Hormones, hormones, and more hormones. Let’s get real about the subject. There is many myths out there when it comes to treatment, so on today’s post I will do my best to dispel some of the most common misconceptions.
Myth: Bioidentical hormone therapy is natural and therefore superior to CHT. (Conventional Hormone Therapy)
Fact: Hormones used in bioidentical hormone therapy may be derived from plant products such as yams, but they need to be commercially processed to become bioidentical and hence not “natural.” Many FDA-approved estrogen products including pills, patches, gels, sprays, and creams are, in fact, bioidentical products that may be derived from equine or other sources. The term “bioidentical” is not synonymous with “natural.” “Bioidentical” refers to the structure of the product, whereas “natural” refers to its source and processing. Bioidentical is a marketing term and not a medical term.
Myth: Compounded bioidentical hormones are better than CHT.
Fact: Compounding is simply a process of mixing different hormonal preparations. Compounded therapies may consist of FDA-approved as well as non-FDA-approved products. Compounded products cannot be individually FDA regulated because of the variation in types and proportion of hormones in each product.
Myth: Custom compounding individualized to the patient using salivary hormone assessment is superior to CHT because it mimics the patient’s own natural hormone levels.
Fact: Individualizing hormonal therapy by monitoring hormone levels has not been shown to be efficacious. Salivary levels do not necessarily reflect tissue levels and can depend on time of day, meal times, and dietary intake. Women with similar salivary or serum levels of hormones may metabolize the hormones differently. Hormone therapy should be individualized by symptom relief and side-effect profile and not laboratory test results.
Estrogen products will not go away and they perhaps shouldn’t. But one can only wish as I do that they will be used sparingly and with a great deal of caution based on straightforward evidence and not one-sided journalism.
Let us hope.
Information obtained from Conventional Hormone Therapy or Bioidentical Medscape: Clarifying Myths about Bioidentical Hormones. Désirée A. Lie, MD, December 15, 2015