Are Bio-Identical Hormones Safe for Menopause?

What are Bio-Identical Hormones?

Bio-identical hormones are estrogen and progesterone with the same chemical structure as the estrogen and progesterone our body naturally produce.  Unlike Premarin (made from horse urine), soy/red clover phyto-estrogen, or other “natural hormones”, bio-identical hormones are indistinguishable from your own hormones.  When used as hormone replacement therapy for women post-menopause, bio-identical estrogen and progesterone have more predictable outcomes, reliable benefit, and less risk.

Benefits and Usage of Bio-Identical Hormone Replacement Therapy

Hormone replacement therapy has been shown to have a number of significant health benefits:

1. Osteoporosis prevention:  Sex hormones play an important role in the maintenance of bone density.  Immediately following menopause, the rate of bone mineral loss increases.   Starting bio-identical hormones immediately following menopause will delay the rapid bone mineral loss and reduce osteoporosis.   Of course, all women should ensure they have a mineral rich diet and healthy exercise routine throughout their lives to build and maintain bone strength.
2. Cognitive brain function:  Foggy memory, depressed mood, trouble finding words and other cognitive decline are often associated with menopause and low estrogen level.  Bio-identical estrogen replacement can return a post-menopausal woman to her former self.  Bio-identical progesterone can also be used to decrease anxiety and/or facilitate sleep to enhance daytime alertness.
3. Pelvic organ health:  Estrogen is required to maintain healthy pelvic organs.  Estrogen provides muscle tone to uterus and vagina, give the mucus membrane elasticity and thickness, and encourages healthy bacteria flora.  Post-menopause, in the absence of estrogen, some women experience dryness of vagina, pain with intercourse, burning urination, prolapse of uterus and bladder, as well as chronic yeast infection.  Some women also experience excessive uterine bleeding, irregular menstrual cycle, and/or PMS like symptoms due to low progesterone level peri-menopause.  Bio-identical progesterone may be one of the solutions to these conditions
4. Cardiovascular health:  Estrogen has natural protective benefits for the cardiovascular system.  While on normal amounts of estrogen, women have better values for good HDL cholesterol, systolic blood pressure, insulin level (less cholesterol and fat production), and fibrinogen level (less random clotting).  Bio-identical estrogen can prevent the onset of artery thicken if started shortly after menopause.  There is no cardiovascular benefit to if started many year post menopause, once atherosclerosis has already developed.
5. Improve hot flashes and night sweats:  Perhaps the best known reason for starting bio-identical hormone are the more obvious symptoms of hot flashes, night sweats, and dry skin.  Bio-identical hormone can achieve freedom from symptoms with just a relatively low dose.  The key is to make sure the body is relatively free from toxin overload by doing a good quality cleanse while ensuring the body is enriched with important micronutrients.

Safety Studies on Hormone Replacement Therapy (HRT)

In 2002, the Women’s Health Initiative sounded alarm bells throughout the medical community.  The 8 year study on HRT was ended early due to discovery of increased risk of breast cancer, heart disease, and stroke.  This study utilized higher doses of conjugate equine estrogen (estrogen from horse urine) and synthetic progestin.

Since 2002 a number of revealing studies have been done on HRT.  The Million Women Study in 2003 show estrogen alone only slightly increased the risk of breast cancer, but estrogen + synthetic progestin doubles the risk of breast cancer.  The 8 year long French Study in 2007 proved that the type of hormone used in HRT matters in the development of breast cancer.  Whereas bio-identical estrogen and progesterone did not increase the risk of breast cancer, women taking estrogen + synthetic progestin combination is 1.69 times more likely to develop breast cancer .

Naturopathic Perspective

Based on current research, the combined used of bio-identical estrogen and bio-identical progesterone appears to have numerous long term health benefits and no increased cancer risk.  The maximum benefit of bio-identical HRT seem to be for women new to menopause, before low sex hormone level related rapid bone loss and arterial plague build up can occur.  Knowing all the safety information, unless there is definite laboratory confirmed deficiency in hormone level, bio-identical hormone is not the first tool I would choose to address perimenopause and menopausal concerns.  As a naturopathic doctor, I would ensure the liver is working at full capacity and there is no metabolic toxin build up.  Very often, a good detox will eliminate menopausal symptoms without resorting to hormones.  In cases where there is obvious deficiency, a good detox will allow the body to respond to a much lower dosage of bio-identical hormone supplement.  How long should women be on bio-identical hormone replacement therapy?  That will be determined on an individual basis.  Because the longest research on safety is 10 years, it may be prudent to stay within this time range.