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Bioidentical Hormone Replacement Therapy vs. Menopause Hormone Therapy: What’s the Difference?

October 16, 2023

Menopause is a natural stage that every woman goes through, but the time leading up to it, perimenopause, can bring a host of challenging symptoms. Many women seek relief from their naturopath or their physician for hormone help. In this article, we’ll explore the differences between bioidentical hormone therapy (BHT) and menopause hormone therapy treatment (MHT) options, while also sharing The Menopause Society guidelines. 

Hormone Therapy:

Hormone therapy, also known as hormone replacement therapy (HRT) or menopause hormone therapy (MHT), involves the use of prescribed hormones derived from a variety of sources. In most cases, estrogen, in the form of estradiol, and progesterone are prescribed to women who have bothersome symptoms. Blood, urine, or saliva testing is not necerssary before prescribing MHT. The goal of hormone therapy is to replace the hormones that decrease during menopause, effectively managing symptoms that can arise during perimenopause and menopause.

According to The Menopause Society, menopause hormone therapy is particularly effective at reducing vasomotor symptoms (such as hot flashes and night sweats) as well as vaginal dryness and painful sex. MHT can also help with preventing bone loss associated with menopause. MHT is ideally prescribed to healthy women less than 60 years old, within 10 years of starting menopause. As with all medications, hormone therapy does carry some risks and potential side effects for certain women, including a slight  increased risk of breast cancer if used for more than 4-5 years, blood clots (especially if estrogen is taken in oral form), and heart disease if started after 60 or more than 10 years after starting menopause. Generally, the risks are uncommon and women find that the benefits outweigh the risks. It is crucial to have a discussion with a healthcare provider and weigh your own risks and benefits to determine if hormone therapy is the right choice for you.

Bioidentical Hormonal Replacement Therapy (BHRT):

Bioidentical hormones  is a non-scientific, made-up term to describe hormones manufactured to be chemically identical to the hormones that the body produced during the reproductive years. They are often derived from plant sources, such as yam or soy. Many women obtain bioidentical hormone replacement therapy (BHRT) from natural food stores or naturopathic healthcare providers. While the concept of bioidentical hormones may seem appealing, it is worth noting that The Menopause Society does not approve the use of bioidentical hormone therapy due to several reasons.

There is very limited regulation and standardization of bioidentical hormones. This means that the manufacturers are not subject to the oversight that is required for government approved hormone products, such as prescribed MHT, and the contents are not always consistent or what the consumer thinks they may be. Plus, BHRT is often custom-compounded by specialized pharmacies. This means that pharmacies create an individualized preparation of bioidentical hormones for each woman, which can lead to less effectiveness and greater risk. For example, if a woman with a uterus only receives estrogen or low doses of progesterone, the lack of progesterone may increase her risk of uterine cancer. There is no standardized dose or delivery method across patients for BHRT. This lack of standardization makes it difficult for healthcare providers to assess the safety and efficacy of BHRT. 

Additionally, studies have not shown that bioidentical hormones are any safer or more effective than traditional hormone therapy. The Menopause Society guidelines focus on evidence-based research and recommend hormone therapy that has been tested and approved by regulatory bodies.

If a woman is seeking alternatives to hormone therapy, there are non hormonal medication options available to manage menopause symptoms. Also, lifestyle changes, such as regular exercise, a healthy diet, limiting alcohol intake and practicing stress reduction techniques, and relaxation exercises, can make a significant difference in symptom management. For many women, counselling or talk therapy can also help manage symptoms and their impact on physical and mental  well-being. 

Menopause hormone therapy (MHT) remains a safe option for managing menopause symptoms for many women. It is important to note that The Menopause Society does not recommend the use of bioidentical hormone therapy (BHT) as these products are not well regulated and may be ineffective and risky. Prescribed, government approved menopause hormone therapy has been extensively studied and is well-regulated, making it a safe, effective and evidence-based option for many women. However, it is always essential to consult with a healthcare provider who can assess your specific needs and do a personal risk-benefit analysis with you to guide you towards the most appropriate treatment option. 

Written By:

Dr. Ariel Dalfen

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