Oprah takes them, so does Suzanne Somers. But are bioidenticals any safer than synthetic hormones? The North American Menopause Society and American College of Obstetrics and Gynecology warn that the claims made by proponents can't be backed up by science. So what should you do? New York City gynecologist, Dr. Laura Corio, explains the facts and explores the controversy behind bioidentical hormones.
My patients frequently ask me if hormone therapy can help relieve their perimenopausal symptoms. Often, the answer is yes, especially hot flashes, night sweats, insomnia, menstrual migraines and out of control periods. For the past 27 years I have been prescribing bioidentical hormones -- rather than synthetic hormones -- even though they are not approved by the FDA. Here are the facts about bioidenticals and why I think any women considering hormone therapy should also consider asking her doctor about bioidenticals.
What are bioidentical hormones?
Bioidentical hormones are manufactured in a lab or pharmacy to have the same molecular structure as the hormones a menstruating woman makes in her own body. Available by prescription and over-the-counter, they are derived from soy and other plant based sources. Their big advantage is that they provide a more customized dose than the FDA-approved synthetic hormones. Since drug companies can't patent a bioidentical structure, they invent synthetic hormones that are patentable and which come in predetermined combinations and dosages (Premarin, Prempro, and Provera being the most widely used).
Why do you prescribe them?Not everyone walks into a store and buys the same dress. Well, it's the same with hormones. Based on blood tests, saliva tests and the symptoms you've been experiencing, your doctor can individualize your prescription so you get as much or as little of each hormone as you need. And, if your symptoms aren't alleviated the first time around, your doctor can adjust the formula until it is right. My patients do very well on bioidenticals. They report less bloating, weight gain and breast soreness compared to the synthetics while experiencing greater relief from the symptoms of perimenopause -- and I haven't seen any adverse side effects in all the years I have been prescribing them. The worst issue my patients report is abnormal bleeding but this can also be a normal consequence of perimenopause so it's sometimes difficult to place the blame squarely on hormone therapy.Are they safe?The argument against bioidenticals is that they remain unregulated: They haven't been tested for purity, potency, efficacy or safety and may contain unknown contaminants. If your doctor uses a well established, reputable pharmacy that specializes in bioidenticals, I believe these issues cease to be a concern. The concerns I do have are more about hormones in general. No matter what type you are on, hormones are hormones. The fact that you are taking bioidenticals doesn't mean you won't increase health risks, as was the case with women who participated in the large Women's Health Initiative study. In this trial, women were given combined estrogen and progestin for preventing later-in-life health conditions but it was halted in 2002 because hormone users were found to have a higher risk of breast cancer, heart disease, stroke, and blood clots than nonusers. Though the added risks were small, many women and their clinicians concluded they must discontinue hormone therapy. (It's worth noting that once the women discontinued hormone use, their symptoms returned with a vengeance.) So if you are on hormones, bioidentical or otherwise, you still have to be watched carefully by your physician, address any symptoms and side effects immediately and do frequent breast checks and testing.
Who should take them?In the case of the Women's Health Initiative, the majority of participating women were postmenopausal and I believe this is part of the reason the researchers found a significant increase in the risk of certain cancers and cardiovascular conditions - because the no longer enjoyed the same protective effects from naturally occurring estrogen as premenopausal women, they were at greater risk to begin with. For this reason, I recommend hormone treatment only be prescribed to perimenopausal women -- never to any woman who is postmenopausal. Although there is still a slight increased health risk for younger women, I actually think hormone therapy offers some preventative benefits especially for the heart, brain and bones. It is my opinion that most women feel better and experience fewer woes on bioidenticals. Obviously, whatever you decide, it's unwise to self treat; you should only take hormones under the care of a doctor.Laura Corio is a highly regarded ob/gyn who practices in New York City. She is the author of The Change Before the Change, a book that has helped millions of perimenopausal women. Visit her website: www.obgyn-ny.com.
