Bioidentical hormones are plant-derived hormones that are marketed as an alternative to conventional hormone replacement therapy for menopausal women. They are synthesized from chemicals found in soybeans and yam and are not found in nature. There is no solid evidence that they are safer than FDA-approved HRT drugs, and some doctors believe they may carry the same risk as their synthetic counterparts.
Bioidentical hormones are plant-derived hormones that are being promoted as an alternative to conventional hormone replacement therapy (HRT) for menopausal women. As the name suggests, they are assumed to be identical to hormones produced in human females in terms of their molecular structure. However, even though bioidentical hormones are obtained from plants, they are not found in nature. Instead, they are synthesized from chemicals found in soybeans and yam.
Specifically, the bioidentical hormones are 17 beta-estradiol, estrone and estriol, the form of estrogen that decreases as a woman ages. As there is no bioidentical version of progesterone, it is simply micronized and added to the preparation to ensure better absorption. Some formulations are sold as over-the-counter products. They are also compounded, which means they are custom blended by a pharmacist in accordance with a doctor’s prescription.
As one might expect, the availability of bioidentical hormone replacement therapy (BHRT) versus prescription HRT drugs has generated a good deal of public interest, as well as controversy. Certainly, concerns have been raised about the safety of HRT drugs, some of which contain conjugated equine estrogens derived from the urine of pregnant horses. In fact, the sale of these drugs has dropped significantly since two major studies revealed they increase the risk of heart attack, stroke and breast cancer. Unsurprisingly, sales of “natural” bioidentical hormones have been boosted as a result.
In a backlash, the makers of one of the most popular HRT drugs have petitioned the US Food and Drug Administration (FDA) to limit the availability of bioidentical compounded hormones, but to no avail. However, the FDA had already taken note of unsubstantiated claims touted by some pharmacies that BHRT compounds could help prevent strokes, some cancers and Alzheimer’s disease. While the FDA has taken action against the use of these misleading claims, it has not banned the sale of bioidentical hormones. It’s also interesting to note that the term bioidentical has no regulatory definition, meaning it has become a marketing word much like “natural” or “eco-friendly.
In terms of actual safety, there is no solid evidence to indicate that bioidentical hormones are safer than FDA-approved HRT drugs. In fact, some doctors believe they may carry the same risk as their equally synthetic counterparts. There is also the consideration that individually composed formulas cannot be compared to any standard protocol by which to measure safety and efficacy. Finally, there is a school of thought that states that HRT of any kind carries some risks and should only be given on a short-term basis to reduce severe menopausal symptoms.
Until more bioidentical hormone clinical trials have been completed, an intermediate approach may be more appropriate. That said, there are several FDA-approved bioidentical estrogen and progesterone formulas available in various doses and forms that do not require inconsistent composition.
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