Experts Caution on 'Bioidentical' Hormones

By Lori Wiviott Tishler, M.D.
Content provided by the Faculty of the Harvard Medical School

Medical research has shown that long-term hormone replacement therapy can increase the risk of breast cancer. So many women with menopause symptoms are looking for alternatives. Some are turning to "bioidentical" hormones, the Associated Press said October 26. Actor Suzanne Somers praised these compounds in a book she wrote. The hormones are compounded for each woman by a pharmacist. But they have not been approved by the U.S. Food and Drug Administration. Many of them contain estriol. This form of estrogen is not approved for sale in the United States. Experts say there's a lack of research about these compounds. Thus there's no proof that they are safe or effective. And they may have the same risks as conventional hormone therapy.

What Is the Doctor's Reaction?

When I explain to my young medical students about hot flashes, I tell them it feels like you are boiling from the inside out. Not a pleasant sensation, we can all acknowledge.

Night sweats, another hallmark of menopause, are equally awful. No one wants to awake drenched to the skin and freezing in the middle of the night. It feels bad and it's terrible for quality of sleep. Yet, if we are lucky enough to live long and healthfully, all women will go through a major life stage known as menopause.

Menopause is normal. Some women have very severe symptoms. Others sail through it, barely noticing.

In 2002, an important study was published about hormone replacement therapy (HRT) with estrogen and progesterone. The study suggested that HRT did not, as we previously thought, help prevent heart disease. It did increase a woman's risk of breast cancer.

One clear benefit of hormone replacement was its impact on bone density. Of course, it also helped to control symptoms of menopause, such as hot flashes, night sweats, moodiness and poor sleep.

Most doctors, myself included, no longer routinely prescribe HRT. That's because the risks probably outweigh the benefits for the majority of women. Symptoms abound, however, and many women have turned to alternative medicines. Among them are "bioidenticals." These specially formulated products use hormones and other substances not approved by the U.S. Food and Drug Administration (FDA).

I have a great deal of compassion for women who are suffering with bad menopausal symptoms. However, I think that bio-identicals are a bad idea.

First, you should be aware that bioidentical is a marketing term, not a medical term. The FDA does not approve any of the formulas. They are not standardized, nor supervised in any rigorous way.

Bioidentical hormones include estriol. Estriol is estrogen. If you wouldn't take it from your doctor, it's definitely a bad idea to get it from an unsupervised pharmacy or compounding pharmacist.

What Changes Can I Make Now?

If you are miserable in menopause, don't give up on your doctor. Discuss your symptoms with him or her and see what your options might be. For example, if vaginal dryness is your worst problem, your doctor might offer a very safe, very low potency estrogen that is applied inside the vagina. If you're worried about your bones, first get a bone density test. If there's a problem, then appropriate treatment for osteoporosis and osteopenia is in order.

If hot flashes or night sweats are disturbing your sleep or making your life miserable, your doctor might talk to you about hormone replacement therapy. Don't run screaming out of the office! The data about increased cancer risk was for women who used this treatment for long periods of time, usually greater than five years. For a few women, hormone replacement -- at low dose and for a short time -- might be the right treatment.

For most women, simple things will help with most symptoms of menopause:

  • Wear cool, breathable cotton clothing. Layers help for temperature changes and hot flashes.

  • Try exercise. It helps decrease hot flashes for some women.

  • Treat vaginal dryness. Many lubricants that don't contain hormones are available over the counter.

  • Limit your caffeine intake.

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Did You Know?

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The average age of a woman having her last period is age 51.