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Bioidentical hormone replacement therapy, or BHRT, is a term used to describe the treatment of female menopause due to a deficiency of estrogen and progesterone. Bioidentical hormone replacement therapy differs from conventional hormone replacement therapy (HRT) in that the hormones are obtained from plants rather than equine urine. However, it should be noted that both forms of therapy use a cholesterol-like molecule obtained from plants called diosgenin to synthetically produce hormones. In addition, both forms possess the same molecular structure as hormones produced in the body.
The other major difference between conventional hormone replacement therapy and bioidentical hormone replacement therapy is how the formulations are prepared. This is also where controversy over bioidentical hormone replacement therapy resides. First, proponents of the latter maintain that since the origin of the material is from a natural source, it means better absorption with less risk of unwanted side effects. In addition, bioidentical hormone replacement therapy formulas are compounded, meaning that they are custom made according to a woman’s unique physiology. In contrast, conventional HRT is considered a synthetic one-size-fits-all approach with a history of associated risks documented by several studies.
The burning question has always been and continues to be, “Is bioidentical hormone replacement therapy more effective and safer than conventional hormone replacement therapy?” Unfortunately, there is no definitive answer due to a few mitigating factors. While it’s true that there have been a few European studies that indicate bioidentical hormone replacement therapy may be safer than HRT, it’s also true that there haven’t been any long-term studies in the 25-plus years of its use. For American women, there is also the fact that many bioidentical hormone replacement therapy products are not approved by the U.S. Food and Drug Administration (FDA) to consider. In fact, the FDA doesn’t even recognize the term “bioidentical,” which translates to a lack of regulatory definition and acceptable practices regarding preparation or administration.
On the other hand, this doesn’t mean that bioidentical hormone replacement therapy is any more dangerous than conventional HRT either. For that matter, the FDA has approved several bioidentical hormones that are produced by pharmaceutical companies. It’s the compounded bioidentical hormones that the FDA does not approve of simply because customized compounding by a pharmacist for individual patients cannot be subjected to standardized procedures.
As with any other drug or therapy, common sense dictates that the patient should make every effort to learn as much as possible about all of the treatment options available. Therefore, it would be a good idea to consult with a qualified practitioner experienced with hormone therapy. This is the best way to make an informed decision and to fully understand the risks associated with any hormone therapy.