the big debate: bioidentical versus non bioidentical hormones

by Sylvia

Hormone therapy: Bioidentical hormones
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As part of my weekly articles on beauty and wellness I’d like to tackle the issue of hormones today. They can create havoc in the life of the 40+ woman and many women decide to start a hormone therapy program. Over the last couple of years there has been a lot of discussion about the safety of hormone therapy and which hormone replacement program is more suitable. I would love to open up the discussion here at 40PlusStyle as well.

I conducted this interview a while ago in reaction to this article by Dr. Lynn Pattimakiel, which aims to explain the difference between bioidentical and non bioidential hormones. It was a good article, but this doctor was clearly in favor of FDA approved drugs as opposed to non bioidentical.

I know that a lot of doctors very much favor the latter and I thought it was good to hear another point of view. Since choosing a hormone replacement program is a decision that many women face every year, it’s good to be well informed.

dr isabelle yeohSo I decided to approach a local doctor that favors bio-identical hormones and ask her the same questions. Dr Isabelle Yeoh has her own aesthetic and anti-aging clinic and is a strong proponent of using natural alternatives such as supplements or nutrients instead of using medication where possible. Here is what she had to say.

What is the difference between bioidentical hormones and non-bioidentical hormones?

Bioidentical hormones have an identical molecular structure to our own hormones. They are formulated in a lab from a plant molecule called diosgenin found in soybeans or wild yam, and converted into bioidentical progesterone. Progesterone can then be converted into the three human estrogen hormones: estradiol, estrone and estriol. Bioidentical hormones are made to fit perfectly into the hormone receptor sites found in our cells. Our bodies respond to them in exactly the same way that we respond to our own hormones.

Non-bioidentical hormones are also known as synthetic hormones. They are chemically unique and not found in nature, this allows them to be patented and sold by drug companies.

Is one better than the other?

Bioidentical hormones are assumed to be safer, given that their effects are more physiologic. They are designed to be consistent with our normal biochemistry and therefore have less chance of side effects when used at low replacement doses. The aim is to balance. Non-bioidentical hormones, on the other hand, work by suppressing our own hormones and taking over our physiologic processes.

Is one more “natural”?– I often hear bioidienticals referred to as “natural.

Natural refers to something that occurs in nature, or has undergone little processing with no chemical additives. ‘Bioidentical’, instead of ‘natural’, is a more accurate term given that they are often man-made (in a lab).

Why is there so much confusion around this issue?

Bioidentical hormones cannot be patented, since they occur in nature. Drug companies make profits by patenting chemicals that do not exist in nature, which allows the drug company to own a proprietary product that they can then sell without competition.

Because drug companies have no financial incentive to produce or market bioidentical hormones, many doctors have not been made aware of the differences between bioidentical and synthetic hormones. This is because doctors receive their continuing medical education at seminars and conferences sponsored by drug companies.

What exactly is compounding hormone therapy?

The process by which a pharmacist prepares a hormone, prescribed by a doctor, to meet an individual patient’s need. The practice of drug or hormone compounding is also known as compounding pharmacy.

Why do people choose the compounding pharmacies?

Compounding pharmacies allow you to:

  • Individually tailor your prescription.
  • Ensure that your prescription is freshly-made each time.
  • Have personal interaction between doctor, patient and pharmacist.

Are there any serious risks to using the compounding hormone therapy?

The recommended guidelines are to use the lowest, most effective dose to improve the symptoms. Compounding hormone therapy is generally well-accepted with few undesirable side effects.

Is there any any time you recommend someone use a compounding pharmacist?

Someone starting a bioidentical hormone program would collect their prescription from a compounding pharmacist.

The Women’s Health Initiative study famously found a link between hormone replacement therapy and breast cancer. It scared a lot of women away from using hormones. Did that study use bioidentical or non-bioidentical hormones?

That study used a non-bioidentical hormone called Prempro, a popular form of HRT, which consists of a combination of synthetic estrogen called Premarin and synthetic progesterone (progestin) called Provera. Premarin is a combination of horse estrogens derived from pregnant mares’ urine (hence the name: Pre-mar-in). Provera is a progestin, a drug that does not exist in nature. Its generic name, medroxyprogesterone, although it sounds like a form of progesterone, has effects which are the opposite of progesterone, Progesterone is the hormone of pregnancy (hence the name: Pro-gestation). Provera, in contrast, can cause miscarriages and birth defects. The study reported that the risk of breast cancer increased with each year that a woman remained on HRT, so that after five years, a woman who was taking HRT had a 26% higher risk of breast cancer than one who was not using hormones. It is thought that the progestin component was the major factor in this increased risk, because progestins turn off the ovaries’ production of naturally occurring progesterone, reducing levels of this protective hormone.

Is it fair to say, then, that the risks found in the Women’s Health Initiative study may not be the same for bioidentical hormones?

If we understand that synthetic hormones are not identical to those produced by our bodies, and do not fit perfectly into the receptor sites in our cells, it is not difficult to extrapolate why they not only will not restore optimal health, but will also increase the risks of breast cancer and cardiovascular disease, if taken over many years.

Have there been any similar long-term studies done with bioidentical hormones?

Although bioidentical hormones are supposed to be safer than synthetic hormones, there are no long-term studies as yet to verify this, one of the reasons being that long-term studies are expensive to conduct. (E.g. The WHI study cost the American public over $628 million, which was partially funded by Wyeth-Ayerst, the manufacturers of Premarin and Prempro.)

So despite the risks, do you still recommend hormone therapy?

Restoring hormones to their optimal level using bioidentical hormones is, in my opinion, a safe and effective way to achieve and maintain optimal health and well-being, when administered correctly. There is still a risk, but with the use of conservative doses and regular screening, the benefits far outweigh the risks.

People should not need to suffer from hormone-related problems such as mood, energy and sleep problems. In addition, bioidentical hormones play an important role in the prevention of heart disease, having healthy bones, good skin and hair. Finally, when a person’s hormones are optimally balanced, they feel so much happier and healthier that the quality of their family, work and social lives is greatly enhanced.

With so many people calling themselves “women’s health experts,” how do you know if you have a “good doctor”? How do you know who to trust?

A good doctor is someone who will help you have a better understanding of the root causes of your health problems and can help guide you onto the path to health and wellness so that you can achieve a better quality of life.
Individuals must also realize that hormone therapy is just one aspect of this path to health and wellness. For example, many hormone imbalance symptoms can be improved by implementing lifestyle changes alone – eating fresh food, drinking enough water, having enough sleep, doing regular exercise and stress management techniques. A disciplined and committed individual is key to achieving the goal of being and staying healthy. The doctor gives you the information and tools you need to make an informed choice, the rest is up to you.

Dr. Isabelle Yeoh owns the IYAC Aesthetic & Anti-Aging Clinic in Singapore. Believing strongly in the power of good nutrition and nature’s ability to heal the body given the right nutrients and environment, Dr Yeoh has a preference for using natural alternatives such as supplements or nutrients instead of using medication where possible. Encouraging her clients to make better beauty, health and lifestyle choices.

Note from Sylvia: Now I’d like to hear from you! Do you have an opinion on this topic or personal experience? What has worked for you?

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Jeannie@gracefully50

I really appreciate this post, Sylvia!
It explained a lot of question I had about this subject. Thanks!

Sumaira shafqat jamil

Hi! How effective would eating estrogen and progesterone rich foods be in replacing declining hormone levels?

Nanne

Thanks for a very informative and useful post, Sylvia!

Greetje

Very informative article Sylvia, but fortunately I am passed this stage. Now there is an advantage of growing older hahaha.

Jane

I have been using bio-identical hormones, at a low dose, for quite a while. I started using progesterone from the health food store. While my doctor at the time promised me it would not stop the constant bleeding I had going into menopause, it did. I stopped and started the progesterone several times just to prove to myself that it worked. This is not to say it would work for everyone. I tend to have a very delicately balanced system, so small doses of just about anything (herbal, drug, or this) tend to work well for me.
Later my new gynocologist prescribed bio-identical HRT. He recommended using estradiol (a stronger hormone), but I insisted upon estriol, a weak estrogen that is said to be protective. I use a cream which I can apply at a very low dose. It has worked well for me, alleviating hot flashes, etc. Using a cream like this also makes it easier to taper off if you feel ready to go without.

Sylvia

thanks for sharing your experience Jane. Much appreciated.

Cheryl

Im 49 went thtough menopause at 29 after i had my daughter (thankfully)! I’ve been on HRT for 20 years now and I wouldn’t be able to function normally or have a quality of life without it. My risks for osteo at my age now would have been inevitable if I hadn’t taken it.
I get checked regularly and I have a good family history.
I weigh up that quality is better than quantity in my situation.

Sylvia

Wow Cheryl, Menopause started early for you. Thanks for sharing your experience with us.

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