Take the Compounded Bioidentical Hormones Quiz

What you need to know about bioidentical estrogen

Estradiol structure - a bioidentical estrogen. Mache Seibel

Are compounded bioidentical hormones (CBH) better or worse than the ones bought in chain drugstores? I get asked this question a lot because there are clearly some good aspects about both and a lot of women are confused. If you are a bit confused as well, these comments will help you gain some clarity.

First, just for clarity, what is bioidentical? It means that a hormone has the same or identical shape as a hormone that you make in your body.

It doesn't mean it is natural. In fact it isn't. Our bodies can't breakdown squeezed yams and make estrogen or progesterone. We don't have those enzymes. But chemical plants can turn natural precursor hormones into bioidentical hormones that you buy.

I also use the term progestogen. That term includes both natural progesterone and a synthetic progesterone that the body interprets as progesterone.

Women and their doctors have had a general distrust of "estrogen" after the publication of the Women's Health Initiative or WHI study in 2002 that showed mistakenly that estrogen plus the synthetic progesterone called Provera caused breast cancer, heart attack, and stroke. After that study, the number of women who were taking estrogen dropped from 10.3 million in 2001 to 5.2 million in 2005. Just after this report, Suzanne Somers touted compounded bioidentical hormones and women began to use them because they felt that the "drugstore" variety were unsafe.

I discuss this in great detail in my book The Estrogen Window.

The numbers of women taking compounded bioidentical estrogens has increased. Today, about 1 million to 2.5 million American women age 40 years or older use compounded bioidentical hormones. According to the article just referenced from the September 2015 issue of the journal Menopause, a Harris pole found that 86% of women surveyed did not know compounded bioidentical hormones are not FDA-approved.

Because the number of women taking the drug store hormones is on the decline and numbers taking CBH has increased, it seems a lot of women don't think CBH carry the same risks as other forms of hormone therapy.

Before the 2002 WHI study, about 40% of American women used hormone therapy. Today about 5% of American women use hormone therapy, which includes estrogen alone and estrogen plus a progestogen. How do you make up your mind to use CBH or one from a drugstore? How would you answer these questions?

  1. CBH are FDA-approved? False. CBH are not FDA- approved.
  2. If you have had a hysterectomy, you need estrogen plus progestogen and not estrogen only. False. If you've had a hysterectomy, you only need estrogen and do not need progestogen. Yet numerous women who had a hysterectomy and were taking CBH reported they were taking estrogen plus progestogen.
  3. No chain drugstore estrogen and progesterone products are bioidentical. False. While many estrogen and progestogen products from chain drugstores are not bioidentical, most of the ones in patches and other non-oral routes bioidentical.
  1. CBH prescriptions always contain the amount of estrogen or progesterone your doctor ordered. False. Much of the time the CBH doesn't have the ordered amounts. Estrogen amounts tend to be too high and progestogen amounts tend to be too low. It isn't because the pharmacist fills it wrong, It's because the compounded hormone isn't mixed evenly in some batches.
  2. CBH can be mixed exactly the way your doctor wants them. True. CBH can contain any amount of estrogen or progestogen.
  3. Chain drugstore estrogen and progesterone prescriptions only come in certain dosages that can't be altered by the pharmacist. True. Chain drugstore estrogen and progesterone prescriptions come in preformulated amounts that cannot be altered, though there are multiple formulations available.
  4. Both CBH and chain drugstore prescriptions can be applied to the skin, or taken vaginally or orally. True. Both sources are available in multiple formulations.
  5. CBH are safer than chain drugstore formulations. False. There is no study done to show that. What is most likely is that if you receive the correct and equal or equivalent amounts of either, their risk would be the same. As question 4 points out, that doesn't always happen.

If you have any pressing questions about CBH or chain drugstore hormones, you can ask me at www.AskDrMache.com. I hope you'll join me at my free monthly calls where I answer your questions. If you miss the call, we have a recording that you can listen to at your convenience.

Continue Reading