Women’s BHRT Safety – but why the fear?

Women’s BHRT Safety – but why the fear?

Bioidentical hormone replacement therapy (BHRT) for women has been used for decades to improve women’s quality of life and to relieve symptoms of both menopause and perimenopause (e.g., hot flashes, night sweats, insomnia, insomnia, painful intercourse). Bioidentical hormone replacement therapy is also used to prevent worsening bone loss in osteoporosis for women who are undergoing menopause. However, there is a degree of controversy which surrounds the usage of BHRT, which has interfered with more widespread usage.

What does the fear of HRT stem from?

Hormone replacement therapy for women is widely misunderstood, even by many some healthcare providers. Much of this misunderstanding stems from a research study that was conducted about 20 years ago called the Women’s Health Initiative (WHI). In the WHI Hormone Trials, post-menopausal women were enrolled in a research study which investigated the use of non-isomolecular (sometimes referred to as ‘synthetic’) hormones.

The two hormones investigated in the WHI were conjugated equine estrogens (CEE or Premarin) and medroxyprogesterone acetate (Provera). To sum up the WHI study, women who were typically less than 10 years into menopause did generally well, and a re-evaluation of the trial data showed some potential benefits.

Women who were more than 10 years into menopause had a higher risk of things like heart attacks, given how the CEE causes changes in the body. In the trial arm that combined Premarin and Provera, things became more dangerous, and the study was halted for safety reasons because of an increase in risks such as breast cancer, heart attacks, vascular dementia, and blood clots.

What does the ‘bio-identical’ hormone research show?

More recent research, which has investigated the use of the isomolecular (sometimes referred to as ‘bio-identical’) hormones, such as oral estradiol and oral micronized progesterone, have shown safety and efficacy. The following is a list of resources which I often share with patients, as well as their other healthcare providers, who have worries or fears regarding BHRT:

The research studies described above, all of which use ‘bio-identical’ hormones, show a reduction in many types of health risk; but, most importantly, demonstrate safety. The most significant aspect of BHRT for women which is not described in these studies, is the profound impact that BHRT can have on women’s quality of life. According to the 2017 hormone therapy position statement of The North American Menopause Society (NAMS) – hormone replacement therapy (HRT) “remains the most effective treatment” for menopause and menopause symptoms. 

Hormone replacement therapy has been shown to prevent bone loss and to lower the risk of breaks and fractures. In the words of the NAMS, “HRT treatment should be individualized to identify the most appropriate type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic re-evaluation of the benefits and risks of continuing or discontinuing.”

Zachary Lott, NP

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