Bioidentical Hormones Explained
Bioidentical hormones create a lot of confusion.
The term “bioidentical” refers to the structure of the hormones used for menopausal hormone therapy (MHT). Bioidentical hormones for MHT (generally a form of estrogen and progesterone) have the same chemical and molecular structure as hormones produced by the human body in the ovaries, while non-bioidentical hormones are structurally dissimilar to the hormones produced by the human body but have the same effect on perimenopausal and menopausal symptoms.
Symptoms of perimenopause (during the 4-10 years before a final period) may include:
Irregular menstrual periods
Hot flashes or night sweats
Vaginal dryness
Frequent urinary tract infections
Changes in mood or increased irritability
Brain fog
Weight gain
Decreased libido
Insomnia or frequent nighttime waking
Joint pain
Changes in skin or hair texture
In addition to healthy nutrition, regular exercise, sleep hygiene, limited alcohol and caffeine, stress reduction, and regular social connection, menopausal hormone therapy using some combination of estrogen and progesterone may help alleviate symptoms of perimenopause.
Due to concerns about safety over the years (and very good marketing toward bioidenticals), bioidentical hormones (which are often incorrectly called “natural” hormones) have become increasingly popular for MHT.
Many women believe that bioidentical hormones can only be prescribed by a holistic or alternative-type medical provider and that all prescription hormones from a conventional physician are synthetic and therefore non-bioidentical, but this isn’t true. A prescription from your primary medical provider can be either non-bioidentical or bioidentical, depending on the product prescribed.
Often the confusion comes from misunderstanding the difference between compounded hormone therapy and non-compounded FDA-approved prescription hormones.
All bioidentical hormones (both the compounded and non-compounded FDA-approved varieties) are derived from a steroid in soy and yams, and both need to be commercially processed prior to use.
Compounding pharmacies use processed bioidentical hormones derived from soy and yams to prepare, mix, assemble, and package hormones into very patient-specific gels, creams, or other formulations. The non-compounded FDA-approved bioidentical hormones (which are also derived from soy and yams and processed in the very same way) are instead routed to pharmaceutical companies to be packaged into standard-dose formulations of pills, patches, gels, creams, sprays, or rings.
It’s important to note here that having FDA approval means a product has undergone extensive third-party testing and standardization regarding safety, efficacy, purity, potency, and consistency from batch to batch. Furthermore, ongoing post-marketing analysis done by the FDA continuously evaluates for adverse events. While custom compounded bioidentical hormones may undergo regulation by state boards of pharmacy, they are not subject to the same federal laws and do not have the ongoing systematic post-marketing analysis.
Compounded products contain different hormone combinations and delivery systems tailored for each patient; however, this highly specific individualization can lead to variation in absorption and inconsistencies from batch to batch in prescriptions refilled by that individual patient each month. Furthermore, because of this specialization, compounded products may not be covered by insurance and can be very pricey. For these reasons, conventional medicine does not routinely recommend compounded hormone products.
