Myths Abound About Benefits, Safety of Bioidenticals
In 2008 I wrote a book, A Woman’s Guide to Hormone Health (Bethany Publishing) in which I surveyed the vast information about use, type, benefits and risks of hormone therapy. Probably no other field of medicine was, and to some degree still is, torn over the hormone controversy. Even today, with various large studies available, coherent, consistent, believable information on hormones is scattered and confusing. I want to take a moment and throw some light on the myths and misperceptions surrounding “natural” or “bioidentical” hormone preparations.
First, some definitions. Let’s start by throwing out the term “natural” altogether. It is a confusing term that has no clear meaning. When I refer to “bioidentical” hormones I am simply referring to hormone medications, regardless of their source, that are equivalent to the hormones produced by the ovaries. These include estriol, estradiol, estrone, progesterone and testosterone.
These bioidentical hormones are prescription medicines that treat the symptoms of menopause. They are not miracle pills, panaceas, magic or cheap. Estradiol and progesterone are commercially available and can be found in various forms (creams, pills, gels and patches) in virtually any pharmacy.
The other bioidentical hormones can be mixed and matched and placed in a variety of concoctions (troches, creams, suppositories, capsules, etc.) at a compounding pharmacy.
No Symptoms, No Hormones
The number one, and some would say only, reason for using hormones of any kind is to treat symptoms. The debate rages on as to the utility and safety of hormones for certain symptoms, and it is vital for you to talk with your doctor about your specific situation.
Let me say from the outset that I prefer the bioidentical estradiol and progesterone as I feel that the medical literature supports that there are fewer side effects and better tolerability. However, there is nothing intrinsically evil about “synthetic” hormones. I feel it is valuable to explore and explode a few misperceptions surrounding bioidenticals.
Myth 1: Bioidentical hormones treat more than menopause.
Several compounding pharmacies, some which make a substantial profit from selling bioidentical hormones, have propagated the idea that bioidenticals can do things they absolutely can’t. For example, I have seen ads claiming bioidentical hormone mixtures can help folks lose weight, prevent Alzheimer’s disease, reduce the risk of breast cancer and slow the aging process. These are blatantly false and have no substantiation in the medical literature. In fact, some pharmacies have been shut down or fined by the FDA for making grossly inappropriate claims about the hormones they “compound”.
Myth 2: Compounded hormones are safer than other hormones.
Because compounding pharmacies are not regulated by the FDA nor are their products tested for quality, purity and potency, bioidentical preparations can vary substantially from batch to batch.
Compounding pharmacies buy the hormones from distributors. It is not known how many of the hormones are imported from other countries. No data have been submitted to the FDA to demonstrate that estriol (a commonly used bioidentical) is safe and effective. The FDA stated in 2008 that pharmacies should not compound products containing estriol unless the prescriber has submitted a valid investigational new drug application. Additionally, custom-compounded hormones don’t always inform patients of the “black box” warning carried on all FDA-approved hormone products about increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary embolism and deep-vein thrombosis in postmenopausal women.
The bottom line is that women should consider the risks of bioidenticals the same as other hormones, even though the risks are relatively small.
Myth 3: Salivary testing is better than blood testing to tell a woman “exactly what hormones she needs.”
This was popularized by that “renowned scientist” Suzanne Somers in one of her gaggle of books. There is no scientific basis for using saliva testing to adjust hormone levels. Free serum hormone concentrations in a midlife woman’s body change from day to day depending on diet, time of day, the specific hormone being tested and other variables. The dosing of compounded progesterone is particularly difficult to assess because the levels in serum, saliva and tissue are markedly different. It is not necessary to test hormone levels to treat symptoms.
The take-home message is be a wise consumer, do your homework and talk with your doctor to meet your unique needs.
Dr. Eaker is an Augusta Ob/GYN and author. He and his wife, Susan, have two teenage daughters.