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Bioidentical hormones

I am 56 and have had menopause since I was 51. However, I do not have any menopausal symptoms. Recently my doctor tested my saliva and told me that the levels of my female hormones were very low. He told me that I needed “natural hormones” to rejuvenate my youth. He gave me a “yam cream” which has to be specially processed by the pharmacist and is not available over the counter or by prescription. I feel uncomfortable and would like to have your opinion. Is it truly effective and safe?

I presume your doctor has prescribed what is known as customised “bioidentical hormones” or “compounded hormones”. These medications are made from plants such as soy or yam and are supposed to mimic hormones the body produces. They are made individually by the pharmacist and may contain only one or more hormones.

Many compounding pharmacies use the term “bioidentical hormones” to imply that these preparations are natural or the same as endogenous substances and, thus, are safe.

The phrase bioidentical hormone therapy has been recognized by the Food and Drug Administration (FDA) of America and the Endocrine Society (USA)as a marketing term and not one based on scientific evidence (Committee opinion, American College of Obstetricians and Gynaecologists 2012). These medications are often advertised as being a safer, more effective, natural, and an individualized alternative to conventional hormone therapy. But these claims remain unsupported by large-scale, well designed studies.

Dosage, absorption and safety information are usually not available for these medications. Because of lack of these data, variation in the absorption of the medications among individuals and the possibility of the presence of contaminants, there is no scientific evidence that these “compounded hormones” are safer and more effective than standard ones.

With regards to the saliva tests to monitor hormone levels, the general consensus is that these tests are of little use because the hormone levels in the saliva does not correlate well with response to treatment in postmenopausal women.

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