This is the final part of our 3 part series.
You can’t take hormones forever…can you?
In Parts 1 and 2 of our Bioidentical Hormone series, we looked at the risks and benefits of bioidentical hormones, and at the compounding pharmacies that produce much of them. For Part 3, our final piece, we’re talking about something we know many of you are curious about: how long can you safely take hormones?
It’s key to draw a distinction here between bioidentical hormones and more conventional HRT. What’s the difference, and how long have they been around? Let’s take a look at HRT first, courtesy a 2015 study in Social Science & Medicine:
“Hormone replacement therapy (HRT) in the United States enjoyed a place of privilege and popularity throughout the 1980s and 90s, reaching its peak in 1999 with more than 85 million prescriptions written for women in that year alone (Chlebowski et al. 2009). But this would soon change. In 2002, the Women’s Health Initiative, the first study of its kind to test the safety and efficacy of HRT, released results on the increased risk of breast cancer and stroke among menopausal women taking combined hormone replacement therapy. Rates of use fell dramatically as a result (Hersh, Stefanick, & Stafford. 2004).”
Note: when we talk about the most commonly prescribed HRT, we are usually talking about the drugs Prempro or Premarin, which are produced using estrogen isolated from the urine of pregnant mares.
So turning our attention now to bioidentical hormones, how are they made, and how emergent of a treatment are they? From our originally cited study, picking up in time in the early 2000s:
“In the meantime, an “alternative” therapy was gaining traction in the media and in “anti-aging” medicine and other areas of women’s health: bioidentical hormone replacement therapy (BHRT). Interest in BHRT increased as women sought alternatives to cHRT [editor’s note: “combined Hormone Replacement Therapy”] to control menopausal symptoms (Fugh-Berman & Bythrow 2007). Anti-aging clinicians and others, including some gynecologists, naturopaths and other “alternative health” providers, began to market and prescribe BHRT as a distinctly different treatment than traditional cHRT. In its strictest definition, “bioidentical hormones” are generally derived from plant extracts but are chemically modified in a laboratory to be structurally (molecularly) indistinguishable from human endogenous hormones and in the U.S. available only by prescription. BHRT most commonly refers primarily to sex hormones–estrogens (i.e., a combination of 17 beta-estradiol, estrone, and estriol), progesterone, testosterone, and perhaps dehydroepiandrosterone (DHEA)(Cirigliano 2007).”
So while HRT has been around for many decades (truly, well before the 80s), bioidentical hormones are a newer form of treatment, which means they have less of a track record, and less research is available on their long-term effects.
That being said, let’s jump into what we DO know about treatment time for HRT and bioidentical hormones, so that you can make informed decisions about how long you can reasonably expect to take them – should you choose to take them at all.
HOW LONG CAN I TAKE HRT?
In a very recent study that received a ton of press, news looked pretty good for users of HRT. A Los Angeles Times article covering the story had this headline: “Up to 7 years of hormone therapy is safe for postmenopausal women, new data show,” and inside the piece, it went on to explain:
“In findings published Tuesday in the journal JAMA, women who were randomly assigned to take some form of hormone-replacement therapy for a median of six to seven years were no more, nor less, likely to die of any cause over the study’s duration than were women who had been assigned to receive a placebo treatment.
The women who got synthetic estrogen and progesterone hormones to replace their naturally declining levels were no more (nor less) likely than those who got a placebo to die of stroke or heart failure. And they were neither more nor less likely to die of cardiovascular disease or cancer.”
It’s incredibly reassuring for the scores of women who have taken HRT over the years, and have been concerned about the 2002 WHI findings correlating HRT and cancer.
The North American Menopause Society also released a statement last year sharing their stance on HRT, as our understandings get more sophisticated around HRT combinations, timing, and duration. Three key points from their statement:
- For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio appears favorable for treatment of bothersome hot flashes and for those at elevated risk of bone loss or fracture. Longer duration may be more favorable for estrogen-alone therapy than for estrogen-progestogen therapy, based on the Women’s Health Initiative randomized, controlled trials.
- For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.
- Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
This is the latest round of research regarding HRT and duration, but something to keep in mind is that research into this topic is on-going. No, you cannot take HRT forever, but at this point in time, some HRT, for a finite length, appears to be safe.
HOW LONG CAN I TAKE BIOIDENTICAL HORMONES?
“But wait,” might be saying. “Seven years doesn’t seem that long! Bioidentical hormones are made from plants…can I take them longer?”
Great question. We defer to Harvard Women’s Health Watch, who had this to share:
“Is there a valid role for bioidenticals? We took the question to two gynecologists who have followed the field for decades and treated thousands of midlife women — Harvard Women’s Health Watch advisory board member Dr. Martha K. Richardson, and Dr. JoAnn Pinkerton, who led a workshop on bioidentical hormones at the North American Menopause Society’s annual meeting in September 2011. Both usually prescribe FDA-approved bioidentical hormones, but only for symptom relief and only for the shortest time that works (often three to five years but sometimes longer).”
There is a lot less research available for bioidentical hormones and safety of duration, and as a result: don’t try to stretch it out longer than recommended, until we know more about the long-term effects. Dr. Sara Gottfried mentions a few drugs by name that have a longer, proven track record. But at this point in time, the bottom line is: they are not a permanent solution to hormone imbalance.
CAN I TREAT MY HORMONE BALANCE WITH ANYTHING?
Of course! And, HRT or bioidentical hormones are incredibly personal decisions – after weighing the risks and benefits against your stage in life, health, and needs, you may indeed decide it’s a helpful course of action for you.
But, knowing you can’t take them forever, there are natural ways to address hormone imbalance that do not carry risk. Diet and lifestyle are huge components, as are nutraceuticals. Asensia® is a natural supplement designed to raise progesterone levels to what’s normal for a younger woman, by helping the body make more of it on its own. As a result, the entire “hormone cascade” benefits, making many of the problems associated with perimenopause and menopause – usually those associated with out-of-whack estrogen levels – ease off and in many cases, go away completely.