In recent years, there been a lot of hype about using “natural” or bioidentical hormone replacement therapy (BHRT) to alleviate the symptoms of perimenopause and menopause. Celebrity endorsements have made the topic hot. Former actress Suzanne Somers is among the most notable proponents of BHRT. With no formal medical training, she has written two books on the subject, calling the therapy, “the juice of youth,” and claiming she plans to take it for life.
Oprah Winfrey recently used her mass communication muscle to continue the discussion around BHRT, devoting entire programs to the topic last year. Her praise of bioidentical hormones sparked backlash from members of the medical community and left a lot of midlife women looking for ways to stop their hot flashes and the clock in the middle of a highly contentious debate.
“Hormone replacement therapy (HRT) once seemed the only answer for many of the symptoms women face as they age, but that’s not the case anymore,” said board certified menopause clinician Barb Silver, founding director of the Women's Health Resource Center at California Pacific Medical Center (CPMC)Opens new window. Ms. Silver has been a nurse practitioner in women’s health for more than three decades. “Traditional hormone therapy has benefits, but we now know long-term use can come with risks.”
The potential for harm became apparent in 2002 when researchers released findings from the landmark Women's Health Initiative (WHI) study. After following more than 150,000 postmenopausal women starting in 1991, they concluded that combined daily estrogen and progestin therapy increased the risk of heart attacks, strokes, breast cancer and blood clots in some women. Investigators found benefits of HRT as well, including decreased risk for colon cancer and increased bone density.
As a result of the WHI study, practitioners and their patients have looked carefully at risks and benefits of HRT. They’ve also searched for different ways to alleviate menopause symptoms.
“Many women are turning to alternative hormone therapies thinking they are safer, but that may not be the case at all,” asserted Ms. Silver.
Bioidentical hormones are derived from plants such as soy and yam. They have a chemical structure that is identical to hormones produced by the body. The term “bioidentical hormone therapy” is often used to describe a specially mixed medication containing estrogen, progesterone or other hormones. The cocktail is typically made in a compounding pharmacy, so the end product is not regulated by the Food and Drug Administration (FDA) and therefore not tested for potency or purity. Doses are tailored to the woman’s needs and determined by blood and saliva tests that measure hormone levels in the body - a debatable practice considering those levels frequently fluctuate.
Because they are sourced from plants, proponents claim BHRT is safer than traditional HRT. In truth, many of the FDA-approved trans-dermal estradiol preparations on the market today are bioidentical. However, the WHI study only tested Premarin, which is an estrogen extracted from pregnant mare’s urine, and Provera, a synthetic progesterone.
“Whether they are made from plants or animals, all hormones we use are manipulated in a lab to get the finished product. When they are referred to as natural, I think that is misleading,” said Ms. Silver. “No matter what the drug is made from, we can’t say this version is bad and this one is good. Until we have the evidence, I am going to operate under the assumption that findings from the WHI study may apply to all hormone replacement therapies.”
HRT is still an important option for women suffering from menopause symptoms, according to Ms. Silver. “If a woman is at the end of her rope, I use the lowest dose possible for the shortest amount of time,” she said. “Typically, I don’t start with drugs. First, we address the lifestyle changes that might help to improve her quality of life.”
Anne Easthope, a nurse practitioner at the Institute for Health and Healing at CPMC, takes a similar approach. She weighs the benefits versus the risks before using any HRT. To promote healing and lessen the challenges that come with the so-called “change of life,” Ms. Easthope blends the best of traditional and Western medicine, placing an emphasis on the mind-body connection.
“Your body responds to the way you think, act and feel,” said Ms. Easthope. “The way we deal with emotional and physical change sends direct messages to other hormones in our body. These chemical messengers, called neurotransmitters, can be measured using a simple urine test and balanced with nutritional supplements.”
To alleviate menopausal symptoms, Ms. Easthope recommends women exercise more, eat healthier, learn to manage stress and try to build social connections. She also suggests using botanicals such as black cohosh and phytoestrogens, such as those found in soy. In studies, both show promise for the treatment of hot flashes.
Whatever the approach, one-size doesn’t fit all when it comes to finding relief. Because some women are more sensitive to the hormonal fluctuations that accompany aging, hot flashes, mood swings, weight gain, sleep disturbances and vaginal dryness can all vary in severity.
“Symptoms may be happening for multiple reasons so it is really important to look at the whole person,” said Ms. Silver. “Let’s face it, midlife can be difficult. You can’t just take a pill to make difficult times go away.”
While sexy and seemingly graceful celebrities endorse unregulated hormone therapy, Ms. Silver touts safer and sage advice. On the road to getting wiser and staying well while going through menopause, she suggests women employ extra TLC, and take something some feel they may have lost: time.
“Women spend their entire lives taking care of other people,” said Ms. Silver. “Midlife is a great time to start learning how to take care of themselves."