Bioidentical Hormone Replacement
In her book, The Sexy Years, Suzanne Somers has made the term "bioidentical hormones" a household word. In this book she describes the positive impact of bioidentical hormones on her life in relieving menopausal symptoms despite warnings against using them given her history of breast cancer. What are bio-identical hormones and what is their role in hormone replacement therapy?
What exactly is bioidentical hormone?
Bioidentical hormones (BH) are hormones that are made with the exact same
molecular structure as those hormones naturally produced in our body. This has nothing to do with whether or not they are made from "yams" or are "natural" - rather it means that
they are manufactured as the identical chemical structure produced in the human body. Many other types of synthetic hormones are made intentionally different so that the drug company
can obtain a patent on a novel structure. Currently many drug companies have caught on to the appeal that BH's have for a growing number of women in the United States, and there are
certain formulations that are "bio-identical." Nevertheless, it is important to individualize therapy to achieve maximum symptom relief at the lowest dose possible.
Are bioidentical hormones better for you than the synthetic type?
Although it makes logical sense that the human body would react better to BH's and that the metabolism of these products would be superior compared to non-identical hormone products, there is very little data to support this claim. The largest study to date, the Women's Health Initiative, conducted a study comparing the risks and benefits of hormone replacement therapy in thousands of women. This study was based on synthetic hormones and thus the results may not necessarily apply to use with BH's, however, most researchers and medical professionals warn that the adverse effects must be assumed to apply to BH's as well.
WHI Study
The Women's Health Initiative is one of the largest US prevention studies designed to look at the effects of Hormone replacement therapy (HT), diet modification, and vitamin and mineral
supplements. Over 16,000 women were involved in the HT arm of the study and after nearly 6 years, the study made the following conclusions:
What were the risks of using HT?
For every 10,000 women taking Prempro (the synthetic hormone preparation used in the study) each year:- 8 more women will develop breast cancer
- 7 more women will have a heart attack or other coronary event
- 8 more will have a stroke
- 8 more will develop a blood clot in their lungs compared to women not taking HT.
What were the benefits?
For every 10,000 women taking Prempro there would be:- 6 fewer cases of colorectal cancer
- 5 fewer hip fractures each year
Prior to the WHI study in 2002, most studies of hormone therapy (HT) in postmenopausal women showed that it had a positive effect on heart disease. The WHI study was designed to be a placebo-controlled, prospective, randomized trial that would definitively establish the value of HT in the treatment of post-menopausal women. The conclusions of the study, contrary to expectations, showed small increases in both cardiovascular disease and breast cancer among the women in the HT treatment groups.
Many physicians began to counsel their patients to stop their HT regimens as a result of this study, stating that HT was placing them at increased risk for heart disease and breast cancer. Many women were put in the position of either stopping their HT and living with the uncomfortable symptoms of menopause, or staying on HT potentially increasing the risk of developing a serious medical condition.
Dr. Leonard Rogatis, PhD, wrote an interesting review of the study conclusions. He noted that once medical professionals and researchers began reviewing the conclusions of the report and the design of the WHI study, there appeared to be some flaws that put into question many of the recommendations against the use of HT in post-menopausal women.
Some of the flaws in the study design include the following:
- the women in the study were disproportionately older (63 years) than the age of women who typically enter menopause (51 years);
- these women had never been on any type of hormone regimen prior to the study
- the particular HT regimen chosen to be used by the study participants had never been demonstrated to prevent cardiovascular disease in previous studies that did show cardiovascular benefit.
He concluded that these facts may not change the findings of the WHI study, but they render the findings much less relevant for most postmenopausal women.