What Are Bioidentical Hormones?

The term bioidentical hormone can be confusing to understand at the first go. Bioidentical hormones as defined by the Endocrine Society, are compounds which have the same chemical and molecular structure as those produced endogenously. (1) However, the source of these compounds can be plant-based, laboratory-derived products which are natural (and not artificial). One of the most common sources of bioidentical hormones is diosgenin, a plant-based sterol (a compound similar to cholesterol produced by the human body).(2)

Bioidentical hormones are prescribed for post-menopausal women to revive the depleting hormone levels in their bodies. This is called bioidentical hormone replacement therapy (BHRT). These bioidentical hormones consist of two main sex hormones – estrogen and progesterone, in their bioidentical formulations, individually or in combination. The ones approved by the US FDA include estradiol, estrone, and micronized progesterone.(3)

However, besides bioidentical hormone therapy, there are multiple compounded formulations available in pharmacies. They are formulated as per specific patient needs and with a valid prescription seeking a specific dosage of hormones. As per the FDA’s definition, compounded bioidentical hormone therapy (CBHRT) employs “the combining or altering of ingredients by a pharmacist, in response to a licensed practitioner's prescription, to produce a drug tailored to an individual patient's special medical needs”.(1) CBHRT uses 17β-estradiol, estrone, estriol, along with progesterone (progestogen), and sometimes testosterone, dehydroepiandrosterone, and pregnenolone in small amounts to get the desired composition.

However, it is on the patient too to ensure the pharmacy where they get their compounded doses, is a licensed one and gets their ingredients from credible sources. Since compounded BHRT is not regulated by the FDA, due diligence is expected from both the prescribing doctor and the patient before using any compounded formulations. Take the first step toward balanced health — start a teleconsultation with Science & Humans experts today to find out if Bioidentical Hormone Replacement Therapy (BHRT) is right for you. Available across Canada, our specialists are here to help you understand the benefits and create a plan tailored to your needs.

Bioidentical hormones are not equal to hormone supplements that are marketed as manufactured from plant sources like yam and black cohosh. Compounds like like isoflavones are sold as “natural” and “herbal” alternatives to traditional hormone therapy, but are synthetic in their chemical nature due to high levels of processing, are in no way similar the chemical and molecular structure of bioidentical hormones, leave alone endogenous hormones.(1) (4) (5)

What Are Synthetic Hormones?

Synthetic hormones, unlike bioidentical hormones, are not identical in chemical or molecular structure as the human (endogenous) hormones. (6) However, the human body converts them to useable forms upon administration. (7) These synthetic hormones are derived either from chemical sources (like synthetic conjugated estrogen, synthetic micronized estradiol, norethindrone acetate) or from non-human sources like equine body fluids (like Premarin, falling under the category of conjugated equine estrogens or CEE and Provera, falling under the category of medroxyprogesterone acetate or MPA). (8) (9)

Synthetic hormone replacement may or may not be specifically indicated while prescribing or while searching through regulatory databases, as most of them are considered as a part of the umbrella term hormone replacement therapy (HRT), but it is their chemical nature which sets them apart from bioidentical hormones.

Most of these synthetic (non-bioidentical) hormones are regulated by the US FDA for use in menopausal hormone replacement therapy. However, both BHRT and HRT are prescribed to those who seek treatment. Choosing between the two depends on the patient and their examining practitioners.

Bioidentical versus Synthetic Hormone Replacement: What is the Difference?

The most basic difference between bioidentical and synthetic hormones is the structure, source, and chemical composition. Bioidentical hormones are synthesized from natural sources in the laboratory, while synthetic hormones are either synthesized artificially from artificial or non-human (animal) sources in the laboratory. Although both are made in the labs, there is a specific methodology and level of processing which makes their chemical natures different. While synthetic hormones vary in structure and must be enzymatically acted upon by the body to be able to produce the desired results, bioidentical hormones have a similar chemical and molecular structure and bind to the same receptors in the body as natural hormones.

Another usage-based difference between synthetic hormones and bioidentical hormones is that synthetic hormones come under fixed doses as decided by the US FDA and are prescribed accordingly. However, bioidentical hormones are often compounded as per prescriptions to ensure maximum efficacy, as not all bioidentical hormones are regulated by the US FDA. However, this prescription is only valid when there is a licensed practitioner involved and the pharmacy where compounding is done has its key ingredients sourced from reliable and certified suppliers. It is up to the prescriber and the patient to conduct a due diligence before resorting to compounded medication.

Which Risk Factors Do You Consider While Choosing Biosynthetic Hormones?

When speaking about risk factors, there are no absolute ways to compare the risks of both bioidentical or synthetic hormone therapies. Every individual has a different system and will have different medical histories.

Patients with cardiovascular and thromboembolism risk factors have been shown to be predisposed to heart attacks and strokes when put on continuous dosing of oral estrogen. Similarly, patients who have been undergoing menopause for more than a decade are generally not advised to pursue any form of synthetic hormone therapy due to risks of ischaemic stroke or cognitive disorders. There are the normal adverse effects like unwanted weight gain, facial hair, nausea, bloating, and general weakness due to synthetic hormone therapy due acting on the elderly. (1)

Since the dosing of synthetic hormones is standard, there is no scope for compounding medications to suit individual needs. Thus, if a woman is subjected to unopposed supply of a certain fixed dosing of estrogen, without any possible modification, over-administration of estrogen may lead to an increased risk of endometrial cancer. Concomitant use of estrogen and progesterone in fixed doses has also shown to increase the risk of breast cancer in some studies. (10)

Bioidentical or Synthetic Hormones For Menopause: Which one to Choose?

The choice between synthetic and non synthetic hormone replacement therapy is best made by a doctor or an endocrinologist who has had a thorough background check on the patient’s medical history, is familiar with their blood tests and the duration of menopause till the time it was reported. Age is also a confounding factor in the choice of therapy. Hence, it is best to consult a physician and a specialist before resorting to any form of hormone therapy. Self-medication is injudicious and should not be practiced at any cost.

Common Myths About Hormone Therapy In Women

There are multiple myths relating to hormone therapy in women. The most common myths are regarding the safety and efficacy of hormone therapy. Since estrogen is crucial in the maintenance of bone health in women, many think that taking vitamin and calcium supplements will be equally effective. Perceptions about the possible risks of exposure to breast and ovarian cancer also make women think twice before going to the doctor to seek help for menopausal syndromes. Age is also a key factor when it comes to HRT-related decisions. Most women believe they are too young or too old to resort to any form of HRT.

But Please Remember That….

One does not need BHRT or HRT just because they are undergoing menopause. But if there is any medical history like hysterectomy or oophorectomy, or there has been extreme cases of menopausal symptoms which are affecting daily life activities, one should not hesitate to consult an expert to seek medical help. Menopausal hormone therapy works best when it is implemented in the early menopausal days, ideally between age 45-55, if one has started menopause early. The late one is, the more risks one is predisposed to.

FAQs

Between BHRT and synthetic HRT, which has least risks?

This decision is only for your doctor to make. There are pros and cons of every therapy, be it BHRT or synthetic hormone therapy. Just because the structure and nature of the bioidentical hormones is similar to the endogenous hormones does not mean that it will suit everyone. In hormone replacement therapy, there is no concept of one-model-fits-all. There are different formulations for BHRT like topical gels, pellets, pills and skin patches, which act in different ways to treat hormone deficiencies.

Are compounded BHRTs better than synthetic hormones?

Compounding is only done for specific cases, depending on individual medical histories and as per the licensed practitioner’s prescriptions. But compounded therapies are also not for everyone. It is also a myth that because compounded therapies contain specific proportions of hormones, it will bring the ‘best of all worlds’ to whoever is taking it. Patients and the prescriber need to get their due diligence done on the pharmacies and their suppliers before prescribing compounded therapies.

I am in my forties and experiencing menopausal symptoms. Is this normal?

Many women experience menopausal symptoms in their forties as well. Please contact your doctor if you are facing any form of severe symptoms, especially if they are affecting your daily life.