Bio-identical hormones: 21st century HT? Or 19th century snake oil?

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Women's Health Activist Newsletter
May/June 2006

One of the most common topics the NWHN receives questions about is bio-identical hormones.  Women know that the earlier claims for menopause hormone therapy (HT) have been disproven and that HT leads to an increased risk of stroke, blood clots, and breast cancer (see related article in this issue).  Many women are looking for a safer version of menopause HT and they’ve been told that bio-identical hormones are the answer.   

Bio-identical hormones are often called “natural hormones” because they’re chemically identical to the hormones that our bodies produce. The word natural has such a nice ring to it – it just sounds safe, doesn’t it?  But what’s the real deal?  Are bio-identical hormones safer than traditional menopause HT?  Are they effective?  Are they even natural?

Understanding the claim that bio-identical hormones are natural (and, by implication, that standard menopause HT hormones aren’t) is probably a good place to start.  All hormone products, bio-identical or not, are manufactured in a lab.  While some are synthesized from “natural” sources (horse urine, plants, etc.), all go through extensive treatments in the lab to become hormone products.  Some are synthesized to be exact copies of the body’s hormones (e.g., estradiol, estrone and progesterone); others are made into forms that are similar, such as progestins and conjugated equine estrogens.  Unlike herbs, there’s no place in nature women can go to harvest hormones for home use.  An interesting aspect to the natural vs. synthetic argument is the little known fact that many pharmacies that promote bio-identical hormones as natural alternatives actually buy the raw ingredients from pharmaceutical companies!

Are bio-identical hormones safer than other forms of HT?  No.  Are bio-identical hormones more effective than traditional HT?  No, again.  There have been no safety or effectiveness trials of combinations of natural estrogen. Only estradiol has been studied; it’s been shown to be similar to traditional HT in its risks for endometrial cancer and failure to prevent heart disease. Natural progesterone and natural estrogens probably slow bone loss similar to traditional forms of hormones, but no form of hormone should be a woman’s first choice for preventing osteoporosis.  Bio-identical hormones can provide symptom relief, however.

Why are bio-identical hormones so popular, if they’re not all that different from traditional HT?  Ads for bio-identical hormones are often full of mis-representations, overblown claims, and implications that they’re completely safe.  Some practitioners also tell women that bio-identical hormones can be customized to fit their individual needs and encourage the use of expensive tests to determine hormone levels.  NWHN opposes the use of hormone tests for this purpose.  Women’s hormone levels fluctuate throughout the day and from day to day.  Tests taken at any given moment shouldn’t be used as the basis to diagnose so-called deficiency and to prescribe hormone treatment.   

So what’s a woman to do?  If you’re looking for long-term prevention, look elsewhere.  There are good products and approaches that minimize the risk of many chronic conditions of aging.  If you’re looking for symptom relief, bio-identical hormones are an option, but so are natural products produced by pharmaceutical manufacturers who are regulated by the FDA and have to maintain quality control standards.  Don’t get taken in by snake oil salesman, even if they’re using 21st century tactics to hawk their wares.