It is also especially important to note that this molecular difference also carries a different risk profile especially when it comes to cardiovascular, clotting and breast cancer risk factors. The route of administration also makes a huge difference. Orally administered estrogens, whether biologically identical or not, raise the risk for cardiovascular and clotting events due to the first pass metabolism, while the topical transdermal (through the skin) administration of estrogens renders this risk negligible.
Oral contraceptives and hormonal IUDs contain a combination or bioidentical estradiol, or CEE and progestins; or solely contain progestins alone. Progestins are designed to block ovulation and thus prevent fertilization of ovum and prevent pregnancy. Oral contraceptives and hormonal IUDs thus deprive a woman’s body of a significant production of progesterone, which leads to estrogen dominance state (abnormal balance of progesterone-to-estrogen ratio) which contributes to increased risk of estrogen-dominant related diseases such as endometriosis, breast cancer, endometrial cancer. Non-biologically active hormones used for contraceptive reasons also deplete the body of very important vitamins and minerals which are the very cofactors necessary in the production of endogenous hormones.
Following the newsflash and publication of the Women’s Health Initiative (WHI) study findings, in 2002, many women on conventional Hormone Replacement Therapy (HRT) went off HRT due to the fear of risk from breast cancer, heart attack and stroke. The average age of the women participants in the WHI study was 63, and they were placed on high doses of synthetic hormones containing estradiol and medroxyprogesterone acetate with oral administration. The findings showed that medroxyprogesterone acetate (a synthetic form mimicking, but not identical to progesterone) raised the risk of breast cancer. Regretfully, a blanket statement was issued by the media which produced confusion and raised the fear frenzy against hormone replacement. No distinction was made between synthetic and bioidentical progesterone. Numerous studies demonstrated that CEE alone (conjugated equine estrogen, natural but not bioidentical estrogen) is not associated with increased risk of breast cancer, even with long-term use, and actually it lowered the risk of breast cancer by 23% when compared to placebo.
Since the WHI study, a lot more research was conducted, and trial results published which helped us learn a lot more. In the WHI study, there were only eight cases of breast cancer yet the risk of osteoporotic fractures, and colon cancer were decreased and so was death from other causes.
In the US, it is important to note the leading causes of death and disability:
- Coronary heart disease is the leading cause of death
- Colon cancer is the second leading cancer in women
- Colorectal carcinoma is the third-most common cancer in the world, and second-most common cause of cancer-related mortality only after lung cancer
- Half of all women over the age of 50 will experience an osteoporosis-related fracture at some point in their lifetime
- 1 in 9 people will develop dementia, while 1 in 8 may develop breast cancer (most of these women are not on hormones since menopausal women make some estrogen in their adrenal glands and adipose tissues, but it is not the type of estrogen that is protective).
- 10–20 % of hip fracture patients are institutionalized following a bone fracture
Age-related loss of hormones can increase the risk of cardiovascular disease, dementia, osteoporosis leading to fractures, increased occurrence of genitourinary tract infections, insomnia, loss of sexual health, depression and anxiety, mood changes and overall loss of quality of life. Women with these symptoms need hormone replacement, support, and re-assurance that their quality-of-life matters!
Decades of medical research and hundreds of published studies conducted in the US and Europe have repeatedly demonstrated bioidentical hormones to be equally or more effective than non-bioidentical hormones for symptom management and cardiovascular, brain, bone, and sexual health protective effects, as well as safety. Bioidentical hormone therapy allows women to feel like themselves again, have energy, mental clarity, strong bones, deep restful sleep, freedom from hot flashes, night sweats and mood changes, and a healthy libido. The fear of hormone replacement kept them from realizing these goals.
Even though many physicians have been providing relief to women, the medical societies have finally blessed the use of hormones and recognized that the benefits outweigh the risk in most cases. The North American Menopause Society recently issued statements in July 2022, and many other organizations now recognize that the benefits of Hormone Replacement Therapy outweigh the risks. Notwithstanding the flaws in the studies that prompted women to go off hormones and physicians to be reluctant to prescribe them, new evidence and a deeper review of the data from old studies clearly shows that there are big differences.