Most of my menopause patients think bioidentical estrogens are safer, more natural and better in every way than non-bioidentical estrogens. Women in book clubs and boardrooms keep hearing bioidentical estrogens have all the benefits of pharmaceutical estrogen with none of the associated risks.
But is that really true? Read on.
What is bioidentical estrogen?
Every hormone in the body has a specific chemical structure. Estrogen looks like chicken wire made from 18 carbon atoms with one, two or three “OH” groups hanging off some of those carbon atoms. If it has one “OH” group it is called estrone or E1. With two “OH” groups it is called estradiol or E2. If it has three “OH” groups hanging off it is called estriol or E3. These are the three main biological estrogen molecules a woman’s body normally makes. Estradiol is the most potent one and before menopause, it is the most abundant.
When people talk about bioidentical estrogens, which estrogens are they talking about?
While there are other bioidential hormones such as testosterone and progesterone, there are only three bioidentical estrogens: estrone, estradiol and estriol. These three hormones can be found in chain drug stores and in compounding pharmacies.
How are bioidentical estrogens different from other estrogen products?
Most of the estrogen molecules that are purchased in a drug store have a similar chemical structure to E1, E2 or E3, but they are not identical to them. Your body thinks non-bioidentical estrogens are close enough to bioidentical ones to respond to them. But they aren’t exactly the same; they might be a little stronger, a little weaker, or just different.
Bioidentical estrogens are exactly the same chemical structure as the biological ones the body normally makes. They may come from plants, but they are not made in plants. You can’t squeeze a plant and get bioidentical estrogen out of it. The only plant they are made in is a chemical plant. So they are not natural. That is why the term used to describe them is bioidentical. The body cannot turn plant estrogens into human estrogens. It doesn’t have the necessary enzymes to do that.
Bioidentical estrogen is safer than non-bioidentical estrogen, Right?
Which weighs more; a pound of feathers or a pound of bricks? They both weigh a pound and are the same. In other words, bioidentical estrogens might be weaker than some pharmaceutical estrogens, but if they are given in equivalent dosages so a person receives an equivalent amount, the benefits and the risks should be the same.
The problem is that while there are many studies with non-bioidentical estrogen medications sold in traditional drugstores, there are very few safety studies on bioidentical hormones. Most doctors believe that if it is given in the equivalent amount, the risk of estrogen is the same whether it is bioidentical or a different molecule.
Is there any real advantage to bioidentical hormones?
For me, the major advantage of bioidentical hormones is that they can be measured in laboratory tests and you can know exactly how much is in your bloodstream. Other estrogens cannot be measured as precisely.
Another benefit of bioidentical estrogens is that the dose can be mixed just for you. So if your needs happen to fall between the available dosages of standard pharmaceutical estrogens, a special dosage or combination can be compounded just for you.
Finally, bioidentical estrogens can be compounded together with bioidentical progesterone and/or testosterone or other hormones and all can be applied in one application rather than having to take more than one medication.
If you think estrogen is for you and your doctor or health care provider believes the benefits are greater than the risks for you, then consider any estrogen as a possible choice.
Many patients don’t realize that there are bioidentical estrogens available in traditional drugstores as pills, patches, creams and other forms. Those formulations must all pass national manufacturing standards. Bioidentical estrogens in compounding pharmacies are mixed in the specific drugstore you purchase them in and are not regulated as closely. Most do a great job. But there are differences in how closely they are regulated.
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