Myths About Bioidentical Hormone Replacement
Estrogen causes cancer.
Probably the most common myth when discussing hormone replacement. Despite all these benefits, many women are apprehensive about starting hormone replacement because of this fear about cancer. Fortunately, estrogen does not cause increased risk of breast cancer and when appropriately balanced with progesterone, does not cause increased risk of uterine cancer. In the largest hormone study, the WHI study, the relative risk of breast cancer with Premarin (the pharmaceutical version of estrogen) alone was 1.0, which means that there was no increased risk of breast cancer with Premarin. Furthermore, bioidentical estradiol actually has slightly decreased risk of breast cancer. Women with higher amounts of visceral fat have increased risk for cancer and estradiol helps reduce visceral fat. In sum, estradiol does not cause increased risk for breast cancer!
Estradiol is dangerous for women who have clots.
Premarin is derived from horses and is a stronger type of estrogen. The consequence of this is that in several studies, it is demonstrated that when a woman has heart disease with clots formed in her blood vessels, there is a chance that Premarin can dislodge some of these clots, resulting in heart attacks and strokes. In the WHI study, this occurred in 30/10,000 women, or 0.3%. While this is not a high risk, it is still of concern.
Multiple studies have not demonstrated that bioidentical estrogen causes such dislodging of clots. To the contrary, estradiol is very protective against heart disease. Studies have shown that women who take estradiol have a relative risk of 0.39 for getting heart disease, or in other words, 2.5 times less likely. Women lose an average of 10 to 15 pounds with bioidentical hormones and much of that loss is visceral fat which generates clots and potentially heart disease and cancer. With the loss of this visceral fat, the risk of heart disease is decreased. Women who take bioidentical hormones lower their LDL cholesterol and raise their HDL cholesterol that reduces clots. Estradiol is very beneficial in protecting against heart disease.
Provera is the same as progesterone.
Provera is a synthetic pharmaceutical version of progesterone. Progesterone is a feel-good hormone that improves mood and improves sleep. Many women felt their best during pregnancy which is the time when progesterone levels are the highest. Progesterone is anti-proliferative; it protects against cancer. Provera blocks many of the receptors for progesterone. Women who take Provera often complain of anxiety, irritability, depression and insomnia. In the WHI study, it showed that Premarin had some cardiac benefits when taking it soon after menopause but Provera negated much of that benefit. Bioidentical progesterone works synergistically with bioidentical estradiol for enhanced cardiac benefit. The WHI study noted that Provera, when taken with Premarin, increased the risk of breast cancer by 30% to 1.3. Progesterone on the other hand is protective. Provera is not the same as bioidentical progesterone.
Women don’t need testosterone.
Before menopause, women produce testosterone, which is a source of energy and vitality. Testosterone production stops at menopause. There are many benefits for women to achieve with replacing testosterone. Testosterone helps burn fat and build muscle. A common symptom of menopause is decreased libido. Testosterone is a key driver of libido for women and will enhance lubrication. A great benefit of testosterone is protection against breast cancer. Testosterone plays a key role enhancing energy and vitality with improved mood. Of course, a woman’s dose is much lower than a man’s.
Osteoporosis is an inevitable.
By taking bioidentical estradiol, women can significantly reduce the risk of osteoporosis and hip fractures. There is dramatic bone loss at the time of menopause, which continues due to the loss of estrogen. Bioidentical estradiol actually promotes bone growth so bone density increases. Estradiol not only decreases the progression of bone loss, but actually promotes bone growth so can reverse osteoporosis, which will obviously decrease fracture risk.