If you’re searching for alternatives to traditional hormone replacement therapy (HRT) for your menopause symptoms, then you likely have come across the term “bioidentical hormones.” But what exactly are they? How do they differ from traditional HRT? Are all bioidentical hormones equal? And are they safe? In this article, we’ll clear up the confusion and give you all the information you need to know to make healthy and safe decisions for your body.
What are bioidentical hormones?
According to the Mayo Clinic, bioidentical hormones are chemically and molecularly identical to those our bodies produce. Examples include 17 beta-estradiol, estrone, and estriol and come from many sources, including the phytoestrogens we cover in our article on the ingredients in our supplements.
How are they made?
Contrary to popular belief, bioidentical hormones and therapies are almost always produced in laboratories, even though they are often labeled as “natural” ingredients. In this situation, “natural” simply means that the hormones have an animal, plant, or mineral source and does not reflect how they are synthesized into medicinal products.
Natural doesn’t always mean biodentical…
Just because a hormone therapy is natural, moreover, does not make it bioidentical. Premarin, the most commonly prescribed HRT, comes from the natural source of pregnant mare’s urine — but it’s not bioidentical, because equine estrogen has a different molecular structure than human estrogen. Not even all natural HRTs from plant sources are bioidentical: Cenestin is an example.
What forms can they take?
Many women assume that bioidentical hormone therapy must be made in a compounding pharmacy, but, in fact, many FDA-approved hormone therapies are made of bioidenticals. You can find a full list of FDA-approved therapies here, courtesy of the North American Menopause Society (NAMS).
These HRTs can take a number of forms: from pills to patches, creams to vaginal gels. In fact, how you take an HRT matters almost as much as what HRT you take. When bioidentical estradiol is taken in pill form, for instance, the liver converts it to estrone, a weaker form of estrogen; when delivered through a patch or cream, however, the estradiol is absorbed directly into the bloodstream and therefore more potent. At the same time, because it bypasses the liver, it avoids stimulating proteins associated with increased risk of heart attack and stroke.
“Designer” treatments are not the safest option…
While some women prefer custom compounds because they are designed specifically for them, it’s important to note that compounding pharmacies are subject to fewer regulations and therefore not always the safest option. NAMS warns that many compounding pharmacies determine the levels of hormone to include in their preparations by taking saliva or blood tests — despite the fact that menopausal women’s hormone levels can vary not just day to day but within the hour! Moreover, it has been reported that some doctors have tested bioidentical compounds and discovered the hormone levels to be dangerously high.
Are bioidenticals safer?
The simple truth is that we don’t know. No long-term, large studies have been done on bioidenticals to prove definitively that they are better than synthetic hormones. This doesn’t mean that bioidenticals aren’t better; it simply means that the evidence isn’t there yet.
Is BHRT right for you?
Bioidentical hormones are one of many possible options available for hormone replacement therapy. Now that you’ve got all the information about them, you and your doctor can decide if they’re right for you.
- “Bioidentical Hormones: Are They Safer?” Mayo Clinic, 19 January 2018.
- Harvard Women’s Health Watch (HWHW), “What Are Bioidentical Hormones?” August 2006.
- Rose George, “What Science Doesn’t Know About the Menopause: What It’s For and How to Treat It,” Guardian, 15 Dec 2015.
- Harvard Women’s Health Watch (HWHW), “Bioidentical Hormones: Help or Hype?” September 2011.
Sara A. Murphy is a freelance writer and editor with a PhD from Columbia University. She has written on a variety of topics, including health and fitness, travel, and social justice; she also edits both fiction and non-fiction. You can reach her at Sara.A.Murphy@gmail.com.