The Bioidentical Controversy — Cure or Curse

By: Red Hot Mamas

Published: May 26, 2010

There’s a lot of confusion about estrogen. Take it? Stop it? How much? How long? What kind?

What about bioidenticals? They’re safe, right? According to Suzanne Sommers, bioidenticals are better and safer.

Maybe. Read on.

Bioidentical is not a medical term. It’s a lay description for a manufactured hormone with the identical chemical structure as its counterpart hormone made in the body. It doesn’t mean natural, even if it originates from soy beans and sweet potatoes – all bioidenticals are synthesized in chemical plants. For women, there are three bioidentical estrogen hormones: estrone, estradiol and estriol. There’s also bioidentical progesterone, and bioidentical testosterone.

Estradiol is the major estrogen because it’s the most potent, and levels vary depending on the day of the menstrual cycle – from 50 picograms per milliliter (a picogram is one trillionth of a gram) to six to eight times higher – about 400 picograms per milliliter. After menopause, ovaries make less than 30 picograms per milliliter of estradiol.

Lower estrogen levels cause many of the symptoms of menopause – hot flashes, dry skin and vaginal dryness, poor sleep, loss of calcium from the bones (osteoporosis) and bladder problems. Hormone therapy raises blood estrogen levels, and even a little helps control symptoms. Gynecologists have been prescribing estradiol for years as pills (such as Estrace), patches (such as Vivelle-Dot and Climara); spray (Evamist); and gels (such as Divigel and Estrogel). Premarin is also estrogen but it isn’t estradiol; its called conjugated equine estrogens because it contains many types of estrogens and is processed from pregnant mares’ urine.

All drugstores carry estradiol that is regulated and inspected by the FDA and doses are accurate. Compounding pharmacies also provide estradiol. They mix it (and/or other hormones) into a cream or gel so it can be rubbed on the skin or placed into the vagina. Many are very good and accurate, but the process is not FDA inspected, and dosages can vary considerably from batch to batch. There are thousands of studies on Premarin, many fewer on pharmaceutical bioidenticals, and very few using compounded bioidenticals.

So are bioidenticals safe? It depends. Which weighs more, a pound of feathers or a pound of bricks? They both weigh the same. So if equivalent amounts of estrogen are used, whether bioidentical or conjugated, their benefits and risks will also be equivalent. The real question is “Is estrogen a good choice for you”. Talk with your healthcare provider. If estrogen is a good choice, bioidentical estrogen is a good choice too. It’s neither a cure, or a curse.