Hormone Replacement Therapy

Bio-Identical Hormone Replacement

By Molly Brignall, ND


A certain celebrity has been in the news in recent years with a book touting bio-identical hormone replacement therapy.  She has been making fountain-of-youth claims, much to the chagrin of the medical community.  This has fueled a controversy surrounding hormone replacement therapy that began a few years ago when large clinical trials studying certain conventional hormone replacement therapies were ended abruptly because a correlation was shown between the hormones and breast cancer, heart attacks, blood clots, and stroke.  Because of these studies and the nationwide scare it precipitated, women are now seeking alternative therapies for their unmanageable menopause symptoms.

What are bio-identical hormones and how are they different from other hormones?  Hormone replacement therapy is mainly prescribed for women with peri-menopausal symptoms including hot flashes, night sweats, mood swings, and abnormal bleeding.  Bio-identical hormones, estrogen and progesterone in particular, are synthesized from plants and are physiologically identical to our own hormones.  Conventional hormones are not identical to those in our bodies and tend to be stronger.  Some conventional hormones are animal or plant derived and many are created from chemicals in laboratories.  Bio-identical hormones are customizable through a compounding pharmacy, which means the prescription dose can be modified for each individual.  Conventional hormones are prescribed at standardized doses.  Finally, most bio-identical hormones have no fillers, chemicals, or dyes and come in different forms such as creams, capsules, and drops.

Even though we intuitively feel bio-identical hormones are a better choice, are they really?  The answer is no one knows.  There are many questions that are unanswered.  For example, are the bio-identical hormones safer or more efficacious than the synthetic versions?  Are hormones safe to use for short periods of time—like to get through the peri-menopausal time only?  Are they safe to use if there is a strong family history of breast cancer or heart disease?

I have to assume that all forms of hormone replacement therapy can potentially carry the same risks and have the same contraindications until proven otherwise.  Risks of hormone use include heart disease, stroke, breast cancer, endometrial cancer and increased triglyceride levels.  Some potential contraindications include breast cancer, endometrial cancer, coronary artery disease, thrombosis, liver disease, and unexplained vaginal bleeding.

On the other hand, there are benefits to taking hormones besides relief of peri-menopausal symptoms.  Research suggests that some hormone therapy is potentially helpful for fracture prevention and reducing the risk of colon cancer, improvement in sleep and pain, lowering of “bad” cholesterol (LDL) and an increase in “good” cholesterol (HDL).  Therefore, when talking to your health care practitioner, the benefits and the risks must be evaluated.

Fortunately, there are other options for treatment of peri-menopausal symptoms.  Dietary changes, supplements, and herbs have all shown benefit.  Unlike hormone replacement therapy, these treatment options have low risk of adverse effects.

If you are suffering from peri-menopausal symptoms, bio-identical hormone replacement therapy may be an option for you.  But remember, no one knows how safe bio-identical hormones really are.  You and your health care provider can discuss different treatment options and decide which is the best fit for you.


Molly Brignall is a naturopathic physician in practice in Tacoma, WA.  She is currently practicing at Alliant Continuum Care and is a member of the South Sound Holistic Healers.  Appointments can be made by calling 253-678-6047.


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