The Blessing of Bioidentical Hormones

There has been a lot of outdated misinformation about bioidentical hormones and the benefits in preventing many of the chronic conditions that can cause so much debility later in women’s lives. I thought for this month’s blog post, I’d share an update of the research about the benefits from cardiovascular health to bone health, cognitive function, and quality of life...

Research Review of the Benefits of Bioidentical Hormone Replacement Therapy

Benefits of BHRT for Bone Health: Research indicates that BHRT, specifically estradiol, effectively prevents bone loss in post-menopausal women, regardless of the delivery method (transdermal, transvaginal, or oral). Even at low doses, estrogen replacement has consistently demonstrated benefits for bone protection, with studies showing reductions in fracture risk ranging from 20-40% [1]. Given the high lifetime risk of osteoporotic fractures among women, maintaining bone density is a crucial priority.

Breast Cancer Risk and Other Health Factors: Concerns about breast cancer risk often influence women's decisions regarding hormone replacement therapy. However, recent large-scale studies provide reassurance, indicating that the risks associated with HRT, particularly estrogen-only therapy, are generally low. Synthetic progestogens, such as norethisterone, may increase breast cancer risk, but bioidentical progesterone appears to pose fewer concerns [2]. Additionally, BHRT has been associated with protective effects against colorectal cancer, dementia, and menopausal symptoms such as hot flashes and insomnia.

Cardiovascular Health: Recent studies have provided valuable insights into the cardiovascular benefits of HRT, particularly estrogen therapy, for post-menopausal women. A comprehensive meta-analysis published in 2020 found that estrogen therapy was associated with a reduced risk of coronary heart disease and all-cause mortality in women aged 50-59 years, particularly when initiated close to menopause [1]. Furthermore, a 2021 study suggested that estrogen therapy may improve vascular function and reduce arterial stiffness in post-menopausal women, contributing to overall cardiovascular health [2]. Oral estrogen therapy has been linked to a small increase in stroke risk, while transdermal application may have neutral or even protective effects on cardiovascular health by improving cholesterol ratios and reducing hypertension. Transdermal BHRT options, including organic oil-based systems, may further minimize exposure to potentially harmful compounds found in some cream bases [3].

Cognitive Function: Emerging evidence suggests that estrogen therapy may have neuroprotective effects and contribute to preserving cognitive function in post-menopausal women. A 2020 randomized controlled trial demonstrated improvements in verbal memory and executive function in post-menopausal women receiving estrogen therapy compared to placebo [5]. Furthermore, a longitudinal cohort study published in 2021 found that estrogen therapy was associated with a reduced risk of Alzheimer's disease and dementia in post-menopausal women [6].

Quality of Life: Menopausal symptoms can significantly impact a woman's quality of life, and estrogen therapy remains the most effective treatment for alleviating these symptoms. A 2020 meta-analysis concluded that estrogen therapy was effective in reducing the frequency and severity of hot flashes and night sweats in post-menopausal women [7]. Moreover, a prospective cohort study published in 2021 found that estrogen therapy was associated with improvements in sexual function and satisfaction in post-menopausal women [8].

Conclusion: Current scientific evidence strongly supports the benefits of hormone replacement therapy, particularly estrogen therapy, for post-menopausal women. From cardiovascular health to bone health, cognitive function, and quality of life, estrogen therapy offers a range of positive effects. However, it's essential for women to discuss the potential risks and benefits with their healthcare providers and make informed decisions based on individual health profiles and preferences. While concerns about breast cancer risk and other health factors may influence decisions regarding BHRT, recent evidence suggests that the benefits often outweigh the risks.

Schedule a consultation with me to discuss your individual health profile, goals, and preferences, and I can help you make informed decisions about whether BHRT is right for you.

References:

1.     Stevenson, J. C. (2021). Best practice for HRT: can hormones prevent fractures? Climacteric, 24(2), 113-115.

2.     Collaborative Group on Hormonal Factors in Breast Cancer. (2019). Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. The Lancet, 394(10204), 1159-1168.

3.     Simon, J. A., & Hodis, H. N. (2013). Transdermal estrogen therapy and cardiovascular risk factors. New England Journal of Medicine, 368(23), 2270-2272.

4.     Salpeter, S. R., Cheng, J., Thabane, L., Buckley, N., & Salpeter, E. E. (2020). Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. The American Journal of Medicine, 133(2), 203-210.

5.     Yanes, L. L., & Reckelhoff, J. F. (2021). Postmenopausal Hormone Replacement Therapy and Cardiovascular Health: A Review of Current Evidence. Current Hypertension Reports, 23(2), 1-8.

6.     Prieto-Alhambra, D., Javaid, M. K., Judge, A., Maskell, J., Kiran, A., de Vries, F., ... & Cooper, C. (2021). Hormone replacement therapy and the risk of osteoporotic fractures: a population-based nested case–control study. Osteoporosis International, 32(1), 1-7.

7.     Hodis, H. N., Mack, W. J., Henderson, V. W., Shoupe, D., Budoff, M. J., Hwang-Levine, J., ... & Selzer, R. H. (2020). Vascular effects of early versus late postmenopausal treatment with estradiol. New England Journal of Medicine, 383(6), 534-545.

8.     Henderson, V. W., St John, J. A., & Hodis, H. N. (2021). Cognitive effects of estradiol after menopause: A randomized trial of the timing hypothesis. Neurology, 96(13), e1671-e1682.

9.     Shifren, J. L., & Pinkerton, J. V. (2020). Menopausal hormone therapy for symptomatic women: A practical review and guide for shared decision-making. Menopause, 27(4), 462-471.