​The Buzz on Bio-identical Hormone Therapy​

By: Holly L. Thacker, MD • Posted on May 20, 2019

​The Buzz on Bio-identical Hormone Therapy​

I wrote my first book Your Body, Your Hormones, Your Choices in 2007 as the buzz began about Bio-identical Hormone Therapy (BHT). I then followed with my second book in 2009, The Cleveland Clinic Guide to Menopause. My focus was on choice, individuation and the opposite of a one-single approach to women.

Finally, a FDA-Approved Combination BHT Therapy

Now a full decade later, we finally have an FDA approved combination BHT therapy (estradiol and progesterone in medium chain triglycerides i.e., coconut oil) in a single capsule taken in the evening after a meal.

Estradiol

For some time we have had several bio-identical estrogen (estradiol) products available separately, including:

  • pills
  • patches
  • sprays
  • gels
  • vaginal creams
  • tablets
  • inserts

So why am I, as a menopause expert, glad that mid-life women now have this new option? Because so many women in the last decade and one-half have turned to unregulated compounding pharmacies. The Women’s Health Initiative shocked the world, caused confusion and led many women to turn to so-called bio-identicals.

The Women’s Health Initiative showed that women who took menopausal hormone therapy actually had REDUCED death rates, and women with hysterectomy who took estrogen alone actually had REDUCED breast cancer rates. Nevertheless, panic ensued and many searched for alternatives to synthetic progestins.

Unregulated compounds, pellets, and unstudied ingredients are not necessarily safer, and they put women at risk for uterine cancer as estrogen is well absorbed via the skin and GI tract whereas progesterone is not. We have reported on a case series of women on unregulated BHT developing uterine cancer.

Well-Studied Menopausal Hormone Therapy Options

There have been several combination oral and transdermal estrogen-progestin combinations like:

  • Activella®
  • Mimvey
  • FemHRT®
  • Prempro®
  • Angeliq®

There are designer hormones with estrogen and non-progestin that still protects the uterus - these therapies have been well-studied and have a role in menopausal hormone therapy. Women with a uterus, who need protection from an increased risk of uterine cancer from unopposed estrogen, there is now an option.

Estrogen protects the breasts, but stimulates the uterus. Progesterone protects the uterine lining, but can stimulate the breasts. Hence, women with a uterus and/or extensive endometriosis need hormone balancing.

Some women are intolerant to progestins (synthetic progesterone like substances used in hormonal contraceptives and many menopausal combination therapies.) Natural progesterone helps some women sleep and can reduce anxiety. On the other hand, natural progesterone in 200mg dose in Prometrium® sometimes can induce heart burn by relaxing the lower esophageal muscle and can cause some somnolence. Any oral natural progesterone should be taken in the evening before going to sleep.

Hormone Therapy Benefits Exceed the Risks

All therapies, hormone and non-hormonal have risks and benefits, but for most symptomatic women, the benefits exceed the risks. One size doesn’t fit all and doses may be adjusted after age 65 when metabolism slows down. There is NO time limit to feeling good.

By the way, I won’t be writing a 3rd book on women and hormones anytime soon, because I work on this award winning website, speakingofwomenshealth.com for YOU!

Be Strong. Be Healthy. Be in Charge!

-Holly L. Thacker, MD

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Specialized Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.


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