The New Naturals
Months after the results of the Women’s Health Initiative were announced in July 2002 — that replacement hormones raised the risk of heart disease, breast cancer, stroke, blood clots, and dementia — millions of women went off hormone therapy, many cold turkey. Doctors followed suit and abruptly stopped prescribing them. "HT prescriptions have gone down tremendously, but hot flashes haven’t," says Nananda Col, MD, an associate professor of medicine at Brown University Medical School, who still prescribes hormones, but infrequently.
So how do we soothe our symptoms? Many of us turn to compounded — or custom-made — mixtures of bioidentical hormones, or hormones that are identical to those produced in our bodies. These formulas are touted as being free of the side effects and the long-term risks of synthetic hormones.
Believers make it sound as if bioidenticals can turn back the clock on aging as well. Best-selling books proclaim these hormones give you energy, make your brain work better than ever, clean your arteries, slim your figure, strengthen your bones, and make your nipples point north instead of south.
But we learned — the hard way — to be skeptical of pharmaceutical companies and doctors who pushed every woman of a certain age onto hormones. Are we now buying equally unproven claims and safety assurances from the promoters of natural hormones? By using bioidentical hormones, are we unwittingly volunteering for a new and uncontrolled experiment on our bodies? To get some answers, I talked with doctors, pharmacists, and researchers to determine the hope and the hype, the knowns and the unknowns, the facts and the fictions of bioidenticals.
Bioidenticals: Facts and Fictions
The Pitch: "Bioidenticals are natural."
My college roommate, devoted to all things natural, cried with disbelief when a boyfriend told her that her beloved vitamin C was also the chemical-sounding ascorbic acid. I thought of her as I considered the new hormone lingo. There’s a whole vocabulary that carefully distinguishes the two types of hormones. Promoters of bioidenticals refer to their products "natural," demonizing commercial products as "synthetic" or even "counterfeit." Supporters talk about replacing the hormones your own body makes. Bioidenticals, they say, augment your natural hormone production and create balance, while synthetics merely mimic female hormones and create a state of hormonal imbalance. Sounds convincing, until you consider that the conjugated estrogens in Premarin and Prempro could arguably be called "natural" too, because they are derived from the naturally produced urine of pregnant mares.
The Bottom Line: You won’t find bioidentical in a medical dictionary yet, because it’s a marketing term — one with an environmentally friendly resonance, much like biodiesel, biodiversity, and biodegradable. There’s no standard definition, so what you’re buying may not be standardized either.
The Pitch: "Bioidenticals come from plant products."
This makes them sound less foreign or invasive than hormones produced from other sources. But actually, bioidenticals don’t come directly from any botanical source: They are all synthesized in a laboratory by manipulating plant hormones from yam or soy. If not altered, some plant hormones can’t be absorbed or used by the human body (which is why wild yam "hormonal" creams sold in health food stores are a waste of money).
"Some women prefer to use plant-derived estrogens, and that’s fine," says Michele Curtis, MD, associate professor of ob-gyn at the University of Texas-Houston School of Medicine. "But if they think that implies something better, more natural, or safer, that’s just not the case."
The Bottom Line: It is the chemical structure of a hormone, not its source, that determines if that hormone is bioidentical or synthetic. Both natural and synthetic hormones can be developed in a lab using pharmaceutical-grade products. But your body can’t necessarily tell the difference.