What Is Bioidentical Or Body
Bioidentical or body-identical hormones are estradiol and progesterone that are molecularly identical to human hormones. Most modern menopause hormone therapy is bioidentical. Keep reading for a list of brands.
The difference between bioidentical and body-identical is that body-identical is the preferred conventional term and bioidentical is the term traditionally applied to customised hormone formulas dispensed by a compounding pharmacist back when compounding was the only way to obtain such hormones.
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A Higher Risk Of Certain Cancers
A 2020 study found that past use of HRT was linked to a higher risk of breast cancer. This elevated risk was associated with both estrogen-only and combined therapies.
There is some debate about the risk of ovarian cancer. Some studies suggest that both estrogen-only and combined therapies raise your risk of ovarian cancer. Other say ovarian cancer is only a risk with estrogen-only therapy, but not with combination therapies.
Estrogen-only HRT may also increase the risk of endometrial cancer . A of 28 studies concluded that the following HRT regimens may all increase the risk of endometrial cancer:
- estrogen-only, sequential combination therapy
- micronized progesterone
Because of the risk, these therapies are generally recommended for women who no longer have a uterus.
Who Should Not Take Menopausal Hormone Therapy
Menopausal hormone therapy may not be safe for some women. You should discuss your risks with your doctor if you have:2
- A history of heart disease or risk factors, such as high cholesterol
- A family or personal history of breast cancer
- High levels of triglycerides, a type of fat in your blood
- A family history of gallbladder disease
- A history of stroke or blood clots
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How Long Do You Need To Take Mht
You can take MHT at low doses for as long as you need. Many women have symptoms for around eight years and one in four women have symptoms into their 60s and 70s. The benefits of MHT far outweigh the risks in healthy women within 10 years of reaching menopause.
When using MHT in midlife:
It can take around six months to find the right MHT. Once youve found an MHT that works for you, its important to review it with your doctor each year.
If you have premature menopause, your doctor will prescribe a higher dose of MHT until the age of expected menopause .
Endometrial Effects Of Transdermal Progesterone Creams And Estriol
Women with intact uteri are prescribed estrogen with a progestogen to oppose estrogen-induced endometrial hyperplasia and cancer. Bioidentical hormone proponents sometimes recommend topical progesterone cream instead of oral progestin for this purpose. However, it is unclear whether topical progesterone can effectively mitigate estrogen-induced endometrial stimulation. Three studies have examined the ability of progesterone to oppose estrogenic stimulation. The longest study, which lasted for 48 weeks, found that transdermal cream containing 40 mg of progesterone could not effectively oppose estradiol-induced endometrial stimulation.42 A 12-week study of a cream containing up to 64 mg of progesterone found similar effects.43 The only study that found that progesterone cream effectively opposed estrogen lasted only 28 days, too short a time to assess estrogenic effects.44 Five studies that measured serum or plasma levels after topical progesterone treatment have found progesterone levels < 5 ng/mL .4549 Only one study found a progesterone cream equivalent to oral progesterone after measuring progesterone concentration in whole blood50 .
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Symptoms And Effects Of Menopause
Menopause is the time in a womans life when menstruation ceases, signaling the end of her reproductive ability. The timing of menopause varies widely, but this event often occurs naturally in women in the fourth or fifth decades of life, at a mean age of 51 years. Certain medical or surgical conditions may induce the cessation of menses before this age. If menopause occurs before the age of 40 years, it is considered premature.
The STRAW classification proposed by the American Society for Reproductive Medicine depicts the natural transition in a female’s life from the reproductive years to the time of menopause.
The reproductive years are divided into early, peak, and late and are characterized by regular menstrual cycles . This is followed by the stage of menopausal transition, which earlier on is characterized by a variable cycle length that is more than 7 days different from normal. During the latter stages of this transition phase, women experience intervals of amenorrhea of more than 60 days. When this duration of amenorrhea lasts for up to 12 months, it is classified as postmenopause. The stage of perimenopause spans from the beginning of the stage of menopause transition up until the completion of 1 year following the final menstrual period.
Hormone Therapy For Menopause
In most women, menopause symptoms like hot flashes aren’t severe enough to need treatment. Short-term hormone therapy can provide relief in women with severe symptoms. Because of the associated risks, long-term therapy is no longer recommended.
During the years leading up to menopause , womens bodies make less female sex hormones. They can then no longer become pregnant when they reach menopause. These natural changes are sometimes associated with symptoms like hot flashes , sleep problems and mood swings. The symptoms can vary in severity and usually go away on their own after a while.
A number of different treatment options are available for women who are experiencing typical menopause symptoms. But most of them haven’t been proven effective. One of the better studied types of treatment is hormone therapy using a combination of estrogen and progestin , or estrogen alone. This is currently the most effective treatment for hot flashes and sweats.
But what is true of all other drugs also applies to hormones: if they are effective, they will also have side effects and risks. These will depend on things like the type of hormone therapy and how long it’s used for. Short-term treatment is usually enough.
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Menopausal Hormone Therapy And Cancer Risk
For decades, women have used hormone therapy to ease symptoms of menopause, such as hot flashes and sweating. This is called menopausal hormone therapy, and you may see it abbreviated as HT or MHT. You may also hear it described as hormone replacement therapy , postmenopausal hormone therapy , or postmenopausal hormones .
In the past, many doctors and their patients believed that MHT didnt just help with hot flashes and other symptoms it had important health benefits. But well-conducted studies have led many doctors to conclude that the risks of MHT often outweigh the benefits.
This information covers only how MHT can affect a womans risk of getting certain cancers. It does not cover other possible risks of MHT such as heart disease or stroke.
You can use this information when you talk to your doctor about whether MHT is right for you.
What Is Bioidentical Hormone Therapy
Companies that make bioidentical hormone therapy use the term bioidentical to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been done to evaluate how safe or effective these products are.
Talk to your doctor or nurse before trying any bioidentical hormone therapy.
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What Are Some Natural Remedies For Menopause Symptoms
Some women report relief for hot flashes and other menopause symptoms with complementary or alternative therapies. Talk to your doctor or nurse before taking any herbal or vitamin supplement. The Food and Drug Administration does not regulate supplements in the same way they regulate medicines. Many supplements can interfere with medicines and make them work incorrectly or not at all.
Some research studies show relief from premenstrual syndrome symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use for menopause symptoms are:3
Research continues on these and other alternative ways of relieving menopause. Talk to your doctor or nurse before trying natural remedies.
Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in Breast Cancer Early Detection.
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Are Compounded Bioidentical Hormones Bad
There are risks to taking compounded bioidentical hormones, but in some cases, they may be a better choice. Compounded bioidentical hormones are not FDA-approved. They are not tested for safety or effectiveness. Many major medical groups do not support using them because not enough is known about their safety and long-term side effects.
Signs You May Benefit From Hormone Replacement Therapy
Menopause is a normal transition in a womans life, and every woman will have her own unique experience. While one woman may notice her periods stop with minimal physical changes, another may experience prolonged symptoms that are uncomfortable.
When your menopause symptoms start to impact on your mental and physical health, making everyday life and tasks difficult or distressing, hormone replacement therapy may be an option.
Signs you may benefit from hormone replacement therapy include:
- Sleeping problems
- Extreme mood changes and irritability
Has your period become more sporadic? Are you experiencing the above symptoms? Learn more about the signs of perimenopause here.
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Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy
Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.
Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin .
Hormone Replacement Therapy For Menopausal Symptoms
Chelsea K. Sanchez, PharmD, BCPSInternal Medicine/Antimicrobial Stewardship
San Antonio, Texas
US Pharm. 2018 43:21-26.
ABSTRACT: Hormone replacement therapy is the most effective treatment for the vasomotor and genitourinary symptoms associated with menopause. Adverse effects associated with HRT are dependent on various factors, including dosage, route, duration of use, timing of initiation, and choice of agent. The decision to start HRT should include a risk assessment, and HRT should be individualized to the patient. The many existing HRT options come in a wide array of dosages and dosage forms. Pharmacists should be able to counsel patients about HRT and its side effects.
The average woman will live one-third of her life in or past menopause.1 Treatment of menopausal symptoms has gained increasing importance owing to the morbidities associated with aging in women.2Hormone replacement therapy , a term used to describe estrogen therapy, estrogen-progesterone combination therapy, or estrogen receptor agonist or antagonist therapy, continues to play a major role in the mitigation of perimenopausal and postmenopausal symptoms.3 Although each womans experience is different, vasomotor symptoms and vulvovaginal symptoms are two of the most common complaints associated with the hormonal changes involved in menopause.4
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What Is Hormone Therapy
Hormone therapy is also known as hormone replacement therapy . It involves taking hormones to replace those that are lost during menopause. There are two forms of HRT: systemic and low-dose vaginal products. Systemic HRT options include high doses of oral medications, patches, gels, rings, creams, and sprays meant to treat an array of menopausal issues. Low-dose vaginal products treat vaginal and urinary issues at the source, and are, as the name suggests, lower in estrogen. Depending on your individual needs and goals for treatment, your hormone specialist Raleigh NC will recommend the best type of hormone therapy for you.
Bioidentical Or Natural Hormones
Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones.
Practitioners claim these hormones are a natural and safer alternative to standard HRT medicines.
However, bioidentical preparations are not recommended because:
- they are not regulated and its not clear how safe they are theres no good evidence to suggest theyre safer than standard HRT
- its not known how effective they are in reducing menopausal symptoms
- the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but theres no evidence that these levels are related to your symptoms
Bioidentical hormones are not the same as body identical hormones. A body identical hormone, or micronised progesterone, can be prescribed to treat menopausal symptoms.
Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones, theyre closely regulated and have been well researched to ensure theyre as effective and safe as possible.
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Types Of Hormone Replacement Therapy
Estrogen-only hormone therapy and combination hormone therapy are the two main types of hormone replacement therapy. If you still have your uterus, your doctor will suggest combination therapy because progesterone reduces your risk of endometrial cancer.
If you have had a hysterectomy and no longer have a uterus, you typically will not need progesterone. This is important to know because taking estrogen alone has been shown to have fewer long-term risks compared to combination hormone therapy.
There are two ways a woman can receive hormone replacement therapy systemically or locally:
- Systemic hormone therapy is mainly taken in a pill, injection, or patch. It works by releasing hormones into the bloodstream and reaching the organs and tissues that need them. This type of therapy can help systemic symptoms like hot flashes, vaginal dryness, and mood changes.
- Local hormone therapy is a cream, ring, or suppository used on a localized area and doesn’t get into the bloodstream. It’s mainly used to help women suffering from vaginal dryness due to the loss of estrogen by rebuilding the vaginal lining and promoting lubrication. Fewer risks are associated with localized hormone therapy, but it does not help prevent or alleviate systemic symptoms like hot flashes.
here to get a closer look at the main hormones within a womans body and their important roles.
Symptoms And Signs Of Menopause
Changes in the menstrual cycle usually begin during a womans 40s, with variation in cycle length. A persistent difference in consecutive menstrual cycle length of 7 days defines early menopausal transition. Skipping 2 cycles defines late menopausal transition.
The marked fluctuations in estrogen levels may contribute to other perimenopausal symptoms and signs such as
-
Breast tenderness
-
Frequent urinary tract infections and/or vaginitis
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What Are The Risks Of Taking Hormone Therapy
While hormone therapy helps many women get through menopause, the treatment is not risk-free. Known health risks include:
- An increased risk of endometrial cancer .
- Increased risk of blood clots and stroke.
- Increased chance of gallbladder/gallstone problems.
- Increased risk of dementia if hormone therapy is started after midlife. HT started during midlife is associated with a reduced risk of Alzheimers disease and dementia.
- Increased risk of breast cancer with long-term use.
Mht And Premature Or Early Menopause
Women who go through premature or early menopause will benefit from MHT.
Premature menopause is when you have your last period before the age of 40 years.
Early menopause is when your final period happens between the ages of 40 and 45 years.
Premature or early menopause results in reduced levels of oestrogen. This can increase the risk of long-term health conditions such as:
- vaginal bleeding .
Most symptoms settle within the first 3 months of taking MHT.
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Influence On Other Symptoms
The studies also showed that hormone therapy can relieve other menopause symptoms such as sleep problems, mood swings or feeling down. And the hormones prevented pain during sex, regardless of whether the medication was swallowed or applied locally. The hormone therapy led to an overall improvement in the women’s sex life and quality of life.