Who Shouldn’t Take Bioidentical Hormones
Using any type of hormone therapy is a decision made between you and your healthcare provider after carefully weighing the risks and benefits. Bioidentical hormones have been controversial, and many are not FDA-approved, but that doesn’t mean your healthcare provider will rule them out as a treatment option.
If you’ve had or are at high risk for the following conditions, hormone therapy may not be safe:
- Memory loss or confusion.
Replacing these lost or low hormones is the goal of bioidentical hormone therapy or conventional hormone therapy. Once hormone levels are increased, most people see their symptoms improve. However, there is not much evidence to support that bioidentical hormones are equal to conventional hormone therapy. Your healthcare provider can discuss your options for hormone replacement with you based on your symptoms and health history.
Heres The Current Thinking On Hormone Therapy
Many doctors don’t discuss the option of hormone therapy with menopausal patients.
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Menopause symptoms arent only uncomfortable, but they can also impact a womans health, relationships and career. Although hormone therapy can reduce or eliminate menopause symptoms, most menopausal women dont take advantage of hormones because of a decades-old study that warned of serious health risks. Although the thinking on hormones has changed, some women remain confused and afraid, and some medical doctors refuse to prescribe hormones. Now, the CEO of a telehealth startup, celebrities, medical doctors and others are trying to raise awareness about how the thinking on hormone therapy has evolved over the last twenty years.
Oncologist Avrum Bluming and social psychologist Carol Tavris are among those trying to raise awareness. They wrote Estrogen Matters to clarify some of the misunderstandings surrounding hormone therapy. Our goal in writing the book and subsequently answering the dozens of emails we receive from women around the world is to educate women and the medical profession about the symptoms and medical ramifications of the menopauseand, in particular, the role of estrogen in ameliorating symptoms and prolonging womens lives, Bluming says.
Usc Doctor Searches For Truth About Hormone Therapy For Women
Hodis is conducting more studies into why hormones might fight brain fog, inflammation and other changes that happen alongside menopause. His newest investigation tests a combination of conjugated estrogen and bazedoxifene, which isnt a hormone but works like one in the body. Hodis believes it could protect against uterine and possibly breast cancer. Participants in the Advancing Postmenopausal Preventive Therapy trial are women aged 40 to 59 within six years of menopause. Half will get the medication, and the other half will receive a placebo. The researchers will follow them for three years and see if the medication reduces atherosclerosis and cognitive decline.
Hodis is hopeful that the results will back up his timing theory and change minds about the benefits of hormone replacement therapy for heart health. Before the Womens Health Initiative study in 2002, 25% of U.S. women were on the treatment. Today, its only about 4%.
53% of U.S. women die from cardiovascular disease.
That has implications for quality of life and longevity, given that 53% of U.S. women die from cardiovascular disease. Hormone therapy also helps prevent bone loss, which is critical for older women. One in 10 women who break their hip after age 70 die.
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Transdermal And Topical Estrogens
Transdermal and topical estrogens bypass first pass metabolism so can be dosed lower than oral estrogen. Because of the avoidance of the first pass metabolism, they have less impact on triglycerides, coagulation factors and gallbladder disease . Absorption varies based on how the patches and gels are applied. Transdermal therapy may not significantly increase VTE risk, in contrast to oral therapy, as seen in the Estrogen and Thromboembolism risk trial . A single nested case-control study showed stroke risk was not increased with transdermal HT, while it was with oral HT. KEEPS, the only randomized control trial comparing oral and transdermal estrogen, was too small to allow a comparative analysis of risks of stroke, VTE, or other clinical events .
Transdermal estrogen patches have a higher likelihood of causing skin irritation compared to other topical or oral formulations. Topical formulations including gels, sprays and emulsions may lead to a small amount of estradiol transferred if skin-to-skin contact is made within two hours of administration .
Push Away From Conventional Therapies
To some degree, every one of the 21 current and former CBHT users in this study expressed distrust and frustration with the mainstream medical approach to managing menopause. Many framed their use of CBHT in terms of an express desire to avoid conventional hormonal approaches based on three key themes: fear and uncertainty about the safety of conventional HT a strong aversion to conjugated estrogens in particular, and and overarching distrust of a medical system that they perceived to be dismissive of their concerns and overly reliant on pharmaceuticals in place of greater clinical attention.
Fear and uncertainty about the safety of HT
Seventeen of the 21 current or former CBHT users described their treatment decision within the context of fear or uncertainty about the safety of conventional hormone therapy. Like those in the overall study, many women choosing CBHT were concerned about the safety of HT, and WHI results confirmed those fears. Susan, a 56-year-old professor who sought CBHT from her gynecologist for a short period of time when she started experiencing more intense and more frequent hot flashes, put it this way:
Like other women in this study, Susan suggests that she was never inclined to seek out conventional HT to manage menopausal symptoms, and media coverage of conventional HT reinforced this belief.
Distaste for conjugated estrogens, in particular
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Distrust of biomedicine and the pharmaceutical industry
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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.
Bioidentical Hormones Versus Synthetic Hormones
Bioidentical hormones have the exact chemical and molecular structure as the human bodys hormones while other types of lab-made hormones do not. As these other synthetic hormones are made differently than the hormones in the body, the body reacts to them.
For example, Premarin is a replacement estrogen that is made with the help of urine from pregnant horses. It binds to human estrogen receptors very tightly and makes them more reactive.
As with all medications that act as estrogen replacement therapies, this reaction may increase a persons risk of cancer if the medication is taken for a long time.
- reduced bloating
- better thinking and memory
Although people often refer to the symptoms women experience as being those of menopause, they are, in fact, symptoms of perimenopause.
Menopause refers to the time when a woman stops having periods every month. Perimenopause is the time leading up to menopause when the ovaries start to produce less estrogen.
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Global Bioidentical Hormones Market: Segmentation Analysis
The Global Bioidentical Hormones Market is segmented on the basis of Product Type, Type, End-User and geography.
Bioidentical Hormones Market by Product Type
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Based on Product type, the market is bifurcated into Tablets & Capsules, Creams & Gels, Injectables, Patches & Implants, Others. Tablets & Capsules accounted for the largest market share in 2018 and is projected to grow at the highest CAGR during the forecast period. This share can be attributed to factors such as high consumption of bioidentical hormone capsule and higher availability tablets & capsule products in the market. Patches & Implants was the second-largest market in 2018 and projected to grow at a CAGR of 4.64%.
Bioidentical Hormones Market by Type
On the basis of Type, the market is bifurcated into Estrogens, Progesterone, Testosterone, Others. Estrogens accounted for the largest market share of 46.63% in 2018 and are projected to grow at the highest CAGR during the forecast period. Progesterone was the second-largest market in 2018 and is projected to grow at a CAGR of 5.13%.
Bioidentical Hormones Market by End User
Bioidentical Hormones Market by Geography
Significance Of This Research
This work is situated within a larger body of work that aims to understand health care decisions within an increasingly patient-centered health care paradigm that encourages shared decision-making between patients and clinicians. This is especially relevant in a health care environment where information and treatment optionseach with their own risks, benefits, and side effectsproliferate. In this context, there is increasing recognition by clinicians that patients priorities and preferences matter . A systematic review of patient-reported barriers to and facilitators of shared decision-making identified patients knowledge and patients perceived power to participate as key themes influencing patients participation in shared decision-making . However, there is also compelling evidence that merely providing patients with more information is not sufficient to support shared decision-making. Rather, atients need to feel supported so they feel capable of acquiring and understanding knowledge about the available options, and so that they value their personal knowledge contribution .
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Global Bioidentical Hormones Market By Types Applications Countries Companies And Forecasts To 2023 Covered In A Latest Research
This report focuses on the Bioidentical Hormones in Global market, especially in North America, Europe and Asia-Pacific, South America, Middle East and Africa. This report also categorizes the market based on manufacturers, regions, type and application.
Pune India – November 22, 2018 /MarketersMedia/
To Reap Benefits Of Hormone Replacement Therapy Sooner Is Better
The studies that found hormone therapy lowered the risk of heart attack involved tens of thousands of women between the ages of 35 and 55. They started to take the medication when they first began to feel uncomfortable or as they reached menopause. In the Womens Health Initiative study, though, the investigators tested a much older population with an average age of 63. Thats more than a decade after women typically reach menopause.
This led to a new idea: The therapy might protect heart health with less risk of breast cancer if women take it before they turn 60.
For hormone therapy to slow down heart disease, a womans blood vessels need to be clean and healthy, Hodis says. If vessels are already diseasedwhich can happen once women are well beyond menopauseestrogen wont help much.
Women who started hormone therapy within six years of menopause had less hardening of their arteries.
Hodis and his colleagues investigated this theory in a study that included hundreds of healthy postmenopausal women. Their results in 2016showed promise. Women who started hormone therapy within six years of menopause had less hardening of their arteries, known as atherosclerosis, and that translates to lower heart attack and stroke risk. But it didnt help women in the study who were already 10 years past menopause.
Researchers are still trying to understand why hormone therapy is more effective in women closer to menopause, but Hodis has a theory.
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Traditional Hrt Vs Bhrt
The goal of hormone replacement therapy is to replace low levels of hormones. While levels may not be completely restored, treatment is usually enough to resolve symptoms. Differences between HRT and BHRT are:
- Traditional HRT refers to synthetic hormones made in the lab. They are FDA-approved medications that come in standard, prepackaged doses.
- BHRT uses synthetic hormones that are the most identical to those in the body. They come in standard, commonly used doses that are approved by the FDA. The chemical structure of the hormones used in BHRT is often the same or similar as those used in traditional therapy.
What Are The Risks Of Hrt
Breast cancer risk differs depending on the type of HRT and a womans personal history of breast cancer.
Based on results from the very large Womens HealthInitiative studies, combination HRT increases breast cancer risk and this increase in risk lasted for more than 10 years after the women stopped taking HRT.
Higher-dose combination HRT increases breast cancer risk more than lower-dose combination HRT.
Combination HRT also increases the likelihood that the cancer may be found at a more advanced stage. Combination HRT is linked to increased breast density, which can make it harder for mammograms to detect breast cancer.
Breast cancer risk appears to be higher with daily progesterone than with less frequent progesterone .
This increase in risk applies to bioidentical and natural hormone products as well as synthetic hormones. Bioidentical means the hormones in the product are identical to the hormones your body produces. Bioidentical hormones are derived from plants, so theyre sometimes called natural. Synthetic hormones are made in a lab and are also chemically identical to thehormones in your body. It’s important to know that many herbal and bioidentical HRT products fall outside the jurisdiction of the United States Food and Drug Administration and so aren’t subject to the same regulations and testing that medicines are.
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Are Bioidentical Hormones Safe
The bioidentical hormones that are approved by the FDA have been tested for safety. They have passed the FDA’s strict standards and are safe for people to use. Like all hormone treatments, there are risks involved. You should weigh the pros and cons of even the FDA-approved bioidentical hormones with your healthcare provider.
Coronary Heart Disease And Cardiovascular Mortality
Based on data from the intervention phase of the WHI, women aged 50 to 79 years in the overall cohort on oCEE + MPA had increased risk of CHD, defined as non-fatal myocardial infarction and coronary death, compared to placebo, whereas women on oCEE alone had neutral CHD outcomes. Sub-analysis from the WHI showed that age made a difference in CHD outcomes, supporting the timing hypothesis. In the oCEE arm, women aged 50 to 59 trended toward decreased risk of CHD compared to women aged 70 to 79 . Follow up at 13 years supported prior data from the intervention phase of WHI that women who started oCEE alone at a younger age had lower CHD risk. In contrast, those randomized to oCEE + MPA at least 20 years after menopause had significantly higher risk of CHD compared to placebo .
Importantly, cumulative follow up at 18 years showed no difference in cardiovascular mortality between the oCEE + MPA or oCEE group versus placebo for women age 50 to 79 years . Furthermore, there was no significant difference in CVD mortality when groups were stratified by age . Potential explanations for why the intervention phase of the WHI showed unexpected cardiovascular effects include the older study population , mean time since menopause of at least 12 years, numerous women with CV risk factors prior to enrollment, higher hormonal doses compared to subsequent studies and many participants who did not have vasomotor symptoms .
Hormone type, formulation and route
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Not An Elixir Of Youth
Hormone therapy is not a magic bullet or an elixir of youth, and it shouldnt be used willy-nilly, Manson says.
But women who are suffering with menopause symptoms should not be denied hormone therapy, she says, unless they are at increased risk of cardiovascular disease, breast cancer or other estrogen-sensitive cancers.
The pendulum has swung widely from the perception that hormone therapy is good for all women to the perception that its all bad for all women, to now a more appropriate place in between where hormone therapy is perceived to be good for some but not all women, Manson says. Were recommending that hormone therapy be used for the duration that its needed to address symptoms at the lowest effective dose and with ongoing reassessment of the balance of risks and benefits.
The time to start therapy is as soon as the symptoms start. Intervening earlier, rather than later, actually seems to carry less risk, Santoro says.
Once symptoms start, they are unlikely to get better soon. On average, the menopause transition lasts about four years, Santoro says. Some women have symptoms that persist even longer, however. Although there are exceptions, most women wont go through menopause before 45, Santoro says.
If youre 45 or older and starting to have hot flashes, night sweats or mood or sleep changes, it could be your hormones and it might be time to start some active management, she says.
Menopause Symptoms Impact Health And Work
Menopause symptoms arent limited to hot flashes and night sweats. Other symptoms of menopause include difficulty sleeping, difficulty concentrating, mood swings, depression, headaches, racing heart, vaginal dryness, decreased recent memory and decreased energy. For some women, these symptoms begin years before menopause.
Hot flashes are uncomfortable, but they are also related to other issues. Hot flashes can disrupt sleep and may cause mood changes, difficulty concentrating, and impairment of short-term memory. In one study, frequent hot flashes and night sweats were associated with a 50% increased risk of cardiovascular disease. And, if these hot flashes and night sweats persisted over time, then there was a 77% increased risk of later cardiovascular disease.
Given the health and career impact of menopause symptoms, its a problem that many clinicians are not well-informed on the current thinking regarding hormone therapy. Bluming explains that part of the problem stems from the fact that menopause education is currently offered to less than 25% of residents studying obstetrics/gynecology. This may also explain why some practitioners still refuse to prescribe hormones. Given that over 50 million women in the United States are over the average age of menopause , one would think menopause care would be a higher priority.
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