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Menopausal Hormone Therapy: Understanding 'FDA-Approved' vs 'Bio-Identical' Hormone Options

Confused about Menopausal Hormone Replacement Therapy? Let's discuss the differences in FDA-Approved versus Bio-Identical Hormones...


I often use analogies when explaining concepts with patients in the office.  Though the issue of Menopause/Hormone Replacement Therapy (HRT)  is a complex one,  with many different considerations…We have to start somewhere in grasping the array of options.  Here’s my bit.  In my analogy we’ll start with 3 options:

1) FDA-approved HRT,

2) Bio-Identical HRT

3) Herbal options.

One of the main differences in FDA HRT and Bio-Identical HRT is their derivation.  FDA/HRT may come from plant or animal sources, whereas the Bio/HRT and herbal options come from plant sources only.  I explain to patients, you can take certain plants (mostly soy containing yams) and “squeeze out’’ products  EQUAL  to “human hormones” (there are both FDA-approved HRTs and Bio-identical/HRT options.)  Certain other plants have “plant hormone” with similar qualities, but not equal to human hormone (isoflavones like soy, Siberian rhubarb.)

 


Menopausal Hormone Replacement Therapy:  FDA-Approved versus Bio-Identical Hormones?

I often use analogies when explaining concepts with patients in the office.  Though the issue of Menopause/Hormone Replacement Therapy (HRT)  is a complex one,  with many different considerations…We have to start somewhere in grasping the array of options.  Here’s my bit.  In my analogy we’ll start with 3 options:   1) FDA approved HRT,  2) Bio-Identical HRT,  and  3) Herbal options.  One of the main differences in FDA HRT and Bio-Identical HRT is their derivation.  FDA/HRT may come from plant or animal sources, whereas the Bio/HRT and herbal options come from plant sources only.  I explain to patients, you can take certain plants (mostly soy containing yams) and “squeeze out’’ products  EQUAL  to “human hormones” (there are both FDA-approved HRTs and Bio-identical/HRT options.)  Certain other plants have “plant hormone” with similar qualities, but not equal to human hormone (isoflavones like soy, Siberian rhubarb.)

 

FDA-Approved Hormone Replacement Therapy

Some FDA-approved hormonal options are ‘bio-identical’ (or ‘natural’) in that they use product derived from natural sources, maintaining a chemical structure equivalent to human hormone (i.e., Estrace.)  Other FDA-approved products adjust the chemical structure of the derived original source hormone, making them similar, but not equal to human hormone (i.e., Prempro.)  Most of the evidence-based research on risks/benefits of HRT is based on study of the FDA-approved products,  which are also governmentally regulated for safety/purity.

FDA-Approved Hormone Replacement Therapy

Some FDA-approved hormonal options are ‘bio-identical’ (or ‘natural’) in that they use product derived from natural sources, maintaining a chemical structure equivalent to human hormone (i.e., Estrace.)  Other FDA-approved products adjust the chemical structure of the derived original source hormone, making them similar, but not equal to human hormone (i.e., Prempro.)  Most of the evidence-based research on risks/benefits of HRT is based on study of the FDA-approved products,  which are also governmentally regulated for safety/purity.

 

Bio-Identical Hormones

Compounded bio-identical hormones use plant sources, and maintain the equivalency of human hormone.   For some, the concept of “Bio-Identical” hormones seems more “natural”, but the risks/benefits are more similar to FDA/HRT than different.  Though their derivation from plant sources (not animal) may be advantageous for some, the FDA has voiced concern of false claims regarding their safety, stating  “…claims like these mislead women and healthcare professionals, giving a false sense of assurance about (safety).”   Compounded products are considered ‘supplements’ by the FDA, and are therefore, not governmentally regulated for safety/purity.

 

Herbal Options

The herbal option, isoflavones  (i.e., over-the-counter soy-based products, plant derived) do not function as “human hormone” in our bodies,  though may work by (weakly) activating ‘similar’ estrogen receptors. They may have less safety concerns (in that they are not equivalent to human hormone), but also may be less effective in treating significant symptoms.  A newer herbal option, (Siberian rhubarb marketed only in the US by Metagenics as Estrovera ) works similarly to soy in our bodies (looks analogous to human estrogen to our bodies own estrogen receptors, but not a ‘real’ hormone, therefore without similar risks.)  Patients report improved symptom control, over soy-based products and the herbal (non-hormonal) option black cohash.

 

Hopefully this explanation helps in distinguishing the different options for Hormone Replacement Therapy and the options for treating menopausal related symptoms.  Consult your healthcare provider rearding your own symptoms and options.

 

For more reading on Hormone Replacement Therapy, see link below from The Harvard School of Medicine:

http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm

 

@drsuzyyhall

http://facebook.com/find.drsuzyyhall

 

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