Bioidentical Hormones: The Truth

Menopause is a natural transition that every woman experiences. It’s also an important stage in a woman’s life, as it marks the end of her reproductive cycle and the beginning of a new chapter. During this transition, women experience various physical, emotional, and psychological changes due to declining hormone levels. You may begin to experience a variety of symptoms such as hot flashes, night sweats, vaginal dryness and itching, mood swings, and decreased libido. To address these symptoms, many women opt for bioidentical hormones – hormones that are made to “mimic” the body’s naturally occurring hormones. Unfortunately, using bioidentical hormones in menopause can have dangerous consequences if not used with caution.
 
Bioidentical hormones are plant-based compounds that are often marketed as being safer than the synthetic estrogens (that are also plant-based, by the way) used in conventional hormone replacement therapy (HRT). However, just because it is “natural” does not mean it is necessarily safe. Here are some of the reasons you should stay away from bioidentical hormones.

Bioidentical hormones are not FDA approved.

These products are not regulated by the FDA and therefore their safety, efficacy, purity, potency, sterility and quality are not guaranteed. They are compounded to give you back what you are “lacking” in a pharmacy that may not be reputable, and do not undergo extensive testing like other hormone replacement therapies. And because of the lack of federal oversight, they are not required to include package inserts or the standard warnings that all approved estrogens provide.

There is no real test for deficiency.

There is no real way to tell how much or how little you need. In order to individualize your compounded hormone regimen, prescribers may recommend salivary hormone level testing. However, there is no evidence the hormone levels in saliva paint an accurate picture. Saliva can be contaminated by blood and bacteria, and levels may vary depending on time of testing, diet and hormone being tested. Overall, your practitioner should be using improvement in symptoms as proof of therapy and these bioidenticals should not be titrated to hormone levels.

Who knows how much you’re actually getting.

As they are not regulated for potency, and they have variable bioavailability and bioactivity (how much becomes available in your body after taking it and how much is used by your body), you may be under- or overdosing on hormones. Certain progesterone preparations used for bioidentical hormones are found in the Mexican wild yam. And while that’s cool and all, they are not actually bioavailable to humans. This means that you may not actually blocking the estrogen effect on your uterine lining, which can lead to hyperplasia and endometrial cancer. In the same vein, if you are underdosing on estrogen, you could run the risk of not protecting against postmenopausal osteoporosis.

Beware of testosterone…

You may be getting hormones that otherwise are also not FDA-approved. I’m talking about testosterone. A lot of people peddle testosterone to help with libido, but testosterone is not FDA-approved for use in menopause treatment. In fact, levels of testosterone do not predict sexual function for women. Use of testosterone can produce acne, enlarge the clitoris, increase body hair (specifically, male pattern hair growth), and deepen your voice. 

Bioidentical hormones are not it.

All in all, while bioidentical hormones may be marketed as a “natural” and “safer” alternative to traditional HRT, they are not regulated by the FDA. And though they may provide relief from some menopausal symptoms, they could pose potentially serious health risks that should never be taken lightly.
 
The best way to determine if hormone replacement therapy is appropriate for you is to have a conversation with your healthcare provider and discuss the potential risks and benefits of all available options. As a nationally certified menopause practitioner through the North American Menopause Society, I always recommend that you find one of us so that you can be informed of the latest, evidence-based recommendations.

About the author: Dr. Sanchez is a Board Certified Obstetrician Gynecologist and Nationally Certified Menopause Practitioner. If you’re in the Miami area and are looking for a new Ob/Gyn to talk to about these topics, you can always make an appointment by calling the clinic or booking online. She explores this and other subjects on her Instagram, so make sure to follow along!

Disclaimer: All content is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis or medication treatment of a qualified physician. Resources listed here do not imply endorsement of any content. Should the reader have any health concerns, promptly seek a consultation with your physician.