Bio-identical Hormones: Dr. Marianne Marchese discusses important considerations for women

Menopause is a time of transition in a woman’s life. No two women enter into menopause the same, and thus cannot address the issues that arise with a one-size-fits-all treatment approach. As women become more educated about these options, they often ask their physician which treatment is best for them. For decades, women in the U.S. have been prescribed hormones for menopause.

Bio-identical hormones are compounds that have exactly the same chemical and molecular structure as human hormones. By contrast, non-bioidentical, or synthetic, hormones are structurally different from the hormones a woman’s ovary makes. The bio-identical hormones made by conventional pharmaceutical companies come with set dosages and fixed amounts of additives and fillers. Compounding pharmacies can formulate estrogen and progesterone pills and creams, estrogen-only pills and creams, and can add other bio-identical hormones, such as testosterone and DHEA, as determined by the physician. The compounded hormones come with unlimited dosing options and the ability to titrate the dose up and down, depending on how a woman responds, which allows for more individualization of hormone therapy.

Are bio-identical hormones safer and more effective than synthetic? In theory, they are. But we are just beginning to see research that includes the use of bio-identical hormones. Remember that synthetic hormones were the main choice of hormone therapy in menopause for decades.

A recent study showed that a combination of bio-identical estradiol, estriol and progesterone shows positive effects on symptoms with less risk of breast cancer and cardiovascular disease. However, a study from 2009 showed an increase risk of ovarian cancer from the use of hormones in menopause, regardless of the type of hormone used, (synthetic verses bio-identical), duration of use or method of administration.

In her younger years, a woman’s ovary produces mostly estradiol, progesterone and testosterone. Estriol is converted in the body from estriol. Estrone is the dominant hormone in menopause, converted from another hormone in a woman’s adipose tissue or fat. Most physicians no longer add Estrone to bio-identical hormones, due to the slight increase risk of breast cancer from Estrone metabolites.

So a formula typically consists of the two estrogens: estradiol and estriol. If a woman has a uterus, she must have progesterone added to the formula to protect it. Often, a doctor will add testosterone and DHEA, as well. Keep in mind that bio-identical testosterone converts to estradiol, and thus increases the amount of estradiol and possible breast cancer risk. Bio-identical hormones formulation and prescribing can be confusing, so a woman should seek out a practitioner that has experience and training in order to formulate a product that is right for them.

For those that are not good candidates for bio-identical hormones, there are still plenty of options for treating the symptoms of menopause, including herbal medicines, nutrients, amino acids, bioflavonoids, homeopathic remedies and diet and nutrition. Protecting a woman from disease conditions common after menopause, such as osteoporosis, should be included in a comprehensive individualized treatment approach.

Dr. Marchese is the author of 8 Weeks to Women’s Wellness: The Detoxification Plan for Breast Cancer, Endometriosis, Infertility, and other Women’s Health Conditions. She graduated from the National College of Naturopathic Medicine, maintains a private practice at Longevity Medical Health Center, in Phoenix, and teaches gynecology at Southwest College of Naturopathic Medicine. Contact her at LongevityMedical.com.