The Wild World of Bioidentical Hormones

A frank discussion about bioidentical vs. synthetic hormones and safety risks.

Now that you have a solid foundation when it comes to menopause hormone therapy, it’s time to dive into the wild world of bioidentical hormones!

A word of caution: there are a lot of Big Feelings about menopause hormone therapy, especially when it comes to bioidentical hormones and hormone pellets. Why? Because marketing can be extraordinarily powerful.

Without further ado, let’s dive in.

I keep hearing about bioidentical hormones and how I shouldn’t take synthetic hormones. What does bioidentical mean and what does it mean in terms of menopause hormone therapy?

“Bioidentical” is a misleading marketing term used to imply that hormones derived from plant compounds are more natural and therefore safer to use than “synthetic” products used by big pharmaceutical companies.

Why is this misleading? For a few reasons.

1. Synthetic just means that something has been made in a chemical laboratory. And guess what? All MHT hormones - “bioidentical” and “synthetic” - are made in a chemical lab and are therefore synthetic.

2. The most commonly used hormones in FDA-approved hormone therapy (micronized progesterone and estradiol) are also derived from plant compounds and are identical to the “bioidentical” hormones that are being marketed as being better alternatives to FDA-approved MHT.

Okay, so “bioidentical” is basically a misleading marketing term. What are hormone pellets?

Menopause hormone therapy has lots of delivery methods. FDA-approved MHT comes in the form of patches, pills and creams. Bioidentical hormones made by compounding pharmacies can come in the form of creams, lozenges, gels, tablets, sprays and rice-sized “pellets” that are implanted under the skin and deliver hormones to the body for 3 months at a time.

In short, hormone pellets are a delivery method of compounded bioidentical hormones.

I don’t know what a compounding pharmacy is. Please explain.

A compounding pharmacy can take the active ingredients used in prescription drugs and prepare them in different forms. This can be helpful for people who can’t take standard forms of drugs (due to allergies to non-active ingredients, for example) or who need customized dosing or combination medications.

While compounded pharmacies play an important role in medical care, there is also a downside. For example, compounding pharmacies are not regulated by the FDA, but by state pharmacy boards. This means there is no formal reporting when adverse events occur.

So if an irresponsible doctor pumps a woman full of much higher levels of hormones than the FDA-approved options and she develops alarming side effects, the incident isn’t reported and no data is gathered to get a sense of larger patterns to determine if the benefits of the treatment outweigh the risks.

Bioidentical hormones are marketed by compounding pharmacies as being a safer alternative than FDA-approved MHT because there’s no data stating otherwise. HOWEVER, an absence of formal data is not proof that hormone pellets are a safer option. The data isn’t there because it’s not legally required. Claims about the benefits of bioidentical hormone therapies need to be backed with data derived through legitimate scientific studies, and they currently are not.

Finally, without FDA oversight, quality control with compounded hormone therapies (and pellets especially) is lacking. This means the hormone dose could be higher or lower than what your doctor intended due to lack of quality control.

Anything else I should know?

Yep. Just two more things.

Bioidentical hormone therapy is often marketed as being superior to FDA-approved MHT because doctors can tailor hormone levels to your specific needs at every stage of your perimenopause journey.

However, the saliva tests used by doctors to determine dosing for compounded hormone therapy don’t provide an accurate understanding of hormone fluctuations or overall hormone decline in perimenopause. In fact, The Menopause Society says these tests, “are of no value in either selecting initial medication doses or monitoring therapy for menopausal symptoms.” In plain English: these tests are a waste of your time and money.

And last - just to make things crystal clear - the official position of The Menopause Society is that they do NOT recommend compounded hormone therapy, for all the reasons stated in this post.

My neighbor swears by her hormone pellets! They can’t be all bad, right?

Your neighbor may love her compounded hormone pellets and have no adverse effects from them - I’m sure many compounded hormone therapies are just fine!

However, I wonder how much information she was given about the true risks and benefits of compounded hormone therapies vs. FDA-approved MHT. With accurate information, would she make the same choice? And without accurate information, was she able to truly consent to having the pellets implanted?

How can doctors responsibly prescribe compounded hormone pellets, given all this information?

I don’t know. My best guess is that most doctors who prescribe compounded hormone pellets genuinely believe they are a good option for treating menopause symptoms. Most doctors received little to no medical training about menopause, tend to work long hours and have limited time for continuing education. So if they learned information about pellets from a compounding pharmacy or colleague, they may have decided to simply take their word for it without investigating further.

Other doctors may know The Menopause Society’s position on hormone pellets and still choose to prescribe pellets based on anecdotal evidence, because they don’t like big pharma, or any other wide variety of reasons, including profiting directly from prescribing the pellets.

Personally, any doctor recommending hormone pellets would be a HUGE red flag for me, and I think it should be for you as well.

Whew. That was … a lot. What are we talking about next?

New up, we’re talking about non-hormone options for women who are experiencing disruptive menopause symptoms but don’t want to take MHT or can’t take MHT.

Until then,

Rebecca

P.S. Very important funeral plans.

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