What are the Side Effects & Risks of BHRT?
In 1965, hormone replacement therapy (HRT) became available to women in the UK who were struggling with menopause and post-menopausal symptoms, including hot flashes, night sweats, sexual dysfunction, sleep disturbances, mood changes, urinary incontinence, cognitive disturbances (memory loss and impaired concentration), and weight gain.
However, starting in the 1970s, several studies drew concern over the potential health risks of HRT, including increased risk of breast cancer, ovarian cancer, blood clots, heart disease, and stroke.
One study, in particular, sounded the alarm over HRT — the Women’s Health Initiative (WHI) Hormone Therapy Trials. Between 1993 and 1998, 27,347 U.S. women ages 50–79 enrolled in the study.
Participants who had had their uterus removed received synthetic estrogen (Premarin), while those who still had their uterus received synthetic estrogen (Premarin) + synthetic progestin (Provera).
The study ended in 2002 for the estrogen-plus-progestin group and in 2004 for the estrogen-only group when participants were told to stop taking the medication due to the increased rates of serious health conditions, including coronary heart disease, stroke, breast cancer, blood clots in the lungs, colorectal cancer, endometrial cancer, hip fracture, and death.
Relatively recently, hormone therapy has been increasing in popularity with the availability of bioidentical hormones — manufactured chemical compounds that are identical to the hormones produced by the body. Bioidentical hormones are a much safer option than their synthetic counterparts. However, there are a few minor risks and adverse side effects you’ll want to consider.
Procedural Risks
Bioidentical hormones can be taken orally — pills, liquid, or sublingually (under the tongue) — by applying a topical cream or receiving injections or by having tiny pellets (about the size of a grain of rice) inserted just below the skin (through a very small incision).
We recommend the option we think is best for each patient and encourage our patients to choose their preferred method(s).
The only method that’s somewhat risky is pellet insertion. A small percentage of women may experience infection, bleeding under the skin, or temporary discomfort. However, this method of delivering hormones to the body is the best option for most women.
Side Effects and Risks of Bioidentical Hormone Therapy
Depending on each patient’s hormone levels, bioidentical hormone therapy involves the use of estradiol (a type of estrogen) and testosterone. While testosterone is considered the male hormone, it plays an important role in women’s health, as well.
Bioidentical hormones are a low-risk alternative to traditional synthetic hormones, but they still present minor risks and adverse side effects of which you should be aware.
Bioidentical Estradiol: Potential Risks and Side Effects
Estradiol pellet therapy is convenient and well-tolerated. Some women report temporary breast tenderness and swelling, which typically resolves on their own over time or in response to a decreased dosage.
Uterine bleeding is another potential side effect that usually resolves on its own. If it persists, we have some simple treatments to address it.
A few women report fluid retention with estradiol therapy, which can usually be managed by decreasing the dose or using a mild diuretic.
As for the risks reported in the most wide-ranging study on menopausal hormone therapy, the Women’s Health Initiative (WHI) Hormone Therapy Trials found the following important considerations for understanding that report’s findings in context:
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The study examined only synthetic hormones, not bioidentical hormones.
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The increased cardiac risk was among study participants who had initiated hormone therapy in their mid-60s — long after their menopausal transition. Likely, they had coronary artery plaques before starting HRT.
Most experts now agree that starting estrogen therapy within a few years of the menopausal transition protects the cardiovascular system. When started soon after the menopausal transition, estrogen therapy reduces inflammation and the development of coronary plaques and lowers mortality.
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The increased incidence of breast cancer among study participants is attributed to those participants who were taking a combination of synthetic estrogen (Premarin) and synthetic progestin (Provera).
The group that received estrogen without progestin actually experienced a reduced incidence of breast cancer. In other words, the synthetic progestin, not estrogen, was responsible for the increased risk of breast cancer in study participants.
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Unlike synthetic progestin, bioidentical progesterone is not associated with any health risk. It’s safe to use by itself or along with bioidentical estrogen.
Bioidentical Testosterone: Potential Risks and Side Effects
Bioidentical testosterone has not been linked to an increased risk of cancer, cardiovascular disease, or other serious medical condition. In contrast, numerous scientific studies suggest that non-oral formulations of bioidentical testosterone protect the health of breasts, heart, bones, and brain.
Testosterone pellet therapy is well tolerated, and few women report any side effects. A small number of women experience increased facial hair or acne, which often resolves with a decrease in dosage or other treatment. After experiencing the benefits of bioidentical testosterone, most women choose to manage any side effects in ways other than reducing their dosage.
Risks of testosterone replacement are mostly related to a synthetic oral drug called methyltestosterone — the only FDA-approved testosterone medication available for females in the U.S. Compared to the testosterone produced by the body, methyltestosterone is a very different chemical compound, and it has very different effects on the body.
For more about hormone replacement therapy, check out our previous post on the topic, “Here is the Safe & Effective Hormone Replacement Therapy in Tampa FL,” which covers symptoms of hormonal imbalance and our approach to restoring a healthy balance.
Don’t accept the commonly held misbelief that feeling old and tired is a sign of aging. It’s just a sign that your body doesn’t have what it needs to feel young and energetic. And you can do something about it!
Hormones are constantly in flux throughout life, so your treatments will need to be adjusted accordingly. It’s important to be on the right bioidentical hormones for the right amount of time and to adjust levels and ratios as needed to optimize your well-being.
BioDesign Wellness Center’s objective is nothing other than to help you look and feel your absolute best. We seek to achieve that by fine-tuning your treatment and making adjustments to address any changes in your biology over time.
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Disclaimer: The information in this blog post about the risks associated with bioidentical hormone replacement therapy is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from the medical staff at BioDesign Wellness Center, Inc., nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.