How Safe Is “Natural” Hormone Replacement Therapy?

The quick and dirty answer to this question is: it’s not safe at all. In fact, no hormone replacement therapy is safe, yet, numerous pre-menopausal, menopausal, and post-menopausal women participate in such therapies regularly. Actually, so do many men; although, it’s far more common for women.
 
In the Women’s Health Initiative Study, a 15-year project performed in the 1990s studying nearly 70,000 post-menopausal women ages 50-79, discovered numerous health effects of hormone replacement therapy (HRT). The therapy used the FDA approved traditional hormone replacement drugs, not “natural” therapies. The study showed significant increases in the risk of breast cancer, coronary heart disease, stroke and venous thromboembolism (i.e. blood clotting).

Research from this study showed that older women who have long been through menopause – regardless of their initial health – were at risk for these serious health issues.

Hormone replacement therapy was originally touted to help women with menopausal symptoms such as weight gain, bloating, hot flashes, night sweats, and similar issues. While that is true and HRT did relieve those symptoms, the Women’s Health Initiative discovered the health risks far outweighed the benefits these benefits.

That brings us to what has been marketed as a safer alternative to synthetic hormone replacement therapies. Known by several different names – bioidentical hormones or natural hormones – this therapy is not necessarily safer.

Bioidentical Hormone Replacement Therapy (BHRT) is controversial because of the mistaken belief that the hormones are personalized to the individual’s body make-up. That’s not necessarily true; and considering how recent these products were introduced, there are few studies on them. Individualization of hormone therapy has made “natural” therapies popular, but not necessarily safer.

A clinical review of BHRT published in 2011 in the Journal of the American Board of Family Medicine provided several specific discussion points for health practitioners in regard to these bioidentical hormones. Here are four critical points to consider:

1. Bioidentical hormones are not necessarily “natural.” Natural refers to the source of the hormones. Natural and bioidentical hormones both come from the same source of soy and plants but bioidentical hormones must be commercially processed.

2. The Food and Drug Administration has approved some bioidentical hormones, but custom compounded hormones are not subject to federal law. These custom hormones contain so many combinations that it would be difficult to monitor and test. Plus, custom compounded hormones will vary from batch to batch causing variations in the doses received and benefits earned.

3. There is no safe hormone therapy. All active ingredients are the same regardless of whether they are synthetic, bioidentical or custom compounded; therefore, the risks are the same. There is no such thing as a safe hormone therapy.

4. It is nearly impossible to accurately monitor hormone levels in those receiving individualized hormone therapy. Every woman is unique in how she processes hormones within her body, therefore, routine blood tests or salivary tests do not necessarily show adequate or accurate results. As an example, even the smallest of elements such as brushing your teeth can affect salivary test results. The journal noted that positive tracking is typically based upon symptom relief not laboratory results.

 

Some positive news can be said about hormone replacement therapies. Evidence from a 2008 study of conventional hormone replacement therapies in younger, menopausal women showed that the benefits did outweigh the risks when the therapy was used short-term. The study was performed in people younger than age 60 who had either been in pre-menopause or menopause.

The point here is that hormone replacement therapies – natural or conventional – can be effective if the individual is young, healthy, active and going through the menopausal process. After a certain point (i.e. post menopause), hormone replacement should be eliminated. If you are interested in hormone replacement therapies, you are encouraged to talk with your physician.

 

Works Used for this Post: 

Bosarge, P. M. and Freeman, S. (2009). Bioidentical hormones, compounding and evidence-based medicine: What women’s health practitioners need to know. The Journal for Nurse Practitioners, 5(6), 421-427.

Kuehn, B. M. (2008). FDA warns claims for pharmacy-made “bio-identical” hormones are misleading. Journal of the American Medical Association, 299(5), 512.

Sood, R., Shuster, L., Smith, R., Vincent, A., and Jatoi, A. (2011). Counseling postmenopausal women about bioidentical hormones: 10 discussion points for practicing physicians. Journal of the American Board of Family Medicine, 24(2), 202-210.

Women’s Health Initiative. (2014). WHI Overview. Retrieved from https://www.whi.org/about/SitePages/About%20WHI.aspx