Are bioidentical hormones safer?

When the Women’s Health Initiative (WHI) study concluded in 2002 that postmenopausal women using synthetic estrogen/progestin had higher rates of heart disease and breast cancer, “people stopped cold-turkey overnight and were scared to death,” says Christiane Northrup, MD. “Many were left with insomnia, intolerable hot flashes, and a decreased quality of life.” But, she points out, the study focused on women ten years past their last period, and only looked at Premarin (an artificial estrogen made from pregnant mares’ urine) and Provera (a synthetic progestin). “Bioidentical hormones were not studied at all,” she says.

Bioidentical hormones are typically plant-based (from sterols found in yams, soybeans, and other plants) and are manufactured in a lab to be chemically identical to those produced in the body. Some are standardized and approved by the FDA; others are custom-compounded in a pharmacy, based on an individual woman’s hormonal needs. Although the medical community is far from convinced, some studies suggest bioidenticals may be safer. One study followed 80,000 newly postmenopausal women in France for eight years and found that those taking bioidentical estrogen had significantly less risk of breast cancer than those on synthetic estrogen. Large multicenter trials are underway to further investigate bioidenticals’ impact on other health risks.

Is it perimenopause?

Although every woman’s experience is different, studies show about 15 percent of women sail through “the change” with no symptoms. For others, mild symptoms start as early as 40 and persist for years during perimenopause, the stage leading up to the last menstrual period. First come dipping progesterone levels, which can lead to insomnia, tender breasts, and irritability. Then, as ovaries produce less estrogen—typically around the mid-to-late 40s—70 percent of women experience hot flashes. Around age 51, as we approach true menopause (defined as the day we’ve gone a full year without menstruating), estrogen, progesterone, and testosterone plummet, often leading to vaginal dryness, brain fog, and a crescendo of discomfort before hormones level off and symptoms subside in postmenopause.

HRT and age: Is younger better?

A growing body of research suggests that when hormones (either synthetic or bioidentical) are used in younger women (ages 49–59) during perimenopause or shortly after, they tend to work better— particularly for boosting memory—and they seem to carry less risk. In March 2010, the North American Menopause Society (NAMS) actually revised its position statement on hormone therapy, saying the benefits may outweigh the risks for younger women. “It appears that the risk of heart disease in women using hormones is largely confined to older women,” says NAMS president Cynthia Stuenkel, MD.