Bioidentical Hormones
What are bioidentical hormones?
The term bioidentical refers to hormones that are identical in structure to human hormones. Some people think the term bioidentical means the hormones come from natural plant sources. However, plants do not contain hormones, they actually contain cholesterol-like molecules that can be used to make human hormones in the laboratory.
Are bioidentical hormones new?
Even though people talk about bioidentical hormones as if they were a new type of therapy, they have actually been around for more than two decades. However, endorsements from celebrities like Suzanne Somers and Oprah Winfrey have greatly increased public awareness of bioidentical hormones and bioidentical hormone therapy (BHRT).
Prior to the availability of bioidentical hormones, women with menopause symptoms were given synthetic or animal-source hormones like Provera and Premarin. These non-human hormones have a different chemical structure than human hormones, which is why some scientists believe these hormone therapies led to an increased risk of heart disease and cancer in numerous studies. Bioidentical hormones can be used to replace deficient hormone levels and help restore well-being.
Some types of bioidentical hormones are available 'off-the-shelf' in pharmacies. Estradiol patches and progesterone capsules are examples of bio-identical hormones that can be prescribed by your physician if he or she is uncomfortable with prescribing a custom compounded bio-identical hormone product. Many women prefer the custom compounded bioidentical hormones, but not every woman has access to them, so it is good to know that there are other easy-to-obtain options.
Custom compounded bioidentical hormones are most often made up into creams, capsules or lozenges by specialized compounding pharmacies. In addition to helping women feel better, the advantage of compounded bioidentical hormones is that doses are individualized and multiple hormones can be combined into one product. For example, many compounding pharmacies offer a Bi-Est (bi [two] estrogen) product that is a combination of two human estrogens: estradiol and estriol. Bioidentical testosterone is available 'off-the-shelf (as a capsule)', but in doses too high for women. Therefore, the compounding pharmacist can prepare a more suitably-dosed product; saving both time and money for the patient. Bioidentical progesterone is commercially available in capsules, but here in Canada creams have to be made up by the pharmacist.
Bioidentical hormones sound great, why doesn't everyone use them?
There have also been criticisms of BHRT. Some critics suggest that compounding pharmacies are unregulated. This is false. All pharmacists require a license to practice pharmacy, and knowledge of compounding (mixing) custom prescriptions is part of their training. That being said, it is best to use pharmacists with additional training in compounding hormones when possible. A list of compounding pharmacies can be found on http://www.iacprx.org/ and http://www.pccarx.ca/.
Another criticism of BHRT is that some celebrities and professionals specializing in hormones have implied that BHRT is completely risk-free. That is also false. All hormone therapy has some risk attached; even bioidentical hormones. However, using bioidentical hormones is undoubtedly a better option than using non-identical, non-human hormones. In any other area of hormone replacement, physicians use identical human hormones; so why should the area of women's health be any different?
One more thing to keep in mind with BHRT is that there are two major approaches to using bio-identical hormones. The first approach is: "maintain the hormone levels of youth". The anti-aging physicians use higher doses of hormones to help reach and maintain the hormone levels of youth. Because this approach tends to use higher doses of hormones, it's important to ensure that you are regularly monitored by your physician. The second approach is: "use the minimum dose required to relieve symptoms". The minimum dose approach uses the smallest dose possible to achieve relief of symptoms, which is theoretically safer. It is important to note that all estrogens have the potential to promote cancer-cell growth, so careful monitoring is essential with any form of hormone replacement. Monitoring should include a regular physical exam (monthly self breast exams should be continued) and might also require follow-up testing.
Should I get my hormones tested?
Many pharmacists and physicians believe a hormone test should be ordered before starting any kind of hormone therapy. In all other areas of medicine where hormones are given, tests are ordered before starting hormone replacement (e.g. TSH is measured before thyroid hormones are prescribed) - so why would we give menopause-symptomatic women hormones without first determining if they are needed and in what proportion? If you are concerned or interested in finding out more about menopause-related symptoms, you can check our section on female hormone conditions.
Hormone testing is an important first step in helping your health care provider find out which hormones are right for you. Testing does not provide an exact prescription for hormones, but does help your health care provider determine where you are deficient or where you have high levels of hormones. Our saliva hormone test shows your current hormone levels and compares them to the expected level for your age and menopause state (pre, post, or peri menopausal).
Although menopause is a natural transition, many women experience difficulties with it. Your health care provider is in a unique position to offer lifestyle, non-prescription and hormone solutions to women who experience mild to debilitating symptoms. Please contact your provider or consider contacting someone from our providers listed to direct you to someone who is currently using hormone testing to determine which, if any, bio-identical hormone therapy is right for you.