Hot flashes, night sweats, vaginal dryness. Fatigue, irritability, lack of sleep, low libido. Ugghhh. These symptoms start for many women in their 40s and beyond the natural age of menopause at approximately age 51-52 on average. Lets break down this commonly requested bioidentical hormone therapy and find out what it really is and what it is for.
Basically — that catchy word “BIOIDENTICAL” means any hormones that are like the ones your ovaries produce – estradiol, natural progesterone, and testosterone.
This type of hormone therapy is the safest for cardiovascular risk, especially when estradiol is given in non-oral form such as gel or patch — and even breast cancer risk over time may be lower with natural progesterone compared to synthetic counterparts. Synthetics = Premarin (conjugated equine estrogens — yes from horses) and progestins such as norethindrone or medroxyprogesterone.
Natural/bioidentical = estradiol and micronized progesterone (plant and non-animal sources).
Bioidentical hormones (BHRT) can include compounded hormone creams, troches (oral lozenge), and pellets which are non-FDA approved and rely upon the pharmacy compounding the products. The quality of your compounding pharmacy matters. There are other brands available which are bioidentical and FDA approved and so therefore the safety is more well-known. These come in commonly known brands such as Estrogel, Divigel, Minivelle, Elestrin. This doesn’t mean the non-FDA approved options cannot be used, but should be used with caution.
The risks and benefits of whichever method you use should be fully explained and understood. Hormones are not required for every patient. Understand long term goals and purpose. It’s an individualized approach. I have seen many patients inappropriately given hormones through the years — there are reasons they should NOT be used, even if BIOIDENTICAL. Talk to your physician. Make sure you know the credentials of the person doing your hormone therapy and the goals of treatment.
Have an evaluation to find out what your options really are. A board-certified gynecologist should be your go-to for management of hormone replacement therapy.