Nature vs. Science: Are Bioidentical Hormone Replacement Therapy For You?


by Colette Bouchez

Hot flashes? Night sweats? Feel like smacking your honey one minute and the next minute smacking him even harder?

If so, you’re living in the “House of Hormones”- that sometimes scary, always weary place that sooner or later every woman passes through on her way to menopause.

But late last month, the news was good: The hormone treatments that can help speed you through the process, may not be as dangerous as once thought.

Indeed, two brand new studies found that if started within no more than 4 years after your last menstrual cycle, hormone therapy may not have the negative impact on the heart as previously shown in the large Women’s Health Initiative trials of 2002. In fact, it may even improve your heart health.

“These new findings suggest the possibility that if a woman starts hormone therapy soon rather than later, perhaps we will see some of the protective effects on the heart that natural estrogen provides – or at least it won’t increase the risk of cardiovascular related harm,” says Dr. Nanette Santoro, Professor and director of division of reproductive endocrinology at Montefiore Medical Center in the Bronx.

But as encouraging as these results are, many experts continue to approach HRT with some caution.

” This new studies hint at the idea that women who want to use short term hormone therapy to control symptoms may no longer have to choose between hot flashes and heart disease – but we still need more studies to know for sure,” says Dr. Steve Goldstein, professor of OB/GYN at NYU Medical Center in New York City.

To this end, several new clinical trials -including the KEEP trial in New York City – are attempting to answer these questions. But that will take upwards of four years.

In the meantime, however, many women are opting for a different approach, turning instead to “bio identical hormones” – a combination of several weaker forms of estrogen, and natural progesterone to quell their symptoms. Frequently endorsed by celebrities such as Suzanne Somers and women’s health specialist Dr.Nisha Jackson, they are garnering lots of attention.

“Natural hormones are hormones in their purest form- bio identical in molecular structure to those made by the human body,” says Jackson, in her book The Hormone Survival Guide for Perimenopause.

Usually made from plants- either wild yam or soy – Jackson says the natural compounds work exactly the same as the hormones produced by a woman’s body – unlike HRT, she says, which only mimics what happens in the body. And therein, she says, lies the difference.

“It is safe to say that the cascade of effects brought about by the release of estrogen into the body is not quite the same when [that] estrogen is synthetically altered, “says Jackson.

A Hormonal Time Bomb Waiting To Explode?

On the surface, “natural hormones ” make good sense. Unfortunately, because most are a blend of several different forms of estrogen made from scratch in small batches by compounding pharmacies the products can vary greatly from one pharmacy to the next, and sometimes even from batch to batch.

In fact, a spot check of compounded medicines conducted by the FDA in 2003 reported up to 34% didn’t live up to their claims.

Moreover, because these compounds are plant derived, they don’t have to answer to the FDA – which means they can also be sold without benefit of any testing. And experts say there have been almost no studies done – and that’s potentially a huge problem.

“Right now there are no studies that I would put stock in, large enough, placebo controlled studies , showing bio identical compounds are either safe or effective,” says Dr. Steve Goldstein, professor of OB/GYN at NYU Medical Center.

Any concerns that we might have about traditional HRT, he says, we are likely to have about compounded bio identical hormones – or worse, he says, likening them to a time bomb that could go off at any time.

Santoro agrees.” There’s essentially no significant safety or efficacy data on these compounds- it’s all a plural of anecdotes and it just doesn’t constitute true scientific testing,” – a position that is echoed in statements from the American College of Obstetricians and Gynecologists (ACOG).

Moreover, Santoro says that because everyone metabolizes compounded medicine differently, even when made to spec, some women may still end up with almost nothing in their system, while others may experience a hormone overload.

“Without testing and manufacturing quality control, women may be playing with dynamite,” says Santoro.

What Every Woman Can Do

If, in fact, you want to give bio identical hormones a try, there are some prescription forms manufactured by traditional pharmaceutical companies that have been tested in clinical trials.

The first is a natural form of estradiol ,the dominant form of estrogen made by the ovaries. It’s sold in pill and cream form, by prescription, under the brand name “Estrace”.

Also available as a prescription patch: Climara®, Alora®, Estraderm®, and FemPatch®. There is also a bio identical progesterone prescribed under the brand name Prometrium®.”

To learn more about the KEEP heart-hormone study – or to find out if you are eligible- visit

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