Bioidentical hormones for women with vasomotor symptoms

Abstract

BackgroundVarious hormone therapies (HT) are available to treat menopausal vasomotor symptoms. Bioidentical hormones are chemically identical to those produced by the human body, and several types are well-tested and available on prescription. Many women have opted for bioidentical hormone therapy (BHT) on the assumption that it is safer than other forms of HT. We evaluated the evidence. ObjectivesTo determine the effectiveness and safety of bioidentical hormones compared to placebo or non-bioidentical hormones for the relief of vasomotor symptoms. Search methodsIn July 2015 we searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), registers of ongoing trials and the reference lists of articles retrieved. Selection criteriaRandomised controlled trials (RCTs) comparing bioidentical hormone therapy (BHT) versus placebo or non-bioidentical hormones. Data collection and analysisWe used standard methodological procedures expected by the Cochrane Collaboration. Our primary outcome was vasomotor symptoms (hot flushes and night sweats). We evaluated the overall quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE). Main resultsWe included 23 RCTs (5779 participants). Most studies (20/23) included only women with moderate to severe hot flushes. All studies compared unopposed 17 beta-estradiol (beta-estradiol) versus placebo or conjugated equine estrogens (CEE). None of the studies reported night sweats as a separate outcome. BHT patch versus placebo1 Bioidentical hormones for women with vasomotor symptoms (Review)

Translational opportunities for broad‐spectrum natural phytochemicals and targeted agent combinations in breast cancer

“…revealed that estrone (E1) has low affinity for ERβ and ethinyl estradiol (EE) has higher affinity for ERα . In the same study, estriol (E3) was found not to antagonize the activity of estradiol (E2) as claimed by many proponents of b(HT) . Also, both bioidentical estradiol (bE2) and estriol (bE3) used in [b(HT)] were found to be full estrogen agonists .…”

“…The specific effects of estrogen and its metabolites on ER isoforms need to be carefully considered in developing combinatorial interventions with phytochemicals. Bioidentical hormone therapy [b(HT)] is being considered as an alternative to conventional hormone therapy (HT) . In a recent study, Perkins et al .…”

“…Bioidentical hormone therapy [b(HT)] is being considered as an alternative to conventional hormone therapy (HT). 188 In a recent study, Perkins et al revealed that estrone (E1) has low affinity for ERb and ethinyl estradiol (EE) has higher affinity for ERa. 189 In the same study, estriol (E3) was found not to antagonize the activity of estradiol (E2) as claimed by many proponents of b(HT).…”

“…189 In the same study, estriol (E3) was found not to antagonize the activity of estradiol (E2) as claimed by many proponents of b(HT). 188,189 Also, both bioidentical estradiol (bE2) and estriol (bE3) used in [b(HT)] were found to be full estrogen agonists. 189 The grape flavonoid resveratrol directly binds to ERa with a more stable antagonistic conformation compared to low energy agonistic conformation.…”

Managing menopausal symptoms after cancer: an evidence‐based approach for primary care

“…Custom‐compounded or bioidentical ovarian hormones appear superior to placebo in relieving moderate‐to‐severe hot flushes; however, their effectiveness relative to conventional MHT, the long term safety and the safety in patients with cancer have not been established 51 . Moreover, these drugs are not regulated by the Australian Therapeutic Goods Administration and their use cannot be recommended, particularly among cancer survivors.…”