What You NEED to KNOW About Bioidentical vs Synthetic HORMONES

Dr. Stengler: Are you a woman considering hormone replacement? Perhaps you're in perimenopause or menopause and experiencing common symptoms — hot flashes, night sweats, vaginal dryness, cloudy thinking, joint pain, fatigue, or insomnia. There are so many symptoms that can come with the menopausal transition. I want to talk to you about the difference between synthetic and bioidentical hormones.

Estrogen replacement has gone through different phases over recent decades. Originally in the 1960s, a pharmaceutical company heavily promoted Premarin — a synthetic type of estrogen, not identical to what the body makes, actually derived from the concentrated urine of pregnant mares. It was heavily promoted through a book called Feminine Forever, which we later found out was written by a gynecologist who was paid to write it in association with the pharmaceutical company promoting the product. Premarin was widely used for many years until a large study called the Women's Health Initiative found increased rates of breast cancer, causing a major scare and leading doctors to advise women to avoid this type of estrogen — or estrogen altogether.

In more recent times, when researchers reanalyzed the Women's Health Initiative data, they found that estrogen replacement itself wasn't as harmful as originally thought, particularly with short-term use. In fact, it appears that most of the harmful effects attributed to hormone replacement were actually associated with the use of synthetic progestins — which are not the same as bioidentical progesterone.

Hormone replacement, when done properly with bioidentical hormones — hormones that are identical to what the body naturally produces — can have many benefits. It reduces menopausal symptoms quite dramatically and quickly, improves quality of life, supports bone density, and can help reduce cardiovascular risk factors. I've used bioidentical hormones with patients for many decades, and more and more doctors are now embracing this approach.

During perimenopause and menopause, we typically use estrogen, progesterone, sometimes bioidentical testosterone, and adrenal hormones like DHEA and pregnenolone, depending on what a woman is deficient in. Not all women going through this transition need hormone replacement — but for those with moderate to severe symptoms, bioidentical hormones are very effective. They're also valuable for women with osteoporosis or high osteoporosis risk, and for those with a strong family history of Alzheimer's disease, since some studies suggest that starting estrogen earlier in the perimenopausal and menopausal years may be protective against cognitive decline and reduce Alzheimer's risk.

What I do with patients is go through their symptoms, personal history, and family history, then run testing to see where hormone levels stand. Once a woman starts bioidentical hormone replacement therapy, we monitor symptoms and lab values over time for proper ongoing assessment. This can be done very safely and effectively.

The take-home point is: do not be afraid of hormone replacement. When using bioidentical hormones, it can be done with a very good safety profile and is highly effective in improving quality of life and getting you through the menopausal transition — with additional benefits for hair, skin, heart health, bone density, mood, energy, joint health, and much more. I have many other videos on menopause and hormone replacement on my YouTube channel.

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