This past weekend, I had the opportunity to attend a bio-identical hormone therapy (BHRT) conference in Toronto led by Dr. Erika Schwartz MD, a leading women’s health and hormone expert who practises in Manhattan, NY.

Although I have been using bio-identical hormones with great success for several years, a common concern among women is the misconception about hormone safety, and it is important to me to have the most up-to-date information to give my patients to ensure them that they are making the right choices for their health.

What are hormones and why do I need them?

Hormones are molecules produced by “endocrine” organs, and the primary hormones are estrogens, progesterone, androgens/testosterone, thyroid hormones, cortisol, growth hormone and insulin.  The ovaries, testicles, thyroid, adrenal glands, pancreas, pituitary, hypothalamus, and even fat tissue (!) are considered endocrine organs as they produce hormones.  These hormone molecules circulate through the body and bind to receptors on your cells.  The binding of a hormone to a receptor is what elicits a hormonal response.

Everyone needs hormones as they control our sexual development, metabolism, blood sugar, reproduction, mood, etc!  They are intimately tied to our existence, and when hormonal balance is compromised, we no longer feel like ourselves.

What is hormone replacement?

As early as 1889, a powder made from dried cow’s ovaries known as Ovariin was listed in the Merck manual from treatment of “climacterica” (now better known as menopause)!  Hormone replacement is not a new treatment for peri-menopausal and menopausal women, but we have certainly refined our treatments since Ovariin!

Hormone replacement is used to restore a healthy hormonal balance for women with declining ovarian function, to promote healthy aging and protect against chronic disease.

Bio-identical hormone replacement therapy (BHRT) useshuman-identical estrogens, progesterone and testosterone to treat insufficient hormone levels and their symptoms, while also protecting women from cardiovascular disease and stroke, bone loss, and cancer.  Common symptoms of peri-menopausal/menopausal hormonal imbalance include:

– Hot flashes
– Night sweats
– Loss of libido
– Vaginal dryness
– Insomnia
– Bloating/weight gain
– Loss of skin tone
– Itchy skin
– Anxiety
– Palpitations
– Depression/mood changes
– Poor memory
– Frequent urination/stress incontinence/frequent UTI’s
– Foggy thinking

These symptoms, due to insufficient hormone levels, can be safely treated with bio-identical/human-identical hormone therapy.

Why does hormone replacement therapy (HRT) have a bad rap?

Synthetic or non-human identical HRT commonly refers toPremarin (conjugated equine estrogens, or CEE, from pregnant horse’s urine) and Provera (Medroxyprogesterone acetate or MPA, also known as “progestins”).  Premarin and Provera were HRT drugs used in the Women’s Health Initiative (WHI) Study in the late 1990’s/early 2000’s.  The WHI trial was discontinued early, due to the strong evidence linking Premarin and Provera to increased cardiovascular disease, stroke, and venous thromboembolism.  

Conjugated equine estrogens and progestins have chemical structures that drastically differ from the structures of the hormones that exist naturally in our bodies/human-identical hormones.   Because of this difference, they affect hormone receptors in different and often unpredictable ways, leading to a myriad of potentially dangerous side effects.

How can we confirm that bio-identical hormones are safe?

BHRT uses hormones that are human-identical to those that circulate naturally through your blood and lymphatic system.  When used in appropriate doses for women with hormonal imbalance or hormone deficiency, they are not only safe, they are better for you than no hormone replacement at all.

The Danish study was a 16-year randomized study, using 1006 healthy women with an average age of 50 and postmenopausal for approximately 7 months.  These women received bio-identical estradiol (estrogen) and were followed for 16 years.  The following results were found:

– Significantly reduced risk of mortality
– Significantly reduced risk of heart failure
– Significantly reduced risk of myocardial infarction (heart attack)
– NO increase in risk of cancer
– NO increase in risk of thromboembolism
– NO increase in risk of stroke

The PEPI trials were a 3-year multicenter, randomized, double blind and placebo controlled study of 875 postmenopausal women aged 45-64 who received either placebo, estrogen with MPA/progestins, or estrogen with bio-identical progesterone.  The women who received estrogens combined with bio-identical progesterone had the most favourable effects on HDL (good cholesterol) levels, blood pressure, and experienced NO endometrial hyperplasia.

The E3N cohort study of 100,000 women studied cancer risk factors in women since 1990.  The results showed that synthetic progestins/MPA/Medroxyprogesterone acetate/Provera may increase breast cancer in women, while bio-identical progesterone did not.  The E3N study showed that women using bio-identical estrogen with bio-identical progesterone had a reduced risk for developing breast cancer, whereas women using synthetic progestins/MPA had a significantly increased risk of breast cancer compared to placebo.

These studies, and many others which confirm the safety of bio-identical hormone use over the use of synthetic HRT are so critical for both myself as a physician and for the patient to be aware of.  Not only do I wish to provide the safest and most effective treatment for my patients, I also want the women who have chosen BHRT to be confident that their decision to alleviate menopausal symptoms, prevent chronic disease, and age healthfully is the right one.

To learn more about Dr. Erika Schwartz MD, visit her website.  You can sign up for her free newsletter and receive a copy of her ebook, The Hormone Solution.  This is a great read if you are interested in learning more about bio-identical hormone therapy!