Bioidentical Hormones for Menopause

Estrogen hormone therapy (with or without progesterone) is FDA approved for alleviating the following four symptoms of menopause: (1) vasomotor symptoms (hot flashes); (2) genitourinary symptoms (vaginal atrophy); (3) bone loss; and (4) hypoestrogenism induced by hypogonadism, primary ovarian insufficiency, or castration.

Dehydroepiandrosterone (DHEA) hormone therapy is FDA approved for treatment of moderate to severe dyspareunia or painful sex, a symptom of vulvar and vaginal atrophy, attributable to low estrogen during the menopause. Testosterone therapy is FDA approved for treating conditions associated with its deficiency in males but is often used ‘off-label’ for females with low libido.

Bioidentical hormones, hormones derived from plants such as soy and yams, are often made by compounding pharmacists. They often consist of weaker forms of the hormone such as estriol, a type of estrogen. There are three types of estrogen that the body makes; estriol, estrone, and estradiol, the last of which is the most potent. Compounded hormones are formulated for each patient’s specific needs at varying dosages. They account for 1% of all prescriptions written each year in the US. Because these hormones are defined as metabolites, they are not considered drugs, but supplements, and are not regulated by the FDA. Women believe that these bioidentical hormones are safer than prescription or synthetic hormones, although many prescription hormones contain the naturally occurring form of the hormone. Estradiol is available as a tablet, transdermal patch, gel, spray, or vagina ring while micronized progesterone is available as a tablet or intravaginal gel.

Biest contains 80% estriol with 20% estradiol and is one of the most popular bioidentical estrogen compounds in the USA. Vasomotor symptoms and vaginal dryness respond well to estriol/estradiol combinations but have not shown efficacy in the prevention of osteoporosis and other menopausal linked conditions such as cardiovascular disease.

Several new estradiol gel products are approved by the US FDA for hot flash symptoms, including Divigel®, Estrogel® and Elestrin™. Gels have an advantage over patches in that there is no adhesive which reduces skin sensitivity. Divigel and Elestrin are the lowest dose formulations and reduce hot flashes by 50% over time. Estrogel has also shown to reduce vaginal dryness.

Prometrium or oral progesterone may prevent or reverse any adverse effects of estrogen on the uterine lining, but vaginal formulations are not strong enough to have that benefit. No long-term studies have been performed on long-term efficacy of combination hormone therapies.

Oral testosterone is not recommended in women due to the adverse side effects, but topical formulations may help with low sexual desire. DHEA supplementation may improve libido and well-being, but data is lacking.

Saliva testing is inconsistent and not reliable to determine dosages. It is best to adjust dosages to achieve the desired symptom relief.

Compounded hormones can be considered if the exact doses of hormones are not commercially available for a patient. The FDA has approved many bioidentical hormones.

Speak to your doctor today to see if bioidentical hormones are for you.

Kimberly Langdon M.D. is a retired, board-certified obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine, earning Honors in many rotations. She then completed her OB/GYN residency program at The Ohio State University Medical Center, earning first-place for her senior research project and placed in the 98^th percentile on the national exam for OB/GYN residents in the U.S.