Good for Oprah…and you? Bioidentical Hormones: Fact & Fiction

Traditional hormone therapy has been used as a treatment for menopause and general hormonal imbalance for decades. However, bioidentical hormones have been gaining popularity due to their more “natural” sources.

In 2002, the Women’s Health Initiative (WHI) conducted a study that found prolonged traditional estrogen and progestin (prescription name Premarin and Prempro) therapy was linked to increased risk of breast cancer, heart disease, and stroke. The results were so startling that the study was ended earlier than planned. Some years later and after further review of the data, the progestin was the main culprit with the risks found in the data in WHI study.

This safety warning contributed to people to looking for alternatives, a major one of which is bioidentical hormone replacement therapy.

In 2009, Oprah Winfrey publicly started using bioidentical hormones, bringing them to the forefront of public conversation.

Winfrey gave her personal testimony on bioidentical hormones, which included improved cognition, focus, and mood. But how much of her personal experience is backed up by clinical trials?

Let’s talk about bioidentical hormones and hormone therapy, as well as the research-backed benefits you can expect.

What are bioidentical hormones?

Bioidentical hormones are mostly derived from plant estrogen, often from yams or soy. These hormones’ chemical and molecular structures, however, are identical to the hormones that our own bodies produce.

This sets them apart from traditional hormone therapy, which uses synthetically crafted versions of hormones. Those searching for a more functional form of medical treatment often turn to these as an effective, more natural therapy for hormone replacement.

When doctors and researchers talk about “bioidentical hormones,” they typically mean these specific forms of estrogen and progesterone.

Below are many of the major brand names of bioidentical hormones available today:

17 beta-estradiol: Estrace, Estring, Estrogel, Estrasorb, Alora, Vivelle
Progesterone (micronized progesterone): Prometrium, Prochieve

Bioidentical hormones can be found in several forms:

Pills
Injection
Transdermal patches
Implanted pellets (inserted under the skin in fatty tissue in the buttock area; or in love handles in men)
Gels
Lotions
Suppositories
Troche (dissolved in mouth)

Bioidentical hormones are used as menopausal hormone therapy, but its uses don’t stop there.

Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy (BHRT) is a more natural alternative to traditional hormone therapy, and it is growing in popularity.

Also called “natural hormone therapy,” BHRT uses man-made hormones mainly derived from plant estrogen (also called phytoestrogen). These hormones are bioidentical because they are chemically and molecularly identical to the hormones the human body already produces naturally.

Because bioidentical hormones are, well, identical to our own hormones, advocates say BHRT is a more natural approach to hormone replacement.

The people who need BHRT are those whose hormone levels are low or imbalanced. This is due to a number of factors, mainly age or menopause.

This treatment often replicates estrogen, testosterone, and progesterone. However, there are other hormones that BHRT may effectively replace.

Bioidentical vs. Traditional

What’s the difference between bioidentical hormone and traditional hormone replacement therapy?

Traditional hormone replacement therapy (HRT) uses synthetic hormone preparations like progestin or equine estrogen derived from the urine of pregnant horses.

Traditional HRT has been linked with an increasing number of health risks, but the risks of not using some kind of hormone therapy are also significant. That’s why many are turning to BHRT.

Bioidentical hormone products are chemically identical (or nearly identical) to the hormones our bodies already produce.

Proponents of BHRT tout the safety and effectiveness of their much more natural approach. Though much of the medical community claims BHRT is not safer than traditional hormone therapy, a few studies find that BHRT is safer.

BHRT Benefits for Women

Bioidentical hormone replacement therapy offers several health benefits for women, particularly postmenopausal women and breast cancer patients.

BHRT use is most common in cases of menopause or perimenopause. Hormone therapy alleviates menopausal symptoms, such as:

Hot flashes
Changes in mood
Issues with sleep
Night sweats
Vaginal dryness
Decreased libido

BHRT improves the quality of life in women who have a hormone imbalance. One study in particular examined women whose hormone levels were imbalanced because of breast cancer.

The study also showed that BHRT relieved breast cancer treatment-related symptoms, like:

Migraines
Incontinence
Insomnia
Loss of interest in sex

That same study concluded that BHRT did not increase these patients’ risk of recurrence of breast cancer.

Hormone therapy relieves symptoms of osteoporosis, a bone disease more common in women than men.

Recent research has talked about how BHRT can improve your skin health, potentially reversing the aging process on your skin.

Animal studies show that BHRT can even improve insulin sensitivity, a promising sign for diabetic women.

BHRT Benefits for Men

Bioidentical hormone replacement therapy is not just for women. Men may reap the benefits of BHRT if their hormone levels are low or imbalanced.

Lower testosterone levels can be due to several risk factors:

Age
Injury to the testicles
Testicular cancer
Infection
Obesity
Type 2 diabetes
HIV/AIDS

Imbalanced testosterone levels may result in a decline of muscle mass. Hormone therapy promotes healthy muscles and prevents loss of muscle mass.

Low testosterone levels can lead to erectile dysfunction, which hormone therapy can often treat.

1 in 5 men will experience osteoporosis in their lifetime. Fortunately, BHRT has treated the symptoms and causes of osteoporosis, including the loss of bone mass.

BHRT Risks and Side Effects

It is controversial whether or not all types of hormone replacements may increase your risk of breast cancer, heart disease, blood clots, and gallbladder disease.

Since you’re adjusting to new hormones in your body, BHRT might come with some side effects:

Acne
Mood swings
Bloating
Weight gain

Women may also experience increased facial hair when adjusting to new hormones in their system, even if they are chemically identical to the hormones you naturally produce.

There are two types of bioidentical hormones, one of which has FDA approval. The FDA has been slow to put bioidentical hormone therapy products to the test.

Bioidentical hormones can also be custom-made by a pharmacy, on doctor’s orders. This is called compounding and is offered by some compounding pharmacies (but not all pharmacies in general).

Compounding and prescribing bioidentical hormones requires specialized knowledge from a doctor familiar with this process. I’ve worked with many patients in this area and would love to discuss the possibilities of this therapy with you during a free 15-minute online consultation.

The FDA has yet to approve any compounded bioidentical hormones. BHRT is individualized for each person. However, on their website, the FDA announced that they began testing compounded products last year.

Always consult your healthcare provider and ask if bioidentical hormone replacement therapy is right for you before you start treatment.

In Summary

Bioidentical hormone therapy is an effective alternative to traditional hormone therapy.
Bioidentical hormones are chemically and molecularly identical to the hormones your body already produces. They are often derived from plant estrogens and progesterone.
The use of bioidentical hormones offers several health benefits, with research to support the following:
- BHRT balances hormones as well as traditional hormone therapy, but with hormones that can already be found in your body.
- BHRT alleviates menopause symptoms.
- BHRT relieves symptoms of breast cancer treatment.
- BHRT improves quality of life in breast cancer patients.
- BHRT improved insulin sensitivity in rats, but reliable clinical trials have not been conducted in humans.
There are several side effects attributed to any hormone therapy, such as acne, bloating, and increased hair growth.
Always consult a healthcare provider before engaging in any hormone therapy.

Sources

Writing Group for the Women’s Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. Jama, 288(3), 321-333. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/12117397
Files, J. A., Ko, M. G., & Pruthi, S. (2011, July). Bioidentical hormone therapy. In Mayo Clinic Proceedings (Vol. 86, No. 7, pp. 673-680). Elsevier. Abstract: https://www.sciencedirect.com/science/article/abs/pii/S0025619611600724
Schierbeck, L. L., Rejnmark, L., Tofteng, C. L., Stilgren, L., Eiken, P., Mosekilde, L., … & Jensen, J. E. B. (2012). Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. Bmj, 345, e6409. Full text: https://www.researchgate.net/profile/Louise_Schierbeck/publication/232225994_Effect_of_hormone_replacement_therapy_on_cardiovascular_events_in_recently_postmenopausal_women_Randomised_trial/links/55a1a5c208ae1c0e04640ff0/Effect-of-hormone-replacement-therapy-on-cardiovascular-events-in-recently-postmenopausal-women-Randomised-trial.pdf
Holtorf, K. (2009). The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?. Postgraduate medicine, 121(1), 73-85. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/19179815/
Fait, T. (2019). Menopause hormone therapy: latest developments and clinical practice. Drugs in context, 8. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317580/
Wiley, T. S. (2015). Bio-identical hormones replacement therapy and the quality of life for breast cancer patients. Abstract: https://ascopubs.org/doi/abs/10.1200/jco.2015.33.28_suppl.87
Abdi, F., Mobedi, H., Bayat, F., Mosaffa, N., Dolatian, M., & Tehrani, F. R. (2017). The effects of transdermal estrogen delivery on bone mineral density in postmenopausal women: a meta-analysis. Iranian journal of pharmaceutical research: IJPR, 16(1), 380. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423263/
White, W. B. (2007). Drospirenone with 17β-estradiol in the postmenopausal woman with hypertension. Climacteric, 10(sup1), 25-31. Abstract: https://www.tandfonline.com/doi/abs/10.1080/13697130601114933
Borda, L. J., Wong, L. L., & Tosti, A. (2019). Bioidentical hormone therapy in menopause: relevance in dermatology. Dermatology online journal, 25(1). Abstract: https://www.ncbi.nlm.nih.gov/pubmed/30710894
Alonso, A., Fernández, R., Moreno, M., Ordóñez, P., González-Pardo, H., Conejo, N. M., … & González, C. (2006). Positive effects of 17β-estradiol on insulin sensitivity in aged ovariectomized female rats. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(5), 419-426. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/16720737
Fui, M. N. T., Dupuis, P., & Grossmann, M. (2014). Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian journal of andrology, 16(2), 223. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/
Horstman, A. M., Dillon, E. L., Urban, R. J., & Sheffield-Moore, M. (2012). The role of androgens and estrogens on healthy aging and longevity. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 67(11), 1140-1152. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636678/
Center for Drug Evaluation and Research. (2018, September 26). FDA announces new compounding research projects. Full text: https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-new-and-expanded-compounding-research-projects