Maida Pharmacy Blog

Choosing BHRT: Why Women are Preferring Bioidentical Hormone Replacement Therapy
A top ten list of reasons why BHRT is preferable to conventional methods
Post by Christy Schmidt on August 12, 2009

From Suzanne Somers and Oprah Winfrey to the FDA and WebMD, there has been a recent flurry of discussions and disputes about the use of Hormone Replacement Therapy (HRT) for relief of women's menopausal symptoms. More recently, the clash of ideas and attitudes has been aimed at the preference of Bioidentical Hormone Replacement Therapy (BHRT) over conventional HRT.

Although these arguments seem to be somewhat newly emerging, these treatments have been around for much longer than many assume. Doctors have been trying to treat menopause since 1930, and the first uses of HRT were being marketed in the United States by the early 40s. Unfortunately for the producers of these HRT drugs, the mid-70s saw a decrease in use due to links between oestrogen and endometrial cancer. This decline led to the development of BHRT as an alternative to HRT.

Whether you believe it is good, bad, wrong or right, there are some facts that must be laid out on the table. We have compiled a Top 10 list of the reasons that women may be choosing BHRT over synthetic hormones and conventional HRT.

1. First, and perhaps most importantly, studies have revealed that while Bioidentical HRT and conventional HRT are similarly used for the relief of menopausal symptoms in women, BHRT is more effective in treating the symptoms for which it is prescribed with far less side effects (Everything Menopause). BHRT is seen as an actual solution to the problem whereas conventional methods of HRT may just be a Band-Aid to cover up the real issues. Now, just on the surface level, if studies suggested that medicine A works better than medicine B with less side effects, which would you choose? Me too. But it goes deeper...
2. If you didn't already know, you may have figured out this next reason from the names of these treatments. BHRT utilizes hormones that are identical to those made naturally in women's bodies. They are referred to as "natural" because they are created primarily from wild yam and soy. Therefore, the body, which has evolved to create a hormonal balance on its own, knows what to do with that hormone and how to break it down. In a video interview, Dr. Christenson explains that on the other hand, synthetic hormones become a problem because they have molecules attached to them that the body has a hard time recognizing and breaking down. The breakdown products, referred to as metabolites, are often toxic to the body and can create disturbances across many different organs systems. Most importantly, doctors and pharmacists are able to better predict what the effect on the human body will be with bioidentical hormones, unlike the effects of synthetic hormones.
3. In the medical world, it is accepted that most medicine does not come without risk. In the case of hormone replacement, safety is extremely critical, and all of the associated risks must be addressed before proceeding with treatment. Scientific reviews have revealed that according to their molecular structure, progestins' effects can vary significantly. A study done by Brent Murphy, MPS, bioidentical progesterone proved to be safer and more effective in all trials that involved its usage, as synthetic progestin increases the risk of breast cancer. Another study done by the Women's Health Initiative supported this fact with the results of its trial beginning in the fall of 1997. This study on the effects of HRT was scheduled to be completed in 2005. However, researchers stopped the study in May of 2002 because they felt that the health risks for the participants taking HRT outweighed the possible benefits.
4. While you and your best friend do share the same love for Macy's and Rocky Road ice cream, this does not means that your chemical makeup is identical to hers. Consequently, the symptoms that each of you will go through with menopause may be very different. Some women deal with hot flashes and mood swings, while others may experience severe depression. One of the greatest benefits of BHRT is that every patient is treated as unique. Compounded bioidentical hormones have the ability to turn "woman with menopause #963" into "Jane Smith, with the symptoms of moderate irritability and aching joints, and family history of breast cancer." Marcelle Pick, OB/GYN and founder of Women to Women admits that the focus of conventional HRT on a "one size fits all" approach may be one of its greatest drawbacks, as each woman has a different set of circumstances that determine her personal risk.
5. The administration of hormones into a woman's body varies upon which method she uses. According to Brent Murphy's study, the BHRT emphasis on topical administration (creams) may avoid problems such as blood clotting that are caused by the rapid metabolism of orally administered hormones. Although there are some topical forms of HRT, it is more commonly found in a pill taken orally which may cause certain unnecessary side effects.
6. Peter Koshland, Pharm.D, is an experienced compounding pharmacist and expert in bioidentical hormone replacement in San Francisco. One of the main reasons that Koshland advocates for BHRT has to do with the goals of each therapy. He believes that the goal of BHRT is to achieve a balance of activities of the hormones to improve quality of life. In opposition, he sees HRT as more of a quick fix and a way for doctors to increase their 401ks. With BHRT comes a closely observed plan... which leads us to the next reason that it trumps HRT.
7. When you make the decision to look into hormone therapy as the fire hose to your menopause hell, there is a significant difference between HRT and BHRT right off the bat. If Jane chooses to go the conventional route, there will be a number of medications she can choose from: Provera, PremPro, Premarin... and the list goes on. She will take these hormones (orally) and hope that her symptoms disappear. On the other hand, if Joan chooses to consider BHRT, she will be set up with an evaluation plan from her doctor and/or pharmacist. Along with her bioidentical hormones, she will receive information on how to correctly supplement the hormones with eating right and exercising. Joan will be evaluated by her doctors to see how she has progressed and to make sure she is staying on track. Maybe it's just me, but I see Joan's fire hose spraying at full force, while Jane's is just a dribble.
8. You may have heard the comical anecdote: God made man (Adam) before he made the woman (Eve) because all great artists make a rough draft before they make a masterpiece. (Isn't there some truth in most jokes?...) HRT can be considered pharmacy's first draft, and BHRT its masterpiece. The two therapies are both geared towards the same outcome, but have very different pasts. BHRT was developed as a safe alternative to HRT once it was linked to several different cancers. Women's Health phrased it well: "Women do not have to be subjected to harmful drugs as the only recourse to menopausal symptoms. By replacing natural hormones with bioidentical hormones, women can have a quality of life that surpasses what women had during menopause in the past."
9. On his blog, Koshland posted two recent trials that have cast more doubt on the use of non-bioidentical hormones. These trials raised questions about the safety of tibolone, a hormone used largely in Europe and other countries outside the US. Tibolone is considered a "catch-all" HRT because it has properties of both estrogens and progestins. The trial in the New England Journal of Medicine studied over 4500 post-menopause women aged 60 to 85. Although the women receiving the tibolone did have a decreased risk of fracture, their risk of stroke doubled when compared to the women receiving the placebo. The second trial published in The Lancet Oncology focused on 3000 women with a prior history of breast cancer. These doctors found that women being given the tibolone had a significantly higher incidence of breast cancer recurrence than those given a placebo.
10. Finally, for those out there who deeply respect their doctors and expect the same regard and genuine care back from them, this reason is for you. Erika Schwartz founded a non-profit organization called Bioidentical Hormone Initiative. Part of their mission statement relays a message of indisputable attention to what their patients need: "Founded by a group of conventionally trained, practicing physicians who have successfully used bioidentical hormones for decades to treat hormone imbalances in men and women, the Bioidentical Hormone Initiative seeks to encourage the use of bioidentical hormone therapy as a key tool in the growing movement to promote true prevention with respect, compassion, and patient advocacy." This statement rings true for compounding pharmacists who practice the theory of patients over profit. Pharmaceutical companies, a significant source of funding, have not sponsored BHRT because the subject hormones are not patentable. Therefore it is understood that these compounding pharmacists believe that these hormones can make better lives for their patients, even if it does not mean striking it rich.

The Wall Street Journal published an article in March titled, "The Truth about Hormone Therapy," where Schwartz, along with two of her colleagues addressed their feelings on BHRT:

"Sadly, seven years after the WHI study finding Premarin/Provera unsafe, the hormone-replacement debate can be summed up in three words: confusion, ignorance, and misinformation. Meanwhile, millions of women have embraced bioidenticals, leaving their conventional physicians looking stubborn and foolish. The medical establishment must stop catering to drug companies and start serving women's best interests -- and that involves widely prescribing bioidentical hormones. This will lead to healthier, happier women and, in the long run, help reduce America's skyrocketing health-care costs."

Now who doesn't want that?

When considering BHRT, it is important to choose a compounding pharmacy that is using the right equipment and has excellent quality assurance for its patients. Talk to your doctor or call Maida today to see if BHRT is your way out of the symptoms of menopause.