“What does modern science and functional medicine have to say about HRT and bioidentical hormones? Let’s find out.” 

“This two part series on HRT will explore the myths and science behind HRT and make the distinction between traditional HRT options and the newer, safer bioidentical hormones that are more common today.”

What do you think of when you hear hormone replacement therapy, or HRT? Does it make you think of something your mother did? Or, fill you with fear around heart disease or cancer? Perhaps you have friends who’ve told you that HRT has been like night and day as far as menopausal symptoms? 

This two part series on HRT will explore the myths and science behind HRT and make the distinction between traditional HRT options and the newer, safer bioidentical hormones that are more common today. 

Let’s dive into the details behind:

• The difference between traditional and bioidentical hormone replacement therapy (BHRT)
• The history of HRT and the concerns about cancer and heart disease

What does modern science and functional medicine have to say about HRT and bioidentical hormones? Let’s find out. 

Bioidentical vs. Traditional Hormone Replacement Therapy

Bioidentical hormones are molecularly identical to those produced by the human body. Bioidentical hormones are FDA approved and increasingly available in pre-made dosages or available through compounding pharmacies. Bioidentical hormones are often regarded as a safer choice to traditional types of hormone replacement therapy. 

Traditional HRT refers to synthetic hormones or hormones from animals that are similar, but not the same as human hormones. One example is Premarin, an estrogen replacement therapy popular in the 1990s. Premarin is derived from the urine of pregnant horses. 

While there are times and conditions where younger women benefit from using bioidentical hormones, we are going to focus on the hormone replacement therapy that is most often used to treat the symptoms of declining hormone levels in menopause.

Menopausal symptoms may include:

• Hot flashes
• Night sweats
• Mood changes
• Weight gain
• Sleep disturbance
• Low libido
• Vaginal dryness
• Thinning skin and wrinkles
• Fatigue
• Memory loss
• Loss of muscle mass
• Painful sex

Estrogen, progesterone and testosterone are the most common HRT therapies prescribed for women in menopause. All are available as bioidentical preparations, although many conventional practitioners still use synthetic versions. 

Bioidentical hormone replacement therapy for women can be customized for each woman based on her age, health status, hormone levels and health goals. It’s incredibly important to work with a knowledgeable functional medicine practitioner who will take your whole health picture into account and do the appropriate testing and follow up.

Is There a Link Between Estrogen Therapy and Heart Disease or Cancer?

Many women still have concerns about HRT risks. To understand why, we need to go back in history to the Women’s Health Initiative study, which began in 1991 and was one of the largest studies ever done looking at how to prevent cancer and heart disease in post-menopausal women. 

Early results from this study published in 2002 suggested that those using HRT as a combination of Premarin (estrogen) and progestin, the synthetic progesterone-like hormone also used in birth control, had an increased risk for heart disease, breast cancer and stroke. As a result of this study, the use of HRT largely stopped in the US. 

Since that time, flaws in this study and its rushed publication have been discovered and new research points to HRT benefits and specifically the benefits of bioidentical hormones. 

Estrogen and Heart Disease

Heart disease is the number one cause of death for post-menopausal women. We know that the ovarian hormones – estrogen and progesterone – are protective against this risk and that heart disease increases as these hormones decline. 

A recent review of bioidentical hormone replacement therapy from a functional medicine perspective reveals that timing matters. For women without contraindications, when bioidentical therapy is initiated early in menopause, the benefits may outweigh the potential risks and provide protection for the heart. 

It’s not necessary to wait 12 months after the last menstrual cycle, as is the accepted definition of entering menopause, to begin therapy. With proper, regular testing, bioidentical hormones (specifically transdermal bioidentical estrogen and oral bioidentical progesterone) may be safe for longer-term use to promote both cardiovascular protection and quality of life. 

Is the estrogen in our bodies carcinogenic?

Since some cancers, including breast cancer, can be rooted in poor estrogen metabolism, there is the worry that estrogen replacement therapy may drive the cancer process. Recent epidemiological evidence still links the use of estrogen to cancer risk, depending on a woman’s weight, when she started using HRT and how long she used it. This is an important piece for each woman to discuss with their provider, especially if she has a history, family history or other risk factors for specific cancers. 

However, it likely doesn’t mean that every woman needs to avoid hormone replacement therapy because of cancer risk, especially when choosing bioidentical options. In addition, there may be benefits for certain women to use progesterone-only therapy instead of estrogen plus progesterone.

I’ll dive more into this in Part 2, where I’ll cover bioidentical estrogen, progesterone and testosterone, along with what to expect and the importance of testing. In the meantime, if you are ready to dive into your personal questions about bioidentical hormones, please reach out to begin that important conversation. 

References

1. Rossouw, J. E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Kooperberg, C., Stefanick, M. L., Jackson, R. D., Beresford, S. A., Howard, B. V., Johnson, K. C., Kotchen, J. M., Ockene, J., & Writing Group for the Women's Health Initiative Investigators (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321–333. Abstract: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial
2. Chester, R. C., Kling, J. M., & Manson, J. E. (2018). What the Women's Health Initiative has taught us about menopausal hormone therapy. Clinical cardiology, 41(2), 247–252. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/29493798/ 
3. Gersh, F. L., O’Keefe, J. H., Lavie, C. J. (2021). Postmenopausal hormone therapy for cardiovascular health: the evolving data. Heart. Published Online First: 22 February 2021. Full text: https://heart.bmj.com/content/early/2021/02/22/heartjnl-2019-316323.full?ijkey=aaPB4xO8RYmwoi7&keytype=ref&fbclid=IwAR1OClPqG56jsuWiqH0SaaeJy6YDBENQxMHABm2yQn6M4cbZtj5PQiBb1xM 
4. Collaborative Group on Hormonal Factors in Breast Cancer (2019). Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet (London, England), 394(10204), 1159–1168. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891893/ 

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