For women with significant perimenopause symptoms, like hot flashes, vaginal dryness and night sweats, hormone replacement therapy (HRT) can provide welcome relief. While HRT is proven to be effective in treating symptoms, it can be risky for certain women, such as those with a history of breast cancer.
Enter “bioidentical” and “all-natural” hormones, which manufacturers claim are healthier, safer options with the same hormones produced by the body. While these medications sound promising, are they too good to be true?
Probably. According to the FDA, the hormones classified as bioidentical and natural are neither safer nor proven to be more effective than traditional hormone replacement therapy.
Hormone replacement therapy options
Allison Ward, M.D., an obstetrician and gynecologist, says every woman should be well-informed about her options so she can make the best choice for her health and body. Because hormone replacement therapy is only recommended at the lowest dose for the shortest amount of time possible, many women hold out until they can no longer handle their symptoms.
“For most women, the dealbreaker is when the side effects of menopause begin disrupting their sleep,” Dr. Ward says. “You cannot overestimate the importance of sleep, especially when you are already experiencing moodiness and anxiety. [Lack of sleep] can be a recipe for disaster for many women.”
When consulting patients, Dr. Ward stresses the following points:
- “Bioidentical” does not necessarily mean the product contains compounded hormones.
- “Natural” does not mean the medication wasn’t chemically made or is safer than traditional therapies.
- Dosage is important. Dr. Ward recommends the lowest dose needed for the shortest amount of time.
Is hormone replacement therapy safe?
Dr. Ward says the decision to take hormone replacement drugs really comes down to a personal decision.
“Every woman has a different threshold for pain and discomfort, so it really is something every woman has to decide on her own. I can help inform and guide you, but at the end of the day, it comes down to how bothersome or tolerable the side effects are for you.”
Alternatives to hormone replacement therapy
There is a lot less data about the safety of alternative treatment options, and there is not a great deal of regulation on the consistency of these products. However, there are two Dr. Ward often recommends to her patients:
- Soy-based products, which have estrogen-like properties.
- Herbal supplements, such as black cohosh for hot flashes.
Non-estrogen alternatives for hormone replacement therapy
There are some women who cannot take estrogen, such as those with a history of breast cancer. Fortunately, there are some alternatives for these women as well. Although they may not be as effective as estrogen, they do provide some relief. They include:
- Antidepressants are recommended as a first-line treatment option for hot flashes in women who cannot take estrogen. Paroxetine is the only non-hormonal therapy that is FDA-approved for hot flashes in the United States. It has been used for many years for depression but can be taken at a lower dose for hot flashes.
- Gabapentin, which is primarily used to treat seizures, also relieves hot flashes in some women.
“Bottom line, hormone replacement continues to be a complicated subject. I can’t assure you that it is a safe option, but you have to analyze your quality of life,” Dr. Ward says. “Keep the conversation going with your doctor throughout your menopausal years, because new treatment options are constantly evolving, and you never know which one will work best for you.”
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