The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?

Holtorf Medical Group, Inc., Torrance, CA 90505, USA.
Postgraduate Medicine (Impact Factor: 1.7). 02/2009; 121(1):73-85. DOI: 10.3810/pgm.2009.01.1949
Source: PubMed

ABSTRACT The use of bioidentical hormones, including progesterone, estradiol, and estriol, in hormone replacement therapy (HRT) has sparked intense debate. Of special concern is their relative safety compared with traditional synthetic and animal-derived versions, such as conjugated equine estrogens (CEE), medroxyprogesterone acetate (MPA), and other synthetic progestins. Proponents for bioidentical hormones claim that they are safer than comparable synthetic and nonhuman versions of HRT. Yet according to the US Food and Drug Administration and The Endocrine Society, there is little or no evidence to support claims that bioidentical hormones are safer or more effective.
This paper aimed to evaluate the evidence comparing bioidentical hormones, including progesterone, estradiol, and estriol, with the commonly used nonbioidentical versions of HRT for clinical efficacy, physiologic actions on breast tissue, and risks for breast cancer and cardiovascular disease.
Published papers were identified from PubMed/MEDLINE, Google Scholar, and Cochrane databases, which included keywords associated with bioidentical hormones, synthetic hormones, and HRT. Papers that compared the effects of bioidentical and synthetic hormones, including clinical outcomes and in vitro results, were selected.
Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a synthetic progestin. Bioidentical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins. Estriol has some unique physiological effects, which differentiate it from estradiol, estrone, and CEE. Estriol would be expected to carry less risk for breast cancer, although no randomized controlled trials have been documented. Synthetic progestins have a variety of negative cardiovascular effects, which may be avoided with progesterone.
Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly.

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Available from: Kent Holtorf, Sep 28, 2015
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    • "In consideration of the increased risk for cancer, stroke, and blood clots related to the use of synthetic hormones, research within the past decade has shown that long-term use of such hormones is inadvisable for some women [15]. Some scholars have reported that, although randomized control trials are lacking, the findings of several clinical outcome studies indicate that bioidentical hormones are related to lower risks of breast cancer and cardiovascular disease and are also more effective than synthetic or animal-derived hormones (e.g., Holtorf [16]). Understandably, conflicting and/or inconclusive findings in this area could lead to many practitioners being confused regarding the kind of hormonal treatment that would be optimal for a symptomatic aging woman with low hormonal levels who is reporting sexual interest problems. "
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    ABSTRACT: Sexual desire is a major component of sexuality at any age, and inhibited desire is one of the main sexual dysfunctions reported by older women. Nonetheless, in medical settings, for a variety of reasons discussed herein, its assessment-as well as the assessment of older women's sexual health in general-is typically avoided or conducted by asking a single sex question. In this paper, we have reviewed the literature (most of which is preliminary in nature) regarding the main psychosocial and health factors that could impact older women's sexual desire, as well as potential obstacles to the assessment and treatment of this geriatric sexual issue. It is certainly advisable that medical care providers who are uncomfortable discussing older women's sexual concerns be prepared to make appropriate referrals to clinicians who possess the proper training to accurately assess and treat sexual challenges (and female sexual interest problems in particular) in this neglected patient population.
    BioMed Research International 06/2014; 2014:107217. DOI:10.1155/2014/107217 · 3.17 Impact Factor
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    • "Bioidentical hormones have received increasing publicity for the treatment of menopausal symptoms due to claims of bioidentical hormone therapy (BHT) being as effective, yet safer than CHT, and for being useful for managing more than menopausal symptoms, even being called a "fountain of youth".17,18 For example, bioidentical progesterone has been said to improve quality of life and to produce a favorable lipid profile, as compared to non-bioidentical progestogens such as medroxyprogesterone.19,20,21 Likewise, bioidentical estrogens have been claimed to be effective in treating menopausal symptoms while being safer than non-bioidentical estrogens such as equine estrogens and synthetic estrogens.17,20,22 "
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    ABSTRACT: To investigate Nova Scotia (NS) pharmacists' knowledge and beliefs regarding the use of bioidentical hormones (BHs) for the management of menopause related symptoms. Using Dillman's tailored design methodology, an invitation to complete the web-based questionnaire was emailed to pharmacists in NS as part of the Dalhousie College of Pharmacy Continuing Pharmacy Education Department's (CPE) weekly email update. Data was analyzed using descriptive statistics. Of approximately 1300 e-mails sent, 113 pharmacists completed the questionnaire (response rate 8.7%). The majority of respondents (94%) knew that BHs were not free from adverse drug reactions. More than 50% were aware that conjugated equine estrogens and medroxyprogesterone acetate were not examples of BHs. For seven of eleven knowledge questions, 33-45% indicated that they did not know the answer. When asked about their beliefs regarding BHs, many believed that BHs were similar in efficacy (49%) or more effective (21%) than conventional hormone therapy (CHT) for vasomotor symptoms. Most respondents also believed that both BHs and CHT had similar safety profiles. Additionally, responding pharmacists indicated that more education would be helpful, especially in the area of safety and efficacy of BHTs compared to CHT. NS pharmacists knew BHs were not free of adverse effects, however knowledge was lacking in other areas. This may reflect the level of coverage of this topic in pharmacy school curriculums and in the pharmacy literature. Results indicate a need for additional education of NS pharmacists with respect to BHs, which could be accomplished through modification of undergraduate pharmacy programs and supplementary CPE.
    07/2012; 10(3):159-67. DOI:10.4321/S1886-36552012000300006
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