All About Bioidentical Hormone

Many of our patients ask about bio-identical hormones for treatment of menopausal symptoms, and it is easy to be confused with so much conflicting information available online and in product advertising.

First of all, the term “bio-identical” is not a scientific or medical term, but refers to hormones that look biologically identical to those produced by humans. Women produce three kinds of estrogen prior to menopause, the predominant one being estradiol. Any estradiol product is by definition bio-identical. Our ovaries also produce progesterone each month after ovulation and in pregnancy. While testosterone is often thought of as the “male hormone”, testosterone is an important hormone for us, too. In fact, women produce more testosterone throughout our lives than estrogen, even though we make about 1/10 as much as men. 

Let’s dig into these terms a bit more. Any progesterone product is by definition bio-identical. Our patients often tell us that they don’t want “synthetic hormones” and prefer something “natural.” Unfortunately, these terms are really marketing terms with no real meaning. All hormones including bio-identical hormones are synthetic; that is they are made in a lab to look exactly like human hormones. Some come from a plant source, hence the term “natural” that may be used in their advertising, but they are not taken out of the ground and put in a bottle; they are synthesized in a lab to be made useful to humans. The only truly “natural” human hormones would be taken out of one human and used in another, which is luckily not the source of any hormones used for menopausal relief! 

Bio-identical hormones (estradiol, progesterone, and testosterone) are available from specialty pharmacies called compounding pharmacies that mix hormones to various specifications. Estradiol and progesterone are also available in several FDA approved forms from commercial pharmacies and are covered by most insurance. The FDA has not approved any testosterone products for women, yet. Estradiol and testosterone are also available in sub-cutaneous pellet form. Pellets are made by high level (503 B designated) compounding pharmacies that are monitored by the FDA.

We prescribe from both commercial and compounding pharmacies according to patient preference. Using a compounding pharmacy is an option, not a necessity, and beware of expensive lab tests and of terms like “natural” which suggest that a product is better or safer. The lab we use in our office is in-network with all major insurance.

Bio-identical hormones can dramatically improve the quality of life for women suffering from hormone loss which is inevitable with age. Testosterone begins to drop as early as our 30’s and low levels can lead to multiple symptoms including fatigue, muscle loss, fat gain, and loss of libido. Progesterone also drops as early as our 30’s and is almost undetectable after menopause since it is made by the ovaries after ovulation. Low progesterone is associated with mood swings, sleep disruption and heavy bleeding. Estrogen fluctuates throughout our cycles before menopause and drops to almost undetectable levels after menopause, causing hot flashes, night sweats, vaginal dryness, brain fog, and a multitude of other unpleasant symptoms. Estrogen depletion in menopause is associated with increases in many diseases including heart disease, osteoporosis, colon cancer and neurologic decline.

These hormones are available in several delivery systems that we will discuss with you at your consultation. In short, estrogen and testosterone are most effective and safest when delivered across or under the skin, in the form of a twice weekly patch (estradiol only) subcutaneous pellet (which may be both estradiol and/or testosterone and lasts for 3-4 months), a cream or gel. Progesterone is a larger molecule that is not absorbed as well through the skin, so it is generally given by mouth at night, and has a great side effect of causing sleepiness.

Here are a few surprising but true facts about bio-identical hormones:

  1. Multiple studies have shown that estradiol is not associated with causing breast cancer, although it will cause more rapid growth or spread of existing cancer. Testosterone decreases breast cancer risk.
  2. Multiple studies have shown that estradiol given non-orally shows no increase in blood clotting risk and decreases the incidence of heart disease, osteoporosis and Alzheimer’s disease if started early, as well as colon cancer.
  3. Progesterone is a great alternative to sleeping pills and is essentially risk free. It also reduces uterine cancer.
  4. Testosterone in cream or pellet form has been shown to improve libido, increase muscle mass as well as slowing bone loss. It does not cause acne, hair growth, or any other unpleasant symptoms when dosed correctly.