Bioidentical Hormone Treatment: Will It Help or Hurt Your Autoimmune Conditions?
In the last few decades, hormone replacement therapy for women of menopausal age has alternately been hailed as a savior and condemned as a potential threat, sometimes simultaneously. Their considerable ability to influence and mitigate both normal and disease processes has been tempered by their apparent deleterious effects on other aspects of women’s health. Below we consider a very specific type of hormone treatment that has invited interest lately, and discuss its impact on autoimmune diseases.
What are bioidentical hormone treatments?
Bioidentical hormones are chemically synthesized compounds that are structurally identical to those found in human beings. While they are derived from soy and yam plants, they are made in the laboratory and are thus considered “synthetic” materials (as opposed to “natural” treatments). The bioidentical estrogens available mainly come in the form of estrogen derivatives known as estradiols and estriols; progesterone versions are simply finely ground progesterone.
In terms of treatments, bioidentical hormones work the same as any other hormone replacement therapies do, by filling the hormonal void left by menopause, in an attempt to alleviate perimenopausal symptoms such as hot flashes and vaginal dryness/discomfort. They are supplemental versions of the natural estrogen and/or progesterone the body has begun to lose. But unlike other forms of HRT – which may be derived from horse urine or plant extracts and therefore not exact replicas of the human hormones they’re replacing – they are exact copies of human hormones in terms of chemical structure, albeit made synthetically. The idea behind these formulations is that identical structures would be most likely to gel seamlessly with our innate endocrine system, making them “natural” from a biochemical standpoint, though still “synthetic” from a manufacturing perspective.
Are bioidenticals only an option for perimenopausal and menopausal women?
No, definitely not. Just as is the case with other hormone replacement therapy, while these hormones are primarily used to relieve symptoms associated with menopause, doctors may use them in many different capacities, depending on the individual patient. The other major reason they might be prescribed is for the prevention of osteoporosis. However, there is substantial concern within the medical community that long-term therapy with female hormones of any kind can lead to increased risk of certain cancers and other conditions.
At the same time, there are plenty of medical professionals who believe in the additional potential to ward off vascular disease such as stroke, in addition to other problems. For these reasons, it is incredibly important to consult with your physician about the reasons for and possibilities of bioidentical hormone treatment, or any hormone treatment for that matter.
Are there any studies about how bioidenticals improve autoimmune disease symptoms or progression?
There’s not a whole lot out there looking specifically for a connection between bioidentical hormones and autoimmune conditions, but there are studies that examine the connection between hormone replacement therapy in general and its autoimmune impact.
Unfortunately, a literature search provided a mixed bag of information, with some suggesting anti-inflammatory protective effects, while others note detrimental effects that increase autoimmune pathology.
It is safe to say that the relationship between autoimmune disease and sex hormones is a complex one that is still only partially understood. It appears that the two most investigated conditions in this regard are lupus and rheumatoid arthritis, but it is difficult from the available information to make a definitive case for or against bioidenticals or other hormone replacement therapy in autoimmune patients. Some of the studies are linked below:
- “The Effects of Hormone Replacement Therapy on Autoimmune Disease: Rheumatoid Arthritis and Systemic Lupus Erythematosus”
- “The Complex Role of Estrogens in Inflammation”
- “Estrogens and Autoimmune Diseases”
- “Hormone Replacement and Contraceptive Therapy in Autoimmune Diseases”
What kind of doctor administers bioidentical treatments and how should they work with my other autoimmune practitioners?
There is really no specific doctor required to prescribe bioidentical hormone treatment, as long as he/she has sufficient experience dealing with hormonal issues and hormone replacement therapy. The clinician would simply write a prescription for the specific drug he or she wants you to take, and specify the route of administration (e.g. pill, gel, cream, patch, etc.). There are plenty of commercially available bioidentical products to choose from. That said, the three most common prescribers of any type of hormone replacement therapy are probably your internist/GP, Ob/Gyn and endocrinologist, depending on the situation.
In light of the above information regarding the connection between bioidentical hormones and autoimmune disease that is known at this time, it would be advisable that any autoimmune patient considering undergoing bioidentical hormone treatment first discuss this with his or her healthcare practitioners, including and especially the internist or rheumatologist managing the autoimmune issues.
Hormone replacement therapy with bioidentical hormones may be acceptable in certain cases and completely contraindicated in others. This is something only your doctors can determine, on a case-by-case basis.
Questions for your doctor:
- Which type of hormone replacement therapy is right for me? Am I a candidate for bioidentical hormones? Why or why not?
- Is this much ado about nothing? That is, is there really a difference, in terms of risk/benefit, between other forms of hormone replacement therapy and those that are bioidentical?
- What are the major pros and cons of bioidentical hormone treatment for my specific situation?
- What is your opinion regarding the potential risk for cancers and other maladies when on long-term hormone treatments? Is it worth the risk?
- Can you point me toward any other resources and/or research involving the uses, risks and benefits of bioidentical hormone therapy?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at email@example.com.
This blog post was originally published by AutoimmuneMom.com, written by Dr. Rothbard, and first published on Nov 7, 2013.
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