Fake news flourishes everywhere, in politics and in health news. The latest in healthcare “fake” news is really based on misunderstandings, especially of bioidentical hormone therapy, otherwise called BHT. In the October issue of Contemporary OB/GYN magazine,[1] the author suggests two topics of fake news: 1) that implantation of ovaries can delay menopause, and 2) that BHT benefits are just a marketing scam.

In our practice, TrueMD Wellness, we do not deny the fact that women go through menopause naturally. This is normally around age 50, plus or minus a few years. It’s going to happen in every woman sooner or later. However, you can prevent some of the symptoms of menopause from affecting your quality of life by starting hormone therapy early and continuing for as long as you can.

Ovarian Implantation

There has been some research on implanting ovaries in women to continue to provide the women with ovarian function when their ovaries stop functioning. This surgery is really used for patients with infertility problems due to malfunction of their ovaries. The fake news part is that the authors of the article suggest that this procedure is being marketed as a method to delay menopause. However, it’s not the ovaries that we want necessarily, it’s the hormones they produce.

This procedure called ovarian transplant is rarely done for this reason and certainly not mainstream. Who would want to go through the expense of having ovaries re-implanted in their bodies and go through a lifetime with immunosuppression to keep those ovaries alive and active when you can very easily simply supplement your body with hormones in a natural fashion? This is done using hormone replacement therapy, including bioidentical hormone therapy.

Menopausal symptoms

Menopause is simply the time in a women’s life when her ovaries stop functioning and no longer produce hormones in adequate amounts. The result may cause a number of symptoms, including changes in mood, libido, clarity of the mind, anxiety, sleep disturbances, and low libido. Hot flashes and night sweats may also occur. Not every woman experience these for each has their own individual variations.

When present, hormone therapy may be prescribed to effectively relieve these symptoms, so the woman can live with a better quality of life and enjoy life better. There’s nothing wrong with this idea. In addition, hormone therapy, when started early, can reduce the risk of developing chronic medical problems, such as heart disease[2], Alzheimer’s disease[3] and osteoporosis[4]. The earlier you start embracing the benefits of hormone therapy, the more the reduction in the risk of developing these chronic medical conditions, as documented in multiple studies.

The article in the magazine, however, suggests that this is “fake news”. They suggest that the above benefits are “far from proven”. The reality is that they have been proven through extensive studies that have consistently confirmed the benefits. One of the problems with the confusion in the studies is that some of the studies include use of synthetic hormones, such as medroxyprogesterone. However, when one eliminates these “synthetic” hormones from the equation, there is no doubt about their effectiveness of preventing these chronic medical conditions when given correctly.

Confusion of BHT (Bioidentical Hormone Therapy)

Another topic of “fake news” is the topic of “Bioidentical Hormone therapy”. The article suggests that BHT is not “reality” and that there is lack of regulation and oversight for compounded pharmacies who manufacture these. My concern is that their criticism of BHT, which I believe is not founded well, may prevent many women from reaping the benefits of hormone therapy and may be a disservice to women.

All compounding pharmacies must undergo rigorous evaluation by not only the federal government, but also their state government and their own pharmaceutical organization. The idea that these pharmacies are not regulated adequately is not well founded. They compound BHT hormones, but this is because BHT hormone therapy does not have big pharma companies to back them.

Much of the confusion about BHT is simply a misunderstanding of the concept of BHT. BHT was formulated to decrease potential complications and side effects of traditional hormone therapy while giving women relief from symptoms caused by lack of hormones (e.g. menopausal symptoms) in the safest fashion possible.

The article mentions the WHI (Women’s Health Initiative)[5], which found an increased risk of developing breast cancer when the synthetic hormone medroxyprogesterone was added to estrogen. In that same study, the group taking only estrogen did not show an increased risk of breast cancer. This estrogen was a natural type of hormone, contains the BHT estradiol, and is not a synthetic. In fact, when extended for another 10 years, the follow-up study of this group had a decreased risk of breast cancer of around 24%.[6] Thus, it’s safer.

Unfortunately, confusion abounds in the medical community regarding this. However, there have never been any studies suggesting natural estradiol with or without natural progesterone increases one’s risk of breast cancer. This is not fake news but is reality. BHT emphasizes use of these natural hormones because they are safer.

In addition, BHT emphasizes use of the transdermal route, i.e. through the skin. The reason is that studies, including the WHI, showed the oral route increases the production clotting factors by the liver as the estrogen passes through the liver. This results in an increase in incidence of strokes, which is NOT what we want. However, when administered through the skin, there is no first-pass effect through the liver, no increase in clotting factors and no increase in strokes. A recent study confirmed this.[7] Thus, they’re safer, confirming the philosophy of BHT as being a safer method for administering hormone therapy.

Do women have to endure the “ravages of menopause”?

The article suggests that women need to endure the “ravages of menopause”, which is entirely false and is not “fake news”. By placing them on hormone therapy early, hormone therapy can treat the symptoms that “ravage” a woman; this then help give her have a better quality of life. This is a good thing. Why should a woman have to put up with symptoms of lack of hormones any more than she should put up with symptoms of depression? As long as the treatments are safe, why not treat?

Plus, some of the health ravages of age, including heart disease, Alzheimer’s disease and osteoporosis can also be prevented by hormone therapy when started early and continued, as mentioned above. The confusion here is that not all studies use the same types of hormones. But if you evaluate the studies and omit the ones using synthetics, the BHT methods without a doubt provide these benefits while are safer because they do not increase risk of breast cancer nor increase risk of stroke, as discussed above.

Conclusion

Although there is fake news about hormones, a thorough evaluation of the literature suggests that use of more biologically similar hormone therapy (BHT) is probably the safest option possible while providing all the benefits of hormone therapy. We believe BHT has been given a bad rap by many due to a misunderstanding in what it is and what it does. To improve a woman’s quality of life and her health, BHT is probably one of the best concepts for her over the long run.

References:

[1] https://www.contemporaryobgyn.net/obgyn-technology/fake-news-obgyn/page/0/1

[2] Hodis, HN, Mack WJ. Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis. J Steroid Biochem Mol Biol 2014; 142:68–75.

[3] Shao H, et al. Hormone therapy and Alzheimer disease dementia New findings from the Cache County Study. Neurology. 79(18) Oct 2012. OI: https://doi.org/10.1212/WNL.0b013e318271f823

[4] Torgerson DJ, Bell-Syer SEM. Hormone replacement therapy and prevention of vertebral fractures: a meta-analysis of randomized trials. BMC Musculoskel Disor 2001; 2:7.

[5] Rossouw JE, et al. 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. doi:10.1001/jama.288.3.321

[6] Anderson, et al. “Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomized placebo-controlled trial” The Lancet Oncology, Vol. 13, No. 5, p476–486, March 7, 2012

[7] Zhu, D, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient, data. The Lancet Public Health. Open AccessPublished: October 03, 2019DOI:https://doi.org/10.1016/S2468-2667(19)30155-0.