How safe are menopause treatments?

Are ‘natural’ bioidentical hormones really a safer option to hormone replacement therapy?

How safe are menopause treatments?

Most women will pass through the time leading up to menopause (peri-menopause) and menopause itself with only mild or no symptoms. However, a percentage of women will have symptoms so bothersome that they may seek help.

Symptoms related to menopause such as hot flushes, night sweats, sleep disturbances, problems with the urinary system such as urinary leakage or urgency, vaginal dryness, formication (sensation of crawling or itching under the skin) and joint pains are related to a fall in the hormone, oestrogen. However, other symptoms such as fatigue, irritability and difficulty concentrating may be more related to the hot flushes and night sweats that reduce the quality of sleep.

The problem for women is where do they go to seek help to relieve the symptoms. Many have become fearful of hormone replacement therapy (HRT) used to relieve menopausal symptoms, after the release of findings from a major study in 2002. The study indicated higher levels of breast cancer (26 per cent) in women using HRT and increased risks of heart disease, blood clots and strokes. However, the study had major flaws, and a subsequent review has shown that when used appropriately, HRT is a safe and effective therapy for symptomatic women around the time of menopause.

However, women remain concerned about the risks and are turning in large numbers towards so called ‘natural’ hormone therapies, also known as ‘bioidentical’ hormone therapy.

Natural or bioidentical hormones are plant-derived products made up in pharmacies to provide individualised dosages for the relief of symptoms related to menopause. They are marketed as natural, safe, risk free, age reversing, sex enhancing, and as cancer preventing. However, women are being misled by these claims.

The main problem is that their effectiveness and safety has not been tested, and their use has been shown in some cases to cause serious health concerns such as endometrial cancer.

Fact 1# Natural is not always safe
The term natural implies ‘not synthetic’ or ‘artificial’, which is misleading. All plant-derived hormone preparations undergo a chemical extraction process to produce the final product. There is little difference between the end products used in bioidentical hormones and those used in many forms of HRT. Therefore, to claim bioidenticals are more natural is misleading.

Fact 2# Natural hormones are not the same as the hormones in our bodies
The term bioidentical hormone implies that the compounds more closely resemble hormones produced in the human body than HRT. The oestrogen, progesterone and testosterone used in bioidenticals are the same as those used in many forms of HRT. 

Fact 3# Bioidentical hormones are not customised
Bioidentical hormones, which can be ordered over the internet, claim to monitor hormone levels via salivary testing as a way of individualising therapy. There is no evidence of a relationship between symptoms and measured salivary hormones, nor between salivary hormone testing and hormone tissue levels. In addition, many salivary hormone tests are not accurate. Hormone testing is not a reliable indicator of hormone levels due to irregular fluctuations, particularly around the time of perimenopause. Therefore, to claim dosages are tailored to an individual’s hormonal profile is not based in science. The only method to monitor the effectiveness of hormonal therapy for the relief of symptoms is via self-report.

Natural or bioidentical hormone therapy is currently untested for safety and effectiveness and is not approved by the regulating body (TGA). There have been documented cases of harm caused by these therapies. Conventional HRT, when given to women in the right age group (50-59), in the lowest effective dose, is approved by the TGA and is safe and effective for the short term relief of menopausal symptoms.

Published with the permission of Jean Hailes for Women's Health
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    Polly Esther
    1st Aug 2014
    Sorry forgive me, but can't let this go through to the keeper. Question: How do you make a hormone? Answer: You kick her in the guts.
    1st Aug 2014
    Leave without Paying !!
    1st Aug 2014
    There is a simple answer to this, "bioidentical "hormones" don't work, so there is no point in taking them.
    1st Aug 2014
    I was lucky and didn`t have menopausal symptoms but made up for after going on breast cancer hormonal medication. My doctor recommended an over the counter medication called Remifemin which includes Natural Black Cohosh. It got rid of my night sweats and eased the hot flushes to an acceptable level. Its a bit expensive but for me it worked and it does say its all natural.
    2nd Aug 2014
    Natural or biological HRT DOES WORK very well!!!!!!!!!! All is needed is a doctor interested in HRT who will liaise with the compounding chemist to the benefit of the patient. Doctor Sandra Cabot introduced this form of HRT treatment to Australia way back around 1997 when there was one compounding chemist in the whole of Australia. His name is Richard Stenlake. Now there is a compounding chemist in most major regional cities as well as more than one in capital cities. The level of hormones used is decided by the doctor and chemist with blood tests results. Whoever wrote this ridiculous article did not get the facts correct....
    2nd Aug 2014
    Sorry, but I'm inclined to think any positive effects are due to placebo. Which is fine as long as it is safe (just expensive...) Some natural products are safe and some are not, or interact badly with prescribed medications. I agree with you that it is important to know which is which and to get the facts re safety correct.
    2nd Aug 2014
    Jenny how long were you on biological HRT for??? Or do you not have any personal experience?......
    I was on bioindentical HRT for years and had the blood tests every six months which PROVED there was NO placebo effect!!!!!!! My troches were adjusted or not depending on how I was feeling and the blood test results.....
    2nd Aug 2014
    I am glad it works for you, I do have personal experience. I have also looked at the research on the effectiveness of plant hormones, and it is controversial.
    Some women have an easier menopause than others which doesn't necessarily last for years. The important thing, and this is my opinion only, is that HRT should improve your bone strength.
    For me BHRT was an expensive rip-off.
    2nd Aug 2014
    I outlined my personal experience with natural HRT and had to go on a fairly high dosage at the time to get the results. In other words to get my hormone levels within the normal limits and not have them really low. Blood tests were always used just as they are for thyroid function tests results which can also be treated with troches or cream...... There's NO placebo effect..... I know being medicated in this way is expensive, that's because the compounding chemist makes a medication exclusively for one patient and not one size fits all.....
    4th Aug 2014
    I would also very much prefer to take a plant based hormone than one originating from pregnant mares urine......
    Most of our modern day drugs originate from plants so why not hormones?.......
    La Verne
    6th Apr 2018
    Regarding Bio Identical hormones (in my case compounded as a troche). I was on these for 5 years and never felt better. More energy, slept well, no hot flushes, no painful sex. And the article above that refers to prescription via saliva testing did not apply in my case. I had pathology (blood test) every 6 months and was monitored by my prescribing Doctor. The reason I discontinued was that there is evidence of thickening of the uterus after too long on this form of HRT.

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