Bioidentical Hormone Replacement Therapy (BHRT) and Compounded Hormone Replacement Therapy (CHRT)

Posted on 13. Jun, 2009 by in Hormone Replacement Therapy

BHRT is also sometimes referred to as natural hormone therapy, it has become sort of the next step in hormone replacement therapy for treating menopausal symptoms, but there is still some controversy surrounding various types of BHRT particularly when it comes to the process of compounding, which is outside of FDA approval and one of the more controversial aspects of BHRT. There are many FDA approved and commercially prepared BHRT treatments, but even though the FDA has approved some BHRT medications they don’t endorse the use of the phrase “bioidentical hormone replacement therapy” and consider it simply a marketing term.

Traditional hormone replacement therapy is made from animal products, specifically the urine of pregnant horses while BHRT is made from plant products, which produces hormones that are an exact chemical match to the ones produced naturally in the body.

The Case For BHRT

In 2002, the Women’s Health Initiative halted a groundbreaking 15 year study on the use of traditional HRT, both estrogen therapy alone and estrogen plus progestin. This study revealed significant risk associated with extended HRT use, in fact, the risks were considered so great that the study was halted prematurely. This except is taken directly from their website and indicates the risks of both types of traditional HRT:

Compared with the placebo, estrogen plus progestin resulted in:

  •  Increased risk of heart attack
     Increased risk of stroke
     Increased risk of blood clots
     Increased risk of breast cancer
     Reduced risk of colorectal cancer
     Fewer fractures
     No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, estrogen alone resulted in:

  •  No difference in risk for heart attack
     Increased risk of stroke
     Increased risk of blood clots
     Uncertain effect for breast cancer
     No difference in risk for colorectal cancer
     Reduced risk of fracture

(Findings about memory and cognitive function are not yet available.)

 

Once the results of this study were revealed the use of traditional HRT dropped dramatically and women were left with little to no treatment options, this is where BHRT enters the picture.

A lot of women report significant improvement in their quality of life and a lessening of menopause symptoms after starting BHRT, but most of these cases are considered antidotal and not scientific in nature. Two of the more famous proponents of BHRT are Suzanne Somers who has been touting the benefits of BHRT since the publication of her 2006 book while recent convert Oprah Winfrey probably caused the biggest stir when she reported that she achieved excellent results with BHRT.

The Case Against BHRT

There are two main controversies surrounding BHRT: compounding and the use of the term “bioidentical” combined with false or misleading advertising claims.

Compounding

Compounding is the process by which a pharmacist “compounds” or mixes up a specific plant based hormone blend made according to each woman’s specific hormone needs which are determined by a blood or saliva test conducted by a doctor.

Controversy

There are a few problems associated with compounding; the main ones are as follows:

  • Saliva testing for hormone levels may not be reliable – this simply has not been studied enough.
  • Compounded hormones are outside of FDA approval. Each woman’s hormone blend is made specifically for her needs, so each blend is unique; this makes the type of standardized testing that is necessary for FDA approval impossible.
  • There is not currently enough scientific testing to confirm or deny that compounded bioidentical hormone replacement therapy (CHRT) is any safer than traditional HRT.
  • The FDA considers the term “bioidentical hormone replacement therapy” to be simply a marketing term.
  • A lot of false claims, have been made about the safety and/or superiority of CHRT over HRT, but at this time, it is unknown if CHRT is actually safer or more effective than HRT. The FDA has begun cracking down on people and businesses making these false claims. 

 

FHA Approved BHRT Drugs

Compounding isn’t the only option when it comes to BHRT, there are several FDA approved medications available on the market, some are estrogen only, some are progesterone only and the last group is blends of different hormones. These treatments come in various forms including pills, creams, gels, patches, vaginal rings, vaginal tablets and vaginal gels.

Some FDA approved BHRT drugs:

Alora
Climara
Climara Pro*
Combipatch*
Esclim
Estrace
Estraderm
Estrasorb
Estring
Estrogel
Femring
Prefest*
Prochieve 4%
Prometrium
Vagifem
Vivelle
*These are combination blends that are only partially made of plant based products

Comments are closed.