No firm research on BHRT safety

DEAR DOCTOR K: I’ve been hearing a lot about “bioidentical hormones.” I’m curious about them, because I’d like a better way to treat my menopause symptoms. Are bioidentical hormones any safer than synthetic ones?

DEAR READER:

Women have good reason to be interested in a new treatment option. Conventional combined hormone therapy (estrogen and progesterone) raises the risk of blood clots and breast cancer. It can increase the risk of heart disease, stroke and dementia in women older than 60 (or 10 years past menopause).

Most doctors now suggest HT only for short-term symptom relief. There are two reasons for that. First, in many women, the symptoms of menopause last only a few years. Second, the risks of HT increase the longer it is taken, and the older the woman taking it.

FDA-approved bioidentical hormones do exist. But supporters of bioidentical hormones are usually talking about a particular regimen called bioidentical hormone replacement therapy (BHRT).

The process involves identifying “deficiencies” in a woman’s hormones. Then a mix of hormones is prescribed to correct the deficiencies. A compounding pharmacy fills the prescription using hormones from “natural” sources.

Proponents of BHRT say BHRT hormones aren’t drugs because they are molecular copies of the hormones made by women’s bodies. The FDA requires “black box” safety warnings for all FDA-approved hormone treatments for menopause. Unfortunately, hormones from compounding pharmacies aren’t FDA-approved. So no black box warning is required.

Until hormones from compounding pharmacies are tested by research, we don’t know if they’re safe. I suggest you stick with FDA-approved bioidentical hormones for now. Talk to your doctor about whether to take them for longer than a few years.