The Safety of Bioidentical Hormones

As someone with a passion for antiaging, the issue of whether or not to use hormone replacement therapy from menopause is a concern to me. While it has helped improve the lives of many women, conventional HRT has also been linked to increased risk of cardiovascular problems, some cancers and even cognitive decline. But can bioidentical hormone replacement therapy, which is heavily promoted by celebrities such as Suzanne Somers, be a better alternative?

Black cohosh, one of our herbal treatments
for menopause. Source: H. Zell

Evidence discussed in an article from The Journal of the American Osteopathic Association suggests that yes, bioidentical HRT could be safer, and possibly more effective, but only when prescribed properly. For example, research on 17beta-oestradiol, the most studied bioidentical hormone, found that 1mg of this hormone (with 2mg of drospirenone) improved perfusion in women with angina compared to placebo, where perfusion actually worsened. This goes against the idea that all HRT has negative effects on cardiovascular health. Another positive effect of 17beta-oestradiol is that it could protect against osteoporosis, though the correct dosage has been debated. One study had found that a daily dose of 1.25mg in gel, or 0.75mg orally, prevented bone loss in naturally menopausal women, while double that was needed for women post-hysterectomy. A second one found that only 0.014mg daily was enough to stop bone loss in 77.3% of women. In fact, there was an average increase in bone density of 2.4%. Only 1% of the over 200 women receiving bioidentical HRT had signs of uterine tissue growth, and the increase in breast tissue density was 19.8% compared to 19% in the "control" group receiving raloxifene. Similar improvements in bone density were seen in yet another, with no cases of breast cancer or uterine growth, but a higher risk of abnormal mammograms. Some women may have elevated liver enzymes from taking 17beta-oestradiol orally, meaning that gel application could be best for some. Oestriol, another form of oestrogen, has in some studies been associated with reduced menopausal symptoms and improved bone mineral density too, but is not always without the risk of uterine tissue growth. One "unique" study found that women with relapsing-remitting MS experienced shrinking of brain lesions and a reduction in symptoms after taking oestriol. Finally, a Danish study of 700,000 women found that there was no association between hormone therapy and heart attacks, but the majority of women on HRT were taking the bioidentical 17beta-oestradiol. A lowered risk, however, was found in women taking progesterone in a cyclical pattern, and women taking HRT as a cream.

The article then moves on to progesterone, which may oppose the negative effects of oestradiol. A study of 358 postmenopausal women found that the risk of uterine tissue growth was only 6% when oestrogen (this was conventional HRT) and progesterone were combined, compared with a 64% risk when only oestrogen was taken. By "conventional HRT", I mean a horse's oestrogen. A Belgian study mentioned found that progesterone could also reduce the risk of breast tissue growth. Additionally, the use of testosterone may protect against the unwanted effects of oestrogen replacement, though the studies discussed showed a lesser effect of testosterone compared to progesterone. Read more of my thoughts on testosterone here. DHEA replacement produced mixed results, though it did show benefit as a cream for skin health.

So, unlike some naturopaths, I do support the use of bioidentical HRT if herbal and nutritional support do not give the desired results, or if it's just your personal choice. However, I would recommend liver support to maintain healthy hormone metabolism, and I recommend that you always arrange a formal consultation with someone who can prescribe these hormones first, instead of self-medicating.