The Controversy Surrounding Bioidentical Hormone Replacement Therapy (BHRT)

After the results of the Women's Health Initiative Study were released in 2002, women were warned away from hormone replacement therapy HRT. This study concluded that although HRT was effective in treating menopause symptoms it posed significant risks in heart disease, strokes, and breast cancer. To be fair, it did show that HRT decreased osteoporosis and colon cancer, but the rewards were statistically small when compared to all the risks so the use of HRT screeched to a halt. Both doctors and women decided that perhaps HRT wasn't the best treatment available so the search continued for something better. A lot of people think that bioidentical hormone replacement therapy may just be that something better, but a lot of people on the other side of the isle disagree.

Traditional HRT is a synthetic drug made from estrogen derived from the urine of pregnant horses. It may sound fantastic, but this is how it's made. So, this horse estrogen, called conjugated equine estrogens or CEE is the primary ingredient in HRT. Although this was the type of HRT that was found to have negative health effects, scientists, women and doctors thought that perhaps there was a way to get all the benefit of HRT without all of the negative side effects, thus giving birth to bioidentical hormone replacement therapy.

BHRT has been around since the early 1900's but only since the downfall of HRT as the menopause treatment of choice has it really risen to prominence. BHRT is widely controversial and compounded BHRT is virtually the Wild West of medical practices. If you're unfamiliar with these terms, let me give you a little history. The first thing you need to be aware of is that no definition of BHRT exists. Yes, you read that correctly, BHRT has no recognized definition, medical or otherwise. What does this mean? Generally it means that there is a lot of misinformation and ignorance surrounding BHRT.

Usually when people refer to bioidentical hormone replacement therapy they are referring to a drug made from a plant based material that is very close to the hormones produced naturally by people, but it can also include animal derived or mineral derived sources of hormones. And to further confuse matters, both bioidentical and nonbioidentical hormones can use the same sources. Another common component of BHRT is the use of compounding; this is when a compounding pharmacist using a saliva test makes (compounds) you a medicine based on your hormonal needs. So, each compounded version of BHRT would be unique based on each specific women needs. Herein lays one of the major problems surrounding BHRT.

Since each compounded batch is different, it can't be approved by the FDA. All FDA approved drugs need to contain each ingredient in exact measurement otherwise no medically scientific testing can be reasonably conducted. How do you test a drug that has no exact ingredients? Well, you can't. This is why compounded BHRT is like the Wild West. No definition exists, no testing exists and everyone is just doing what they think is in the greater good.

Suzanne Summers has been a vocal proponent of BHRT for years and is cited as perhaps the originator of the term "bioidentical" by using the term her book and more recently Oprah has been singing the praises of BHRT which has obviously increased interest in the subject. What is both interesting and somewhat frightening at the same time is that BHRT is being touted as a safe alternative to traditional hormone replacement therapy, but this has not been proven. Maybe it is safer, maybe it's not. Closer to the truth is that we simply don't know. Although FDA approval isn't a guarantee of drug safety as recent history has shown, ignorance isn't bliss either. Since BHRT and compounded BHRT have only recently become popular, the verdict isn't in yet.