Bioidentical Hormone Replacement

Most naturopathic doctors use bioidentical (natural) hormones in their practice. “Bioidentical” refers to naturally-derived hormones that are the same chemical structure as those produced by the body. The identical structure of bioidentical hormones to those manufactured by the body eliminates many of the risks and undesirable side effects of synthetic hormone replacement. For example, progestins (synthetic progesterones) are associated with vasoconstriction and increase the risk of coronary heart disease; bioidentical progesterone does not.[i] When combined with estrogen, synthetic progestins increase the risk of breast cancer, whereas natural progesterone does not[ii] and may even provide protection against breast cancer.[iii]

Bioidentical hormones are most often used to treat symptoms of menopause and perimenopause (the time leading up to menopause), particularly hot flashes, night sweats, mood disturbance, vaginal dryness, decreased libido, weight gain and insomnia. Many men, as they get older, can also experience changes such as altered body composition, mood disturbance and lowered sexual function due to decreasing hormone levels, especially testosterone. This is sometimes called andropause or male menopause.

While bioidentical hormone replacement generally refers to sex hormones (estrogens, progesterone and testosterone), naturopathic doctors commonly prescribe natural forms of other hormones as well, such as sex hormone precursors like DHEA or pregnenolone, and especially thyroid and adrenal hormones. (See hypothyroidism and adrenal fatigue under the “treatable health conditions” section for more information.)

Usually prescribed as creams, bioidentical hormones may also be in the form of pills, suppositories, or troches (dissolving tablets). Naturopathic doctors will usually send a prescription for bioidentical hormones to a compounding pharmacy — a special type of pharmacy that makes customized hormone treatment preparations with the specific hormone dose and delivery method the doctor has ordered.

It is often possible to treat menopause and andropause symptoms without the use of any hormones. A naturopathic doctor will discuss alternative treatment options for the symptoms associated with hormone decline if hormone replacement therapy is not desired.

[i] Miyagawa K, Rosch J, Stanczyk F, Hermsmeyer K. Medroxyprogesterone interferes with ovarian steroid protection against coronary vasospasm. Nature Medicine 1997;3(3): 324-327.

Sitruk-Ware R. Progestins and cardiovascular risk markers. Steroids 2000 Oct-Nov;65(10-11):651-8.

[ii] Campagnoli C et al. Progestins and progesterone in hormone replacement therapy and the risk of breast cancer. J Steroid Biochem Mol Biol. 2005 Jul;96(2):95-108.

[iii] Mendelson CR & Hardy DB. Role of the progesterone receptor (PR) in the regulation of inflammatory response pathways and aromatase in the breast. J Steroid Biochem Mol Biol. 2006 Dec;102(1-5):241-9. Epub 2006 Oct 17.

Fournier A et al. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer. 2005 Apr 10;114(3):448-54.