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Plant-Based Bioidentical Hormones

Do compounded bio-identical hormones for menopause carry the same risks as conventional hormone replacement drugs such as Premarin?

November 14, 2012 |
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Supplementary Info

Sources Cited

Martha Rosenberg. Born with a junk food deficiency: how flaks, quacks, and hacks pimp the public health. Amherst, N.Y.: Prometheus Books, 2012.

Panay N, Fenton A. Bioidentical hormones: what is all the hype about? Climacteric. 2010 Feb;13(1):1-3.

Bioidentical hormones. Med Lett Drugs Ther. 2010 May 31;52(1339):43-4.

Files JA, Ko MG, Pruthi S. Bioidentical hormone therapy. Mayo Clin Proc. 2011 Jul;86(7):673-80, quiz 680.

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and American Society for Reproductive Medicine Practice Committee. Compounded bioidentical menopausal hormone therapy.

Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.

Shumaker SA, Legault C, Kuller L, Rapp SR, Thal L, Lane DS, Fillit H, Stefanick ML, Hendrix SL, Lewis CE, Masaki K, Coker LH; Women's Health Initiative Memory Study. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study. JAMA. 2004 Jun 23;291(24):2947-58.

Espeland MA, Tindle HA, Bushnell CA, Jaramillo SA, Kuller LH, Margolis KL, Mysiw WJ, Maldjian JA, Melhem ER, Resnick SM; Women's Health Initiative Memory Study. Brain volumes, cognitive impairment, and conjugated equine estrogens. J Gerontol A Biol Sci Med Sci. 2009 Dec;64(12):1243-50.

Omar R, Sampson EL, Loy CT, Mummery CJ, Fox NC, Rossor MN, Warren JD. Delusions in frontotemporal lobar degeneration. J Neurol. 2009 Apr;256(4):600-7.

Clarke CA, Glaser SL. Declines in breast cancer after the WHI: apparent impact of hormone therapy. Cancer Causes Control. 2007 Oct;18(8):847-52.

U.S. Food and Drug Administration. 2006. Limited FDA Survey of Compounded Drug Products.

Acknowledgements

Images thanks to: Quadell via Wikimedia Commons, Lameer Witter, Dan&Corina Lecca, Marji Beach of Duchess Horse Sanctuaryjustthismoment, and Institute for Nearly Genuine Research.

Transcript

As Martha Rosenburg noted, the author of an excellent book Born with a Junk Food Deficiency, just as this lithograph tells you everything you need to know about slavery, the fact that the electroconvulsive therapy used to be prescribed for menopause in the United States tells you everything you need to know about Western medicine's view about aging women.

Here, in this 1946 medical journal ad, amphetamines—speed—are recommended in conjunction with such fundamental measures, as electric shock and estrogenic therapy. You can also throw in a little thorazine too, while you're at it.

Hormone replacement therapy grew to prominence in the 1990s when millions of women were sold hormones from pregnant mare urine on the promise it would prevent age-related diseases, increased risk of heart disease, stroke, pulmonary embolism, and invasive breast cancer. They said it would help preserve women's memory but may in fact cause dementia as it shrinks women's brains.

When the truth got out in 2002 and the number of prescriptions dropped, so did the rates of breast cancer, and horses got to walk around again.

Thanks to some high-profile celebrity endorsements, interest then switched to so-called compounded bio-identical hormones, from plant rather than equine sources and advertised as not carrying the same risks. But what does the science say?

A bunch of new reviews out on the subject from the American College of OB/GYNS, Mayo Clinic to the editors in chief of the Journal of the International Menopause Society. They all concluded that bio-identical hormones, being bio-identical, carried the same risks, benefits, and side effects, which is not a good thing, and even worse when the FDA actually analyzed them to if the contents matched the label, and nearly a third failed the analysis. And even in the same bottle, doses could be all over the place.

How do we know everyone isn't just in the pockets of the pharmaceutical industry who don't want the competition? Whenever I’m skeptical I turn to The Medical Letter on Drugs and Therapeutics, considered one of the least biased sources in medicine. They’re kind of like the consumer reports of the drug world and in fact was actually co-founded by the co-founder of the publisher of consumer reports more than 50 years ago.

As they like to brag on their website the Medical Letter does not accept grants, from any source, donations, from any one, funding—from any entity, they won’t let their work be used for promotional purposes and they don’t accept any advertising.

They recently reviewed bio-identical hormones and came to the same conclusion: “There is no acceptable evidence that bio-identical hormones are safe or effective. Patients should be discouraged from taking them.”

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Kerry Skinner.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Another way to rid oneself of excess estrogen is in the way nature intended: Relieving Yourself of Excess Estrogen. We can also stop consuming steroid hormones, see Anabolic Steroids in Meat and Acne & Cancer Connection. For other ways to decrease breast cancer risk see The Answer to the Pritikin Puzzle, Breast Cancer Survival and Soy, and Broccoli Versus Breast Cancer Stem Cells.

For more context, check out my associated blog posts: Stool Size and Breast Cancer RiskAre Bioidentical Hormones Safe?Mushrooms for Breast Cancer Prevention, and Treating Breast Pain with Diet

If you haven't yet, you can subscribe to my videos for free by clicking here.

 

  • HemoDynamic, M.D.

    Just what the Doctor ordered. . . Knowledge!!
    Thank you for that piece!

  • jylle

    Dr. John Lee did some excellent work on progesterone therapy for post-menopausal women. Anecdotally he relates amazing reversal of debilitating osteoperosis (sp) in elder women. Are you familiar with his work?

  • veggiegirl78

    I have been vegan for almost two decades. I have extremely heavy, long, painful periods (since onset of menses) and hypothyroidism and my doctor put me on oral bioidentical progesterone about a year ago. It has been very helpful to me. Are you saying that it is not safe to be taking that?

    • Jo

      For dysmenorrhea, look into taking vitamin B1 (thiamine) and vitamin B6. Just do a Google search: vitamin B6 dysmenorrhea thiamine B1.

      Too, have you seen Dr. Greger’s video on PMS: http://nutritionfacts.org/video/saffron-for-the-treatment-of-pms and http://nutritionfacts.org/video/wake-up-and-smell-the-saffron.

      You can buy saffron capsules on Amazon

    • Jo

      Also, drinking green tea daily helps. Google: green tea menstrual cramps. Just watch your iron, as green tea can reduce your iron intake.

      • veggiegirl78

        Thanks Jo, I will look into that. I currently take a B complex that contains B1 and B6, but I don’t know what the amounts are. I also take a green tea extract supplement as I don’t like the taste of green tea (I take it 4 hours apart from my iron supplement). My iron has been low since it was first checked 15 years ago. I was borderline anemic before starting the iron supplements. It’s still chronically low, and I do include vegan sources in my diet (lentils, spinach, quinoa, soy, etc). I do sometimes wonder if red meat might improve my iron status, but I am sickened by the thought of actually eating it.

        • Veganrunner

          Hi Veggiegirl,

          Late to your post but I am borderline anemic whether I eat meal or not. I guess we are just the unlucky ones who don’t absorb iron well.

          • Sophie

            Study in India asked women not to drink tea around their meals and eat one orange after each meal – their iron levels went right up – vit c increases iron absorption..

          • Veganrunner

            Yes. Those are important things to be cognicent of.

    • http://www.facebook.com/profile.php?id=608590997 Lori Woods

      Dose, vehicle (oral or skin), and age of person all make a huge difference as to safety. I take estradiol and synthetic progesterone via skin patch at low dose and it has totally cured my excessive bleeding. You may want to talk to your doctor about the patch. Good luck. I’m a vegan too, btw.

    • Khari

      I have always been anemic. Even the entire time I ate meat. It’s taken a bit to get my iron up since I became vegetarian and now vegan. But I find steeping raw organic stinging nettle dried loose leaf (you could use fresh leaves as well) over night and consuming once I wake up in the morning has helped immensely. My iron levels are perfect now.
      Google nettle infusion (Susan Weed has a infusion that I use) and it is very high in iron plus many other nutrients.

  • DonnaJay

    Dr. Greger, I’m wondering about what I should do in regards to my hypothyroidism. I was diagnosed with Graves disease in 2006 and shortly took the radioactive iodine treatment which left my thyroid non-functioning. I have since been taking levothyroxine off and on for several years now. Levothyroxine makes my T4 numbers look good when I get tested but I don’t feel any better when i take it. I have been a vegetarian for many years now and a plant-based vegan for a short time now and am not sure what I should do in regards to my thyroid, as the only time I feel better is when I monitor my diet and eat plant-based. My endocrinologist swears that I need to take the hormone but I really don’t feel any better when I do. Please help. Thank you.

  • Ann

    Thank you for this one. My doctor gave me a yam compound that I smeared on for a month. I had horrible results. It did nothing to rid me or night sweats or hot flashes. It did nothing for my mood except worsen it.
    I told him I was afraid of hormones but he said this was harmless. I doesn’t seem harmless to me.

  • Lesley Jacobs-Keeler

    At the age of 35, I had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. I take compounded BHT and thank goodness I do!! I would rather know the risks and take the plant derived hormones over horse piss any day. Without the BHT, I would be in the loony bin with the electroshock therapy!! Women have had to suffer through so much!

    • Roger T

      Isn’t bht butylated hydorxytoluline, a synthetic antioxidant used for preserving cooking oils? What hormonal effect does it have. I have read that it may antiviral activity since it can disrupt the fatty coat of some species.

      • Lesley Jacobs-Keeler

        BHRT – sorry forgot the R

  • Roger T

    I don’t know about the long-term safety of bio-identical hormones- but my girlfriends can tell you from personal experience that they’re effective. They stopped her hot flashes and depression, helped her sex drive and energy and made her skin more youthful- including the skin inside her legs that used to be all dried up.

  • Roger T

    I also wanted to point out that bio-identical hormones are not identical to the synthetic hormones that big pharma patents and doctors prescribe. They are unpatentable natural substances with well-established effects. It is the synthetic unnatural chemicals derived from horse urine which we have reason to suspect.

  • John

    Dr Greger,
    Do you have any information on treatment with single agent bioequivalent progesterone given without estrogen
    treatment? I know there have been some small studies indicating that
    treatment with progesterone alone can help ameliorate symptoms, but
    haven’t seen anything about decreased risk of cancer with progesterone
    alone versus estrogen or estrogen + progesterone. Thanks in advance.

  • Susan Lavelle, FNP

    From my understanding of the literature, we just don’t have enough studies in the US of women using strictly bio-identical hormones to say much of anything. We are all an experiment! I think there is more and more evidence, both in Europe and here, that synthetic progesterones (progestins) may have harmful effects. But what is more striking to me is the practice of placing women on a static doses of estrogen, progesterone and testosterone hormones, with no variation in dose with the cyclic rhythm of the month. There is nothing biologically “natural” about this practice. I think it is here that we may be way off the mark. Many women take hormones after menopause for very legitimate reasons that make a significant difference in their quality of life. Hopefully someday we’ll have some decent studies that really look at these issues.

    • Christy Begley

      I agree completely! There are some real quality of life issues that some women would like to avoid.

  • Mirador

    What hormones are we talking about here? Estrogen only? Estrogen plus progesterone? Estrogen plus progestin? Progesterone only? Testosterone? Thyroid hormones?

  • Christy Begley

    “Patients should be discouraged from taking them”. Hmmmm…. What about those women who would like to continue enjoying sex, but are concerned about vaginal atrophy? If this were a men’s issue, it wouldn’t even be being discussed, because of course men want to continue having sex. But women should be discouraged from taking bio-identical hormones due to the (not huge) increased risks of certain diseases…

  • Amanda

    Dear Dr.Greger, please please answer my question because Ive been wondering forever and my doctor is no help at all.
    I have had higher than normal androstenedione levels since I was 17 (only got tested then, so dont know earlier), I am now 26. I was vegetarian, then became vegan, even tried raw veganism but failed, so now am vegan half-raw half-cooked. I have had back acne since 14-15, hairgrowth on my body is increasing with every year… I have little bumps all over my face but you only see them in certain lighting.Ive been tested for PCOS but they saw nothing. So my question is: what else can this be :S
    I was low in vitamin D and B 12 but am supplementing this daily.
    I am in good shape, exercise, bmi 19.5, oh and female ofcourse. My testosteron is to the high side as well but not too high.

    Thx in Advance

    • http://www.DonForresterMD.com/ Don Forrester MD

      Hi Amanda, Congratulations on the diet sorry to read about your difficulties. Of course there are normal variants between patients and if you are following a good whole plant based diet with Vitamin B12 supplements you should be avoiding many of the dietary and chemical contaminants that contribute to acne and hair growth. In addition to the level of hormones in the body patients cells actually respond differently to the same hormone levels. I would suggest that you continue to be followed by a knowledgeable endocrinologist as there are other conditions other then PCOS that may cause your difficulties. A good dermatologist might have other suggestions both as to the underlying cause and to help treat the acne. Good luck and sorry I couldn’t be of more help.

      • Amanda

        Thx a lot for your reply :) I appreciate it

  • Amy

    What would be recommended, then, for young women who have to have their ovaries removed? I have a BRCA-1 mutation and have been vegan since finding out 2.5 years ago. I am 37 and recommended to get bilateral mastectomy and oophorectomy ASAP, or at least before age 40. This is a really hard thing to go through, and I’d like to know anyone’s advice on what would be the best way to remedy the hormone loss.

  • http://www.facebook.com/stillpointjoy Pamela Joy

    Obviously the study did not consider the danger of trying to function on less than 2 hours sleep every night for months/years! I woke up every 90 minutes for years until I discovered bioidentical hormones. A very low dose gives me 8 hours of rejuvenating sleep at night and I’m not giving them up until something else works. Believe me, I’ve tried every other natural insomnia remedy out there.

    • lea

      I have had the opposite happen to me. Been on Bioidenticals for 6 yrs and I still have to take a sleeping pill. But it does help with the hot flashes. Have my blood work done every so they say I am on the right dose but….no sleep without a pill which I don’t want to be on.

  • Jodashde

    Your advice, Dr. Greger, is almost always very understandable to me, but I do want to know what you recommend for women who have vaginal atrophy or other issues that bio-identical hormones can help? What is your opinion about a cream? Not a vaginal cream, but a topical cream that is smoothed onto a woman’s inner thighs or inner upper arms, so it bypasses the liver? I would think as a middle-aged man that this issue would affect you as well, so what works for your sexual partner?

  • http://www.facebook.com/profile.php?id=608590997 Lori Woods

    Combipatch- Bioidentical estradiol and synthetic progestrone – taken via a patch is fairly safe, especially for women who are still going through menopause, has been a miracle for me. Insomnia, anxiety, hot flashes, excessive bleeding, depression…all controlled from patch. I am a vegan who eats a very balanced diet of whole foods, gets her blood levels checked often, takes supplements, etc. But only the patch worked for me. I also have to stay away from soy, flax and most legumes as they mess with the balance of estrogen and progesterone and cause symptoms. (I get my protein now from veggies, whole-grains and some seeds and nuts, particularly almonds.

  • matt

    For those talking about dysmenorrhea I find chaste tree berry is great to help normalize the menstrual cycle via the HPO axis

  • Kim

    What about the Wiley Protocol? It is not only bio-identical but bio-mimetic.

  • Kay

    I had such bad symptoms when I weaned myself off bio-identicle hormones, that I started taking them again….and feel much better. Having a good, compounding pharmacy is important.

  • Tia Haenni

    Dr. Greger, please advise. I just had a bi-lateral hysterectomy with complete oophorectomy (sp) due to enlarged uterus, large fibroids and a septated ovarian cyst. I was not having any menopause symptoms prior, however I had stopped having periods since a D&C in 2011. I am having severe “hot flashes” with exacerbated asthma to the point of being almost non-functional. Prior to the hysterectomy I had no asthma attacks in 40 years. I’ve also had a pre- cancerous breast mass removed in 2007. That along with a family history of blood clots makes me uncomfortable with synthetic/equine estrogen HRT or ERT. I’ve heard that soy may be effective in regards to estrogen replacement. I’m also concerned about preventing Osteoporosis. Are fortified calcium and Vitamin D such as that added to plant milks safe? What do you suggest? Thank you so much in advance.

    • Thea

      Tia: I’m not a doctor and can’t comment on most of your questions. However, I thought you might appreciate a reference to a book about preventing osteoporosis.
      “Building Bone Vitality” by Amy Joy Lanou, Ph.D. and Michael Castleman.
      http://www.amazon.com/Building-Bone-Vitality-Revolutionary-Osteoporosis–Without/dp/0071600191/ref=sr_1_1_title_0_main?s=books&ie=UTF8&qid=1392152304&sr=1-1&keywords=building+bone+vitality

      Dr. Greger would take issue with some of the theories in the book, but I think the overall recommendations and bottom line for the book is valid and helpful.

      Good luck.

      • Tia Haenni

        Thanks! I’ve read several books, including Suzanne Somers “I’m too young for this”. I’m perusing BHRT as I think this is the healthiest option for both men and women when they experience “the change”. Unfortunately, you really have to dig deep and educate yourself, then insist on a better answer from your doctor! Mine first wanted to give me Premarin, which I refused (see the WHI study if 2002), then I was given the estrogen patch that “works for most people” who apparently are ok with the serious risks. I declined that ad well. I’m getting by with a natural estrogen cream until my BHRT is properly formulated. For that, you have to seek out a compounding pharmacy.

        • Thea

          Tia: Good for you for standing up for yourself and what you know would be bad decisions. I think you saved yourself some trouble down the line by doing your research. I don’t know anything about BHRT or issues around supplementing with estrogen, but like you, I do know that Premarin is a bad idea.

  • Rivka Freeman

    The way to not need prescription HRT or compounded bio-identical hormones adjusted to your personal physiological needs is to eat at least 2 tablespoons of ground flax seeds in something good and tasty every day for the rest of your life, and pumpkin seeds, avocados and olives and be as green vegetarian as you can possibly be. Don’t consume any oils except very small amounts of extra virgin olive oil and coconut oil for baking or sautéing, everyday oil competes with omega 3. Drink water as your primary beverage with unsweetened electrolye salts added. Take bathes with lots of Himalayan salt crystals, get alkaline. Don’t ever eat anything #GMO. Check me out on twitter.com/rivkafreeman where I try to teach nutrition therapy.

  • Natasha

    Thank you for these videos, they are so inspirational and eye opening….it is so great to discover all of this wonderful insight. I’ve also found this video helpful because I have recently considered trying bioidentical hormones because i am finding the ones I am on seem to be causing some depression.

    I feel curious what is the best treatment for premature ovarian failure ?

    I am 34 and I had menopause at 26 and I have only just been put on an estrogen patch a month ago after a hospital admission however, because I have had heart issues in the past i am really interested to discover the best treatment so that I can protect the health of my heart in the future.

    This site has been helping me in many ways in terms of changing my diet to a plant based one and taking responsibility to improve my health ,overcome a food addiction and turn many things around for the better…11 months ago…I had some paralysis in my left side and now i am walking around and living life again. It is amazing what good nutrition and self care can do. So I am immensely grateful for the information that is here. This site is so helpful , it gives us the freedom to make well informed decisions based on science and it is also great for motivation and inspiration to stay on track with these great nutritional principles.. This information save lives.,. Thank you. :-)