Bioidentical HRT vs. Traditional HRT: What You Need To Know!

As the great singer-songwriter Joni Mitchell once sang, …You Don’t Know What You’ve Got Til’ It’s Gone, our sex hormones, estrogen, progesterone, and testosterone provide a whole host of functions that help improve our overall health and wellbeing. In addition to being key players in reproduction, they also help boost and maintain sex drive and function, maintain a healthy weight, improve mental health and memory, contribute to bone health, and support cardiovascular health. Although we may not realize it in our youth, our sex hormones help maintain balance and homeostasis our body needs. When those levels start to decline, we feel the aftermath.

As we age, our sex hormones decline. For men, testosterone declines by 1% per year starting at the age of 30. For women, the average age of menopause, which is the cessation of one’s menstrual period for at least 12 consecutive months, is age 51. A decline in hormone production is primarily related to natural aging, however for some, these causes can be more idiopathic, such as premature ovarian failure, or due to surgical or other medical causes, such as obesity or type II diabetes. Typical signs and symptoms of hormonal decline are varied between men and women. Below is a list of the most common signs and symptoms:

Women	Men
Hot Flashes	Low Sex Drive
Night Sweats	Erectile Dysfunction
Changes in Menstrual Periods	Difficulties with Concentration and Memory
Changes in Mood	Changes in Mood
Sleep Disturbances	Fatigue
Vaginal Dryness/Painful Intercourse	Loss of Muscular Strength and Bone Mass
Urinary Symptoms	Increased Body Fat

What Are Traditional Hormone Replacement Therapy?

Traditional hormone replacement therapies (HRT) are FDA-approved hormonal medications for treating signs and symptoms of aging. Specifically, Traditional HRT is approved to treat vasomotor symptoms of menopause, including night sweats, hot flashes, and difficulties sleeping, as well as vaginal symptoms of menopause, such as vaginal dryness and pain. Testosterone is approved for treating primary hypogonadism (low testosterone) in men. Testosterone is also used as adjunctive treatment in women to address sexual dysfunction.

Estrogen and Progesterone are the two most common types of HRT used in practice. The body naturally produces these hormones (In men, estrogen is produced in very minimal levels), and these hormones typically fluctuate corresponding a women’s menstrual cycle or during pregnancy. These levels gradually decline as women age, and when menopause occurs, very minimal estrogen and progesterone is produced, which results in menopausal symptoms. HRT is often used to supplement and restore hormone levels back to functional and therapeutic levels. Estrogen is combined with the use of progesterone in women who have an intact uterus to protect the uterus from endometrial hyperplasia, which could result in endometrial cancer. For women who do not have a uterus (i.e., hysterectomy, etc.), estrogen-only HRT without the use of progesterone is used. HRT come in a variety of formulations, including oral tablets, creams, gels, and patches.

What Are Bioidentical Hormone Replacement Therapy?

Bioidentical hormones (BHRT) are manmade sex hormones that are nearly identical molecularly to the hormones your body naturally produces. Bioidentical hormones, like traditional HRT, help restore sex hormones that have been lost due to menopause, including estrogen, progesterone, and testosterone, to more functional levels. As a result of bioidentical hormones being similar molecularly to the sex hormones your body naturally produces, your body is more likely to accept these hormones, appropriately use and metabolize these hormones, and excrete them when they are no longer needed for use. This is opposed to traditional hormones, which are not identical to the hormones your body naturally produces, and thus may contribute to more problematic cardiovascular adverse health outcomes, such as blood clots and heart disease. BHRT also comes in a variety of different formulations, including oral tablets, creams, and patches.

What Are the Main Differences Between BHRT and Traditional HRT?

Traditional HRT are made of animal by-products, specifically horse urine and other synthetic products, and are FDA-approved to treat moderate to severe menopausal symptoms. They come in standardized dosages that are prepackaged, and thus cannot be specifically tailored to meet the dosing needs of patients with varying degrees of symptoms. Traditional HRT are readily prescribed in local pharmacies and are thus easier to access than BHRT, which are dispensed by compounding pharmacies, and are thus typically prescribed by specialized or alternative healthcare practitioners.

Conversely, Bioidentical HRT, such as estriol, are FDA approved for use in treating moderate to severe menopausal symptoms. BHRT are synthesized by chemical extraction from plant sources, primarily wild yams or soy. BHRT can be pre-made by a drug company, or custom-made by a pharmacist. Custom-made HRT by a pharmacist is known as compounding and they are generally not given the stamp of approval by the FDA for quality and safety, similar to vitamins and supplements found over the counter at various stores. Therefore, it is important for an individual considering BHRT to inquire with a healthcare practice who uses compounding pharmacies whether their compounding pharmacist adheres to best practices.

At Embodied Wellness, we prefer the use of BHRT over Traditional HRT for their efficacy and abilities to fine-tune treatment to meet the needs of our patients. We exclusively work with compounding pharmacies who are fully accredited and licensed US pharmacies who abide by strict, FDA standards for ensuring quality and safety, and reducing contamination and other health risks of compounded medications. Specifically, our 503A compounding pharmacies are outfitted with three USP 797 Sterile compounding facilities, and one USP 800 Hazardous Sterile compounding facility, to ensure the highest level of safety and accountability.

What Are the Risks of Hormone Replacement Therapy?

Whether an individual opts for traditional HRT or BHRT, there are risks associated with the use of both forms of treatment. HRT should not be used in those with a history of the following health conditions:

• History of reproductive cancers, including breast cancer, ovarian cancer, endometrial cancer, uterine cancer
• Cardiovascular disease, including stroke and blood clots
• Unexplained vaginal bleeding
• Severe active liver disease or Gallbladder disease
• Dementia
• Hypertriglyceridemia

For women who smoke or are over the age of 60 and/or greater than 10 years since reaching menopause, they should discuss with their healthcare provider risk vs. benefits of treatment, as women in these categories are at increased risk of adverse health outcomes from HRT use.

The risk of HRT use is varied, and may include the following:

• Risk of endometrial hyperplasia that can lead to endometrial cancer (when taking estrogen alone without progesterone in women with an intact uterus).
• Increase risk of breast cancer with long-term use or for women with advanced age (age 60 and over).
• Possible risk of cardiovascular disease with long term use or for women with advanced age (age 60 and over).
• Increased risk of blood clots or strokes, particularly in patients with increased risk factors (smoking, obesity, diabetes, history of blood clots).

Some assume that because BHRT are made from natural plants, that there are no health risks associated with their use. However, because BHRT are derived from phytoestrogens (plant estrogens) which mimic estrogenic hormones found in human bodies, they pose the same risks as traditional HRT as described above. Consultation with an experienced healthcare provider regarding risk vs. benefits of treatment should be discussed and considered before starting on any HRT.

The Women’s Health Initiative Study Results and The Aftermath

The landmark Women’s Health Initiative (WHI) Study of 2002 was the largest study on HRT ever conducted. The results of the study revealed shocking information regarding the potential dangers of HRT among women. Specifically, the study revealed increased risk of breast cancer, cardiovascular disease, stroke, and blood clots in those taking synthetic (traditional) estrogen and progesterone (i.e., conjugated equine estrogen (CEE) (Premarin) and medroxyprogesterone acetate (MPSS)) compared to those in the placebo group.

What was more alarming was the increased risk ratio of developing cancer and other health problems. According to the WHI study, the relative risk of developing breast cancer was reported to be 26 percent increased likelihood. The results from this study made national news and prompted various doctors and healthcare providers to reduce or stop prescribing HRT to women suffering from menopausal symptoms altogether.

However, since the WHI study was published and reported, various researchers and other advocates for HRT pointed out the various flaws and inaccuracies of the study. For one, the relative risk of 26% increased likelihood of developing breast cancer was adjusted when considering absolute risk. In research, relative risk compares two groups of people, but does not give us the actual odds of something happening to a given person. When secondary analyses of the WHI study was conducted by various researchers, they noted that the absolute risk of developing breast cancer was only increased by 8 breast cancer patients over 10,000 women in the estrogen + progestin group. In other words, the absolute risk increase was only 0.08%, not 26% found in the relative risk calculation.

Additionally, problems from the WHI study cited by researchers included that the study used traditional HRT, such as Premarin and medroxyprogesterone, versus bioidentical hormone therapy. The women in the study also ingested oral estrogens, as opposed to transdermal methods, such as patches and creams, which bypass the liver, and thus, are associated with decreased risks for blood clots and other complications. Furthermore, opponents of the WHI study results note that the women sampled in the study were over the age of 60 (average age 63) with varying degrees of health complications, including history of cardiovascular disease and smoking, increasing their risk factors for complications with HRT use.

Researchers Chester et al. (2017) conducted a secondary analysis of the WHI study, stating that the absolute risks of adverse cardiovascular events for menopausal hormone therapy (MHT) in younger women close to menopause are low, and that all-cause mortality effects are neutral or even favorable for younger menopausal women. The benefits of MHT likely outweigh the risks for healthy women early in menopause for symptoms management.

Advantages of Bioidentical HRT over Traditional HRT

Although the WHI study revealed some inaccuracies in secondary analyses, the study did highlight increased risk factors for developing worsening cardiovascular disease in postmenopausal women with the use of traditional HRT. As a result, at Embodied Wellness, we prefer the use of bioidentical HRT in younger menopausal women for their safer side effect profile compared to traditional HRT, and their nearly identical molecular structure to human sex hormones. With BHRT, we can tailor dosing to meet your specific needs, and compound specific hormones together to address your various symptoms more efficiently. The following formulations are described below:

Bioidentical HRT Creams: BHRT creams are preferred for their ease of use and instant absorption to the bloodstream. They are applied topically to the skin and are pre-measured allowing for the perfect amount of medication to alleviate your menopausal symptoms.

Oral Bioidentical HRT: Oral forms of BHRT, such as Progesterone, are used for certain women to treat systemic symptoms of menopause, such as hot flashes, low libido, and disturbed sleep. It is generally administered once a day along with estradiol creams or patches and is designed to meet your specific needs.

Bioidentical HRT Patch: BHRT estradiol patches, for example, are delivered transdermally through the skin into the bloodstream, and are a popular and highly effective way of treating both systemic and localized menopausal symptoms for women. They are convenient and are replaced bi-weekly.

In addition to estrogen and progesterone, we may supplement when appropriate with other hormones, such as DHEA or testosterone, to help improve hormonal levels and treat menopause-related symptoms.

Want to learn if bioidentical hormone replacement therapy or its alternatives are right for you? Take the next step by scheduling your free consultation or give us a call at 1-888-843-2038.