources: yams and soy. A small number of BHRT products come from other plant and animal sources. Manufacturers and pharmacies extract 17 beta-estradiol, estrone, progesterone, and estriol from these sources and synthesize them into a different delivery format, like powders, pills, creams, or patches.

Is Bioidentical Hormone Replacement Therapy Safe?

Like other forms of hormone supplementation and treatment, bioidentical hormone replacement therapy is relatively safe and effective when prescribed and monitored by medical professionals. Furthermore, there is evidence to show that BHRT may carry a lower overall risk profile than synthetics.

BHRT is still a form of hormone therapy. Taking BHRT may increase your risk of certain serious side effects, including certain cancers, strokes, heart attacks, and other cardiovascular events. However, these risks are associated with hormone treatment as a whole and aren’t necessarily specific to BHRT.

Patients taking BHRT should expect to have their condition monitored, with frequent testing to verify efficacy and hormone levels. Medical oversight from either a physician or pharmacist is also vital to improved treatment outcomes.

Can it Cause Side Effects?

All medications carry the potential risk of side effects, including BHRT. The most common side effects include:

• Tirednesss
• Headaches
• Breast growth
• Breast tenderness
• Issues with mood
• Issues with sex drive (increase or decrease)
• Sweating, hot flashes, or perceived temperature changes
• Memory loss, brain fog, and/or other mild cognitive challenges

Many of these side effects are transient, stopping gradually as the body adapts to hormone treatment over the course of a few weeks. If you find these side effects intolerable, speak with your pharmacist. He or she may recommend a slight dosage change to ameliorate your symptoms.

Are there Any Contraindications?

Yes. Despite BHRT’s excellent safety profile, there are some patients for whom hormone therapy as a whole is contraindicated. The American Association of Family Physicians (AAFP) lists the following as contraindicated conditions:

• Deep venous thrombosis (DVT) and/or pulmonary embolism
• Active liver disease (e.g. hepatitis C; fatty liver disease; liver cancer)
• Arterial thromboembolic diseases, including angina and heart attack
• Allergy or sensitivity to any of the hormones contained in BHRT
• Genital bleeding and/or undiagnosed gynecological conditions
• Cancers of the breast, either current, past, or suspected
• Porphyria cutanea tarda (absolute contraindication)
• Certain rare estrogen-sensitive conditions
• High blood pressure and/or high heart rates
• Endometrial hyperplasia

Ultimately, this list is far from exhaustive. If you aren’t sure whether your health condition allows for bioidentical hormone replacement therapy, ask your pharmacist to review your file. In many cases, BHRT isn’t completely contraindicated; a small dose or format adjustment may ameliorate contraindications.

What About Interactions?

Yes. Hormone therapies mostly interact with the following:

• Other hormone therapies
• Treatments for cardiovascular disease
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroid treatments

However, other interactions are possible. Most interactions are mild and involve a slightly elevated risk for cardiovascular events or mildly uncomfortable symptoms (like nausea).

Tell your pharmacist about all medications and drugs you regularly take, including street drugs, marijuana, cigarettes, and alcohol, to prevent potentially dangerous interactions before they occur.

Getting hormone therapy “just right” often takes time, patience, and repeated testing. A difference in just a few milligrams or micrograms can be the difference between success and failure, and that’s what makes compounded BHRT so unique. When pharmacists can individually tailor your dose down to the microgram, it’s easier to achieve success at the lowest possible dose. When bioidentical hormone replacement therapy does work, it can provide the following benefits:

• Improved mood
• Reduced the symptoms of menopause
• Alleviated thyroid conditions
• A protective effect on the body

If you have questions about whether bioidentical hormone replacement therapy is right for you, schedule a consultation with your pharmacist.