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the natural state helps keep breast cell cancer cells; the opposite effects of bioi- terone as a safer option. A double-blind
growth in healthy balance. dentical or natural progesterone. study comparing transdermal estradiol
Commercially and compounded Among the lay public as well as within and Premarin reported in the American
bioidentical hormone preparations con- the scientific and medical communities, Journal of Obstetrics and Gynecology as
taining progesterone include: Progester- there remains considerable confusion early as 1985 suggested that bioidenti-
one in peanut oil capsule (Prometrium), surrounding estrogen and progesterone cal hormones were superior in relieving
progesterone vaginal gel (Crinone), mi- formulations. The confusion comes from postmenopausal symptoms without side
cronized progesterone in various com- the lack of clear distinction between their effects.
pounded forms (capsules, troches, trans- molecular formulas, the lack of focus on
dermal creams, vaginal suppositories), their different effects in the human body, Women’s Health Initiative
combinations of estradiol and progester- and the use of nonspecific nomenclature
one in compounded formulations. when referring to estrogen and progester- Most recently, the Women’s Health
Beyond the commercial bioidentical one regardless of their actual differences Initiative (WHI) has been the source of
hormone formulations, individually com- in chemical structure or activity. confusing and sensationalized reports
pounded preparations of bioidentical es- indicting all hormone replacement for
trogens, progesterone and testosterone Hormone Replacement Therapy causing breast cancer and heart disease.
are prepared in compounding pharma- The goal of the study was to evaluate the
cies or laboratories (some are FDA ap- Scientific studies on the effects of long-term effect of hormone-replacement
proved; all are regulated by the state they hormone replacement therapy after therapy (HRT) versus placebo in the pre-
operate in) on an individualized basis as menopause have had conflicting results vention of heart disease, osteoporosis,
prescribed by a physician. These prod- and conclusions. As early as 1976, sci- cancer, and strokes in postmenopausal
ucts contain the same active estrogens, entific data demonstrating the safety of women. The only form of hormone-
progesterone, and testosterone as those bioidentical hormones appeared in the replacement therapy used in the study
found in the commercial preparations conventional medical literature from the was synthetic conjugated equine estro-
listed above. The difference is that they American College of Obstetrics and Gy- gens (Premarin) and synthetic progestins
are individually mixed in tablet, capsule, necology. Reports of increased risk of en- (Provera). Unfortunately, the WHI did not
troches, gels, or creams to the specifica- dometrial and breast carcinoma among include a bioidentical arm even though
tions of the prescribing physician for the users of synthetic conjugated estrogens bioidentical hormone usage and statisti-
individual patient. also appeared in the scientific literature cally significant studies consistently dem-
The synthetic, non-human progestin around the same time As early as 1980 onstrated positive results and sustainable
found in Provera is medroxyprogesterone and continuing into the recent literature,
(MPA). It has very different biologic effects untoward side effects of synthetic pro-
than natural human progesterone. Prove- gestins, such as thrombotic phenomena;
ra reduces the beneficial effects of estro- breast tissue cell hyperplastic changes;
gen on plasma lipoproteins, can lead to cardiovascular symptoms, headaches,
vascular spasms, opposes the beneficial elevated blood pressure, and changes
effects of estrogen on the brain and has in cholesterol, carbohydrate, and lipid
been shown to enhance the estrogen-in- metabolism prompted more research
duced proliferation of pre-existing breast into bioidentical (micronized) proges-
October 2009
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