Bioidentical Hormones: Safer For Hot Flashes Than HRT?

To take hormones or not to take them? That is the question that plagues women suffering from nasty menopausal symptoms—those hot flashes and night sweats and the severe sleep deprivation and crankiness that come with them. Some women still opt for traditional hormone therapy, like Prempro, estrogen combined with progesterone, given to protect against endometrial cancer which can be triggered by using estrogen alone. But they're told to take the lowest dose for the shortest duration of time to minimize the increased risk of breast cancer associated with postmenopausal hormone use.

Other women have turned to what they believe to be a safer alternative: bioidentical hormones. These compounds are identical in molecular structure to the sex hormones produced in a woman's ovaries. For this reason, some experts theorize, they may act differently than those hormones most commonly used to treat menopausal symptoms, like conjugated equine estrogens, made from horses' urine, or medroxyprogesterone acetate, made in a lab. Indeed, recent research suggests that bioidentical hormones, created from plant chemicals, may not be as damaging to breast tissue as the most widely-used hormone regimens. A February study using data from the Women's Health Initiative found that taking a combination of estrogen and medroxyprogesterone acetate for five years doubled a woman's annual risk of getting breast cancer; the researchers didn't find the same increased breast cancer risk from women with hysterectomies, who were able to safely take estrogen alone, leading to theories that non-identical forms of progesterone called progestins are the primary culprit.

[See more on hormones and breast cancer.]

A European study of more than 80,000 postmenopausal women published last year in the journal Breast Cancer Research Treatment found that those who took progestins along with estrogen for an average of eight years had about a 70 percent higher risk of breast cancer than those who took bioidentical progesterone or who didn't use hormones at all. "Progesterone is definitely starting to look like a better hormone" than progestins, says Adriane Fugh-Berman, a physician and associate professor in the complementary and alternative medicine master's program at Georgetown University Medical Center. "There's some preliminary basic science showing that it might not stimulate the growth of breast cancer cells as much as synthetic progestins." She says bioidentical estrogens in a spray, gel, or suppository form, which enter the bloodstream directly through the skin, may offer protection against an increased risk of blood clots normally associated with estrogen pills, which enter the blood by passing through the liver, potentially spurring the production of blood-clotting proteins.

Still, Fugh-Berman stresses, "we shouldn't assume human hormones are our friends. After all, women with naturally higher estrogen levels have higher rates of breast cancer, and men with higher testosterone levels have higher rates of prostate cancer. So more is not always better." Where bioidenticals may come in handy, she says, is to treat that subgroup of menopausal women who suffer miserably through sleepless sweaty nights and seek a product that may be safer than traditional hormone therapy. But most doctors agree that those who take bioidenticals should still follow the "lowest dose for the shortest amount of time" rule of thumb.

[See how women deal with their HRT dilemmas.]

At the moment, that message may be getting lost in the homage being paid to bioidentical hormones by megawatt celebrities like Oprah Winfrey and actress and bestselling author Suzanne Somers. A January Oprah show featured both discussing their positive experiences on the hormones, which came across as a virtual cure-all for aging. Somers, who takes much higher doses of bioidentical hormones than most experts recommend, believes that the supplements keep her young and feeling sexy and are preventing her breast cancer from coming back. On her website, Winfrey writes, "After one day on bioidentical estrogen, I felt the veil lift. After three days, the sky was bluer, my brain was no longer fuzzy, my memory was sharper. I was literally singing and had a skip in my step."

Many medical experts have expressed alarm over the hype. Susan Love, a breast cancer surgeon and author of Dr. Susan Love's Breast Book, says Somers is taking a "crazy" approach to breast cancer prevention. "It isn't the flavor of the hormones," Love says, "but the fact that we're not supposed to have high levels of hormones during the second half of life." Days after the Oprah show aired, the American College of Obstetricians and Gynecologists issued a press release reiterating the group's stance against the use of "so-called bioidentical hormones." The organization is particularly concerned about the use of those hormones that are compounded from individual ingredients on a patient-by-patient basis by pharmacies. The process can vary widely from pharmacist to pharmacist. Unlike with drugs made in large manufacturing facilities, there is no way of knowing if the product is pure or contains a standardized dose.