Menopause Part 15: Bioidentical Hormone Therapy

Welcome to part 15 of the ODX Menopause Series. Here we provide a brief review of FDA-approved bioidentical hormone therapy.

The ODX Menopause Series

1. Menopause Part 1: A Quick Overview of a Slow Process
2. Menopause Part 2: Biology and Physiology of Menopause
3. Menopause Part 3: Increased Risk of Disease Associated with Menopause
4. Menopause Part 4: Identifying Menopause: Signs and Symptoms
5. Menopause Part 5: Laboratory Evaluation of Menopause
6. Menopause Part 6: Cardiovascular Risk in Menopause
7. Menopause Part 7: Beyond Hormone Testing in Menopause
8. Menopause Part 8: Natural Approaches to Menopause
9. Menopause Part 9: Diet and Nutrition Intervention in Menopause
10. Menopause Part 10: Characteristic of Herbal Derivatives used to Alleviate Menopause Symptoms
11. Menopause Part 11: Lifestyle Approaches to Menopause
12. Menopause Part 12: The National Institute on Aging Addresses Hot Flashes
13. Menopause Part 13: Hormone Replacement Therapy (HRT) in Menopause
14. Menopause Part 14: North American and European Guidelines for Hormonal Management of Menopause
15. Menopause Part 15: Bioidentical Hormone Therapy
16. Menopause Part 16: Optimal Takeaways for Menopause
17. Optimal The Podcast - Episode 10

Despite the fact that women become “deficient” in estrogen and progesterone following menopause, hormone replacement therapy comes with significant risks.

HRT using equine estrogens and synthetic progesterone had been widely used in the past. However, these hormones are not chemically identical to human hormones and have been associated with increased risk of breast cancer, dementia, cardiovascular disease, myocardial infarction, and stroke. Estrogen therapy as a standalone is associated with uterine cancer. Researchers propose that hormones structurally identical (bioidentical) to human hormones may have significant benefits with less risk:[1]

Bioidentical hormones may be available in various forms including patch, lotion, gel, spray, ring, suppository, or oral, including a combination capsule containing 100 mg of progesterone with 1 mg estradiol. Bioidenticals are available as FDA-approved formulations including compounded products. They may also be available as custom compounded products though some concerns about standardization and efficacy have been raised.[2] [3] [4]

Orally administered hormones can be rapidly metabolized by the GI tract and liver, prompting clinicians to prefer the transdermal route.[5] An early randomized controlled trial evaluated the effect of transdermal cream containing 20 mg of bioidentical progesterone from diosgenin, a Mexican yam extract. Results revealed that 25 out of 30 women reported significantly improved or completely resolved vasomotor symptoms with the transdermal cream.[6]

References

[1] Mahmud, Khalid. “Natural hormone therapy for menopause.” Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology vol. 26,2 (2010): 81-5. doi:10.3109/09513590903184134

[2] Pinkerton, JoAnn V. “Hormone Therapy for Postmenopausal Women.” The New England journal of medicine vol. 382,5 (2020): 446-455. doi:10.1056/NEJMcp1714787

[3] Stuenkel, Cynthia A. “Compounded bioidentical hormone therapy: new recommendations from the 2020 National Academies of Sciences, Engineering, and Medicine.” Menopause (New York, N.Y.) vol. 28,5 576-578. 11 Mar. 2021, doi:10.1097/GME.0000000000001735

[4] Ward, Katherine, and Angela Deneris. “An Update on Menopause Management.” Journal of midwifery & women's health vol. 63,2 (2018): 168-177. doi:10.1111/jmwh.12737   

[5] Whelan, Anne Marie et al. “Bioidentical progesterone cream for menopause-related vasomotor symptoms: is it effective?.” The Annals of pharmacotherapy vol. 47,1 (2013): 112-6. doi:10.1345/aph.1R362

[6] Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol 1999;94:225-8