The Comprehensive Guide to Bioidentical Hormones: Dispelling Myths and Understanding Facts

Bioidentical hormones have become a focal point in the medical community, particularly in the realm of women's health post-menopause. These compounds, which share the same chemical and molecular structure as endogenous human hormones, are often contrasted with synthetic or nonbioidentical hormones, which are structurally dissimilar from endogenous hormones. 

The rise of bioidentical compounded hormone therapy (BCHT) in the United States has been significant, largely due to the increasing concerns of women about conventional hormone therapy. This trend has been particularly noticeable since the publication of the Women's Health Initiative clinical trials. However, it's essential to understand that while BCHT offers certain advantages, it is not a panacea for hormone therapy.

Contrary to some claims, there is no scientific evidence to support the notion that BCHT reduces the risk of breast cancer, coronary artery disease, stroke, or thromboembolism. Therefore, it's crucial to dispel myths about the use of compounded hormones and provide accurate information about BCHT.

One common misconception is that "bioidentical" means "natural." However, the term "bioidentical" refers to the structure of hormones, not their source. Bioidentical hormones and endogenous hormones share the same chemical and molecular structures. On the other hand, "natural" refers to the source of hormones. For instance, phytoestrogens are plant-derived, "natural" estrogens found in soy products. These phytoestrogens are structurally dissimilar to endogenous human hormones, resulting in weak receptor binding and modest clinical effects.

Another misconception is that "custom-compounded hormone therapy" is synonymous with "bioidentical hormone therapy" (BHT). In reality, bioidentical hormones can be obtained via custom-compounded formulations or standardized, commercially available, FDA-approved products. Custom-compounding is one way to obtain bioidentical hormones, but patients and providers may choose other alternatives, such as FDA-approved formulations.

It's also important to note that the concept of a completely safe hormone is a myth. All hormones can cause side effects. Therefore, it's advised to assume that if the active ingredients are similar, whether the hormone is from a compounding pharmacy or not, it should have a similar side-effect profile.

Lastly, it's a common belief among women that all prescription hormones are "synthetic." This is not true. Conventional (FDA-approved) products are available as both nonbioidentical (synthetic and nonhuman) hormones and bioidentical hormones.

In conclusion, while bioidentical hormones offer certain advantages, they are not a panacea for hormone therapy. It's crucial to dispel myths and provide accurate information about these hormones to ensure that women can make informed decisions about their health.

Now, let's delve deeper into the world of bioidentical hormones.

The History of Bioidentical Hormones

Bioidentical hormones have been around for years, as suggested by historical accounts of older women consuming young women’s urine to preserve youth. Bioidentical hormones were previously available as injectable preparations to avoid destruction by gut enzymes. Bioidentical preparations may now be delivered via oral, transdermal, or vaginal routes. Synthetic, or nonbioidentical hormones, were initially developed to enable oral hormone absorption and have been widely used for menopausal symptoms until recently.

The Controversy Surrounding Bioidentical Hormones

Bioidentical hormone therapy (BHT) is a controversial topic because of the mistaken belief that BHT is synonymous with “bioidentical compounded hormone therapy” (B

CHT). BHT is a broad term that encompasses BCHT, or custom-compounded hormones, as well as the non-compounded, US Food and Drug Administration (FDA)-approved bioidentical prescription hormones. The individualization of hormone therapy with salivary hormone measurements, which has made BCHT popular, has not been well researched. Also, the claim that BCHT is safer than conventional hormone therapy (CHT) with regards to breast cancer and cardiovascular outcomes is unsubstantiated.

The Role of Bioidentical Hormones in Women's Health

Menopausal women may experience hot flashes, vaginal dryness, mood changes, compromised cognition, sexual problems, and fatigue. Health care providers often prescribe hormones for these symptoms. Hormone therapy (HT), containing estrogen with or without progestogen, is the most effective therapy for menopausal symptoms. However, decisions about hormone therapy have become challenging because concerns about the safety of hormones have surfaced in recent years. 

The Impact of Bioidentical Hormones on Heart Health

HT had been considered to be invariably favorable for the prevention of coronary heart disease and stroke, but now it is known to be harmful if initiated in older women many years after menopause. Studies have shown that oral combined hormone therapy did not decrease coronary heart disease (CHD) events in women with pre-existing CHD. In another study, oral estradiol (E2) did not reduce mortality or stroke recurrence in women with pre-existing cerebrovascular disease. 

The Women’s Health Initiative (WHI) study randomized 16,608 postmenopausal women to combined hormones versus placebo and showed that women who were given conjugated equine estrogens plus medroxyprogesterone acetate (MPA) had an increased risk of breast cancer, coronary heart disease (nonfatal myocardial infarction and CHD death), stroke, and venous thromboembolism. In response, millions of women stopped hormone therapy.

Conventional hormone therapy (CHT) in the United States has traditionally utilized synthetic or nonbioidentical hormones. However, with rising concerns over the side effects of CHT, alternatives are becoming popular. Of these, bioidentical hormones, sometimes incorrectly referred to as “natural hormones,” have gained favor among women. 

Bioidentical hormones have been around for years, as suggested by historical accounts of older women consuming young women’s urine to preserve youth. Bioidentical hormones were previously available as injectable preparations to avoid destruction by gut enzymes. Bioidentical preparations may now be delivered via oral, transdermal, or vaginal routes. Synthetic, or nonbioidentical hormones, were initially developed to enable oral hormone absorption and have been widely used for menopausal symptoms until recently.

Bioidentical hormone therapy (BHT) is a controversial topic because of the mistaken belief that BHT is synonymous with “bioidentical compounded hormone therapy” (BCHT). BHT is a broad term that encompasses BCHT, or custom-compounded hormones, as well as the non-compounded, US Food and Drug Administration (FDA)-approved bioidentical prescription hormones. The individualization of hormone therapy with salivary hormone measurements, which has made BCHT popular, has not been well researched. Also, the claim that BCHT is safer than conventional hormone therapy (CHT) with regards to breast cancer and cardiovascular outcomes is unsubstantiated.

In conclusion, while bioidentical hormones offer certain advantages, they are not a panacea for hormone therapy. It's crucial to dispel myths and provide accurate information about these hormones to ensure that women can make informed decisions about their health.