Why You Need Bioidentical Hormones | Christiane Northrup, M.D. (2022)

Many women approach menopause with the desire to take only “natural” hormones to help alleviate their symptoms. This causes quite a bit of confusion and miscommunication between doctors and their patients. That’s because all hormones can be marketed as “natural” or “plant-based,” and many pharmaceutical companies are capitalizing on women’s quest for “natural” hormone replacement therapy by marketing proprietary hormone products in this manner.

The problem is, while many of these hormonal molecules may have been derived from plant sources, most are not even close to being anything like human female hormones, nor do they perform as such in the body. Many proprietary HRT options marketed as “plant-based” and “natural” as well as purely yam-based creams fall into this category. Moreover, they are often not effectively converted or used in the body and sometimes have actions that are more deleterious than the symptoms they purport to quell or stave off.

What’s the Difference Between Natural and Bioidentical Hormones?

All hormones are “natural.” But what most women mean when they say they want natural hormones is that they are interested in using bioidentical hormones. The distinction is that bioidentical hormones are identical in their molecular shape, makeup, and structure to hormones made in the human body. This is what makes bioidentical hormones the perfect “keys” to unlock the body’s receptor sites. In other words, it’s the shape of the molecule not the source.

Today, most women know that, while natural, the hormone Premarin, which is marketed as Prempro when combined with the synthetic progestin Provera, is not bioidentical. My colleague, the late Dr. Joel Hargrove, used to say, “Premarin is a natural hormone if your native food is hay!” That’s because it’s made from conjugated mare urine. Provera (medroxyprogesterone acetate) does not occur naturally in nature. It is used as a substitute for bioidentical progesterone. Pharmaceutical companies do this because they cannot patent a naturally occurring hormone!

If you are in doubt as to whether a particular product offered to you by prescription is bioidentical, check the label. If it lists “esterified estrogens,” “progestins,” or “progestogens,” the product is not bioidentical. You can also research the products you may be considering, as many have their own websites.

Why Bioidentical Hormones Work Better

Our hormones are comprised of a solid steroid base (cholesterol), decorated with “arms,” “legs,” and “tails” pinned on here and there. These attachments are what turn hormones into specialized molecules, allowing them to plug into receptor molecules throughout the body, turning on and off much of the cellular behavior that makes us tick.

When we take hormonal replacement therapy that doesn’t fit the original design that our cells have evolved to recognize, the end result simply may not feel or act quite right. Hence, all those side effects, ranging from annoying and uncomfortable to downright dangerous, can occur.

Bioidentical hormones, on the other hand, duplicate the structure of our hormones exactly as they are found in our bodies. This is why they work better in our bodies.

Which Bioidentical Hormones Should You Take?

The molecules naturally produced in the human female body for which we most often seek replacement include:

These truly “natural” hormones are available by prescription. Estradiol is available as Estrace pills, Estrace vaginal cream, or transdermals as the Vivelle Dot, and Climera. (Pharmaceutical companies have been able to patent the delivery system on these hormones, though the hormone itself is still bioidentical. Estriol is available only through formulary pharmacies. Most women do fine with just estradiol plus or minus some progesterone. And sometimes a bit of testosterone, which is available by prescription as AndroGel.

What is the Best Natural Progesterone Cream?

Many women are confused about the use of progesterone creams, particularly regarding the efficacy of yam-based or other plant-based creams. Unlike soy and flax, which contain plant-based adaptogenic estrogens (phytoestrogens) that convert into usable forms in the body, wild yam (Dioscorea barbasco) cannot be converted into progesterone in the body.

The conversion can occur in a laboratory setting, however; therefore, wild yam is sometimes used to synthesize the progesterone found in progesterone creams. Some progesterone creams are yam-based, but the active ingredient is not the wild yam itself but the USP progesterone that has been added.

For this reason, while the body may absorb wild yam extract through the skin, which may then confer mild effects on menopausal symptoms, results of research on oral and topical applications of wild yam extract have not detected a significant change in progesterone levels in the blood.

If you want the beneficial effects of bioidentical progesterone, make sure the ingredients on the label include United States Pharmacopoeia (USP) progesterone. USP progesterone is available in over-the-counter 2% creams as well as by prescription. Choices for prescription-based bioidentical progesterone include Crinone Vaginal Gel in 4% or 8% concentration or in an oral micronized form such as Prometrium capsules.

How to Talk to Your Doctor

I receive letters almost daily from women who have taken the initiative to offer their health care providers information on bioidentical hormones. If you want to use bioidentical hormones as replacement therapy, here are the salient points to know and share with your doctor about bioidentical hormones:

  • They have been prescribed by doctors for many years.
  • They are readily available through formulary pharmacies.
  • They are easily titrated to suit a woman’s individual needs.
  • They are readily absorbed and utilized.
  • They are safe and effective.

Many formulary pharmacists work in partnership with physicians to provide individualized hormone-replacement solutions. You may want to call a local formulary pharmacy to consult with a knowledgeable pharmacist to develop your customized plan.

Additional Resources on Bioidentical Hormones

For information about compounded hormones or to locate a pharmacy that provides individualized prescriptions, visit the Alliance for Pharmacy Compounding.

American Hormones, Inc., founded by Erika T. Schwartz, M.D., renowned expert in the field of natural hormones, offers concierge medical services, including high-quality pharmaceutical-grade hormones shipped nationwide and internationally. The website has extensive information on bioidentical hormones.

There are also many books that you can consult. My books, The Wisdom of Menopause and Women’s Bodies, Women’s Wisdom provide in-depth information. I also recommend reading The 30-Day Natural Hormone Plan, by Erika Schwartz, M.D.; New Menopausal Years, The Wise Woman Way: Alternative Approaches for Women 30–90, by Susun S. Weed; and TCM: A Woman’s Guide to a Trouble-Free Menopause, by Nan Lu, O.M.D., L.Ac., with Ellen Schaplowsky.

Why Bioidentical Hormones Could Be Banned in the Near Future

If you are reading this blog, you are most likely interested in natural hormones and other therapies as a way of maintaining your health. Perhaps you have used some or all of the bioidentical hormones I mention above. And maybe you even prefer these proven therapies over prescription drugs and over-the-counter medications to treat illnesses.

If so, here is something you need to know: On July 9, 2020, the FDA made an announcement—seemingly out of the blue—stating that bioidentical hormones are a “public health concern” and that a “ban is likely.” This statement could not be more false. All estrogens—bioidentical included—that bind to the alpha estrogen receptor (and testosterone too when converted) can act as growth promoters in estrogen-sensitive tissue, including breast and uterine tissue. This is why some women prefer herbal approaches instead. However, bioidentical hormones have long been found to be safer and more effective than their pharmaceutical counterparts. In fact, a review of the studies found that compounded bioidentical hormone therapy (cBHT) is associated with lower risks of breast cancer and cardiovascular disease and is more effective than synthetic or animal-derived hormones. And there are many women who have comfortably stayed on low doses of bioidentical hormones for years with great results.

So, why would the FDA issue this statement? The FDA statement came one day after the National Academy of Sciences, Engineering, and Medicine (NASEM) published a review of the “clinical utility” for cBHT. And, it may not surprise you to learn that the NASEM study titled “Clinical Utility of Treating Patients with Compounded ‘Bioidentical Hormone Replacement Therapy’”—was sponsored by none other than the FDA itself.

In its review, the NASEM committee acknowledged that many women expressed a distinct preference for compounded bioidentical hormones. Yet, the committee recommended only allowing cBHT to be prescribed under very specific circumstances, such as a documented allergy to an FDA-approved BHT product. In addition, the committee said that just because a patient prefers to use bioidentical hormones, that alone is not enough to justify their use. In other words, the only way you will be able to get cBHT is if there is no other FDA-approved drug option. And, in the slim chance you are approved for cBHT, the dosage cannot exceed FDA-approved product dosages, even though dosing of compounded hormones is very different than the one-size-fits-all dosages of drugs.

The committee also recommended that the FDA Pharmacy Compounding Advisory Committee (PCAC) review select hormones for addition to the “Difficult to Compound” list, including estradiol, estrone, progesterone, estriol, testosterone, and the pellet dosage form of these. When an item is placed on the “Difficult to Compound” list, it can no longer be made at compounding pharmacies.

Finally, the committee recommends increased oversight of “traditional” pharmacies by the federal government and the State Boards of Pharmacy to ensure quality standards for every cBHT preparation dispensed.

Why Are These Restrictions Happening Now?

The FDA has always had the authority to regulate the substances used in making compounded drugs; however, until now, the agency has chosen to leave oversight to the states. Now, all of a sudden, the FDA has decided to regulate substances used in compounding. By doing this, the FDA is, in effect, regulating the practices of medicine and pharmacy rather than regulating the drugs being prescribed and sold. In my opinion, this is a huge overreach of power, and it waves a big red flag for me during this time of increasing government control over our bodies and our lives.

Further, the committee’s calling for the “education” of health care providers and pharmacists who currently prescribe, compound, and dispense cBHT is nothing more than a thinly veiled threat against these practitioners, who will be forced to practice medicine the way Big Government and Big Pharma dictate or risk losing their licenses and practices.

And, according to a newly proposed rule on September 5, 2020, it appears that the FDA is on a mission to ban other compounded natural therapies as well, including homeopathic remedies and natural substances, such as curcumin, that have been proven safe and effective for decades!

By limiting your ability to use natural substances that are proven safe such as bioidentical hormones, the FDA has launched a full-fledged attack on your health and your health freedom while supporting Big Pharma. But it doesn’t stop there. The FDA, FTC, and even some state attorney generals are restricting medical practitioners from even discussing natural therapies for treating conditions with their patients and the public, including therapies that may reduce the severity and length of COVID-19 symptoms. Yet, every time you go to the pharmacy, they try to give you a flu vaccine. In fact, a new “informed consent” law in the District of Columbia allows children just 11 years old to decide for themselves whether to receive a non-mandatory vaccine without parental consent or knowledge. This includes flu and HPV vaccines. Of course, this means that when a COVID-19 vaccine is available, no matter how unsafe or unproven, the same law would apply. We should all be outraged by this!

What You Can Do to Protect Your Health Freedom

Frankly, I trust Mother Nature’s millions of years of wisdom much more than I trust 50 years of biochemical wizardry from Big Pharma. If you feel the same way and want to be able to preserve your freedom of choice when it comes to your body and your health and stop the FDA from banning bioidentical hormones and other safe, natural therapies (and restricting your doctor from even giving you advice about them), one of the best things you can do is write to your senator, representative, and the FDA. Here is a letter created by the Alliance for Natural Health USA that you can use. Another thing you can do is join Millions Against Medical Mandates, an organization fighting for your rights to medical freedom and bodily autonomy. The Children’s Health Defense is another wonderful organization founded and run by Robert F. Kennedy Jr.

Have you tried bioidentical hormones? What was your experience? Do you think the FDA is wrong in banning bioidentical hormones? Leave your comments below.

Last Updated: November 3, 2020

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