BHRT stands for Bio-Identical Hormone Replacement. For years the terms estrogen and progesterone have been thrown around in the medical literature interchangeably and led patients (and some providers) to believe that all hormones are the same. Simply put, this is not the case and there are synthetic hormones that are biochemically similar (but not the same – think trying to use your key at your friend’s house; it may fit into the lock, but it won’t get you inside) and those that are created to be identical to those that your body makes itself (endogenous hormones – think a copy or spare key.)
Turns out… the answer is NO! There are numerous studies showing that when you replace endogenous hormones with synthetic ones such as conjugated equine estrogens (ex: premarin from pregnant horse urine) or progestins (ex:medroxyprogesterone acetate or MPA), you can certainly see some change in symptoms, yet the risks of cancers, cardiac implications and blood clots – to name a few- are far greater than when replaced with bioidentical hormones. Unfortunately, synthetic hormones do not have the same actions on the receptors or your body as those that are molecularly identical to your body’s own hormones and can only cause partial actions- sometimes even causing more side effects than intended positive effects. The method of replacement also matters greatly in the way in which your body will metabolize these hormones.
There are a few ways to tell if a person even needs hormones in the first place. If a patient is not on any replacement, bloodwork is a quick and easy way to check your levels. Insurance will typically cover these blood tests. If you are currently on oral or injectable replacement, bloodwork is still a valid and reliable way to monitor levels. However, if you are currently on topical replacement (creams, gels, patches), the best and most accurate way to follow these levels is with salivary testing. While saliva is not yet covered by all insurances, it remains a very reasonably priced testing method and is only required 2-3 times per year. Emerging tests do utilize urine, yet the cost is still quite high.
Bioidentical hormone replacement has been shown to be a safe and effective way to restore balance in a female or male with symptoms and laboratory proven deficits. When we discuss hormones, it is important to remember that replacement does not mean introducing more hormone than was previously there or that your body needs, it means restoring a deficiency. Too much of a good thing is, unfortunately, never usually a good thing. Additionally, there are always exceptions to every rule and for some patients BHRT is just not a safe option (such as patients with active cancer or clotting disorders.) There are numerous studies showing benefit and safety with the use of bioidentical hormones and just as many to show the risks associated with the use of synthetic ones. Bottom line: only replace what is needed, use the closest form you can get to what your body used to produce, replace them in the safest way possible and continuously monitor levels, signs and symptoms closely.
Benefits of Estrogen
2013 study: researchers estimated that over the past decade between 18,600 to 91,600 postmenopauseal women ages 50-59 who had had a hysterectomy may have died prematurely because they did not take estrogen. (Sarrel, P. et al., http://www.ncbi.nlm.nih.gov/pubmed/23865654 )
2009 study: meta-analysis of 27 published studies showed a 28% reduction in mortality in menopausal women under age 60 who used hormone replacement therapy and also had improved quality of life.
Risks of using synthetic Progestins (not actually bio-identical progesterone)
(Roussouw, J., et al., “Risks and benefits of estrogen plus progestin in healthy postmenopausal women”) http://www.ncbi.nlm.nih.gov/pubmed/23262943
Porch JV1, “Estrogen-progestin replacement therapy and breast cancer risk: the Women’s Health Study (United States).” http://www.ncbi.nlm.nih.gov/pubmed/12462550
Liang, Y., et al., “Synthetic progestins induce grown and metastasis of BT-474 human breast cancer xenografts in nude mice.” (http://www.ncbi.nlm.nih.gov/pubmed/20461021 )
No significant increase in risk in use of bioidential Progesterone. This study showed an increase in risk when synthetic progestins were added to an estrogen therapy regimen, but adding bioidentical micronized progesterone did not.
Wood, C., et al., “Effects of estradiol with micronized progesterone or medroxyprogesterone acetate on risk markers for breast cancer in postmenopausal monkeys.” (http://www.ncbi.nlm.nih.gov/pubmed/16841178 )
Study done by researchers in E3N study in 2008 showed that natural progesterone has been shown to decrease the risk of developing breast cancer. The same researchers showed that when synthetic progestins were used with estrogens, the risk of breast cancer actually went up by 40%. In women who used estrogen combined with bioidentical progesterone, there was a trend toward a decreased risk of developing breast cancer.
Fourier, et.al, “Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort.” http://www.ncbi.nlm.nih.gov/pubmed/%2015551359
Percutaneous estradiol/oral micronized progesterone has less-adverse effects and different gene regulations than oral conjugated equine estrogens/medroxyprogesterone acetate in the breasts of healthy women in vivo.