Bioidentical Hormone Debate: Are Bioidentical Hormones Safer or More Efficacious Than Commonly Used Synthetic Versions in HRT?
Source: Abstract from Postgraduate Medicine, Volume 121, Issue 1, January 2009, ISSN-0032-5481, e-ISSN-1941-9260
Author : Kent Holtorf, MD, Holtorf Medical Group, Inc, Torrance, Ca.
Due to the ongoing debate regarding safety and efficacy of bioidentical hormones (estradiol, estriol, and progesterone), this paper aimed at evaluating evidence comparing the same to commonly used synthetic hormones and HRT. Utilizing published papers identified from PubMed/MEDLINE, Google Scholar and Cochrane databases, evidence was collected regarding compared effects for physiologic actions on breast tissue, risks for breast cancer and cardiovascular disease, clinical outcomes and in vitro results.
Reported was patient satisfaction with HRT that contained progesterone compared to synthetic progestin. Bioidentical hormones have “distinctly different, potentially opposite, physiological effects compared to synthetic counterparts, which have different chemical structures.” While research indicated increased risk for synthetic progestin, conversely, progesterone consistantly is associated with diminished risk for breast cancer. Four articles were cited for progestin and seven articles for progesterone. Regarding cardiovascular disease, progestins carry a variety of negative effects which may be avoided with progesterone. Estriol has some unique physiological characteristics from estrogen counterparts and while it is expected to carry less risk for breast cancer, no randomized controls have been documented.
The effects of progesterone compared with progestins included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstral bleeding, a 40% reduction in cognitive difficulties, and a 30% improvement in sexual function resulting in 65% of women who felt HRT combined with progesterone was better than the HRT combined with progestin.
The conclusion of this article, based on thorough review of medical literature is support for the claim that bioidentical hormones have some effects distinctly different or opposite of their synthetic counterparts. More randomized control trials of substantial size and length will be needed to determine these differences.
Dr. Holtorf discloses no conflicts of interest.
