Bioidentical Hormone Replacement Therapy - 101 Statistics about BHRT in 2021


Interested in learning more about  Bioidentical Hormone Replacement Therapy? We know finding facts and figures about BHRT can be time-consuming and frustrating, so we put together this list of the top 101 facts, notes, and statistics so you can easily reference them and refer back to them any time in the future.  This space is constantly changing, so if you see a fact that is not up-to-date, feel free to let us know. And if you know a stat, fact or figure that we should add, let us know that too!

  1. Data from clinical outcomes and physiological studies demonstrate that bioidentical hormones are effective and produce fewer side effects than their non-bioidentical counterparts, including a lower risk of breast cancer and cardiovascular disease (Fournier et al, 2005; Fournier et al, 2007; Holtorf, 2009).

    Most experts believe the risks of BHRT and HRT have similarities.

  2. Hormone balancing using bioidentical hormone replacement therapy (BHRT) is a form of treatment that uses hormones with an identical molecular structure to the hormones naturally produced by the body.

    BHRT is highly recommended in treating men and women when their hormone levels

  3. Estriol has also been shown to have a protective effect with regard to risk of breast cancer. The protective effect of estriol relies on its high affinity to bind estrogen receptor (ER)-beta (which inhibits breast cell growth), while other estrogens, including CEE, have a preference for ER-alpha (which promotes breast cell growth) (Paech et al, 1997; Paruthiyil et al, 2004; Bao et al, 2006).

    Estriol is known as the weak form of estrogen.

  4. Synthetic progestins used in non-BHRT are known to down-regulate ER-beta, which may explain why a combination of synthetic progestins with estrogens increases the risk for breast cancer (Bakken et al, 2004).

    Compounded bioidentical hormones are often believed as much safer and more effective than synthetic hormones.

  5. In regard to cardiovascular disease, the Women's Health Initiative (WHI) demonstrated that a combined hormone therapy using the non-bioidentical form of estrogen CEE with a synthetic progestin, MPA, resulted in an increased risk of heart attack and stroke (Rossouw et al, 2002; Chlebowski et al, 2003; Anderson and Limacher, 2004).

    FDA and most doctors will warn us that those claims haven’t been proven in some studies, and that these hormones may even be probably dangerous depending on each case.

  6. Compounded BHRT improves quality of life by 52% and reduces  menopause-associated symptoms in women

    One of its benefits is to increase the levels of the hormones that have dropped and then improve gradually to severe menopause symptoms.

  7. All 21 menopause-associated symptoms assessed were significantly reduced after compounded BHRT treatment, including difficulty in sleeping, feeling tired or lacking in energy, loss of interest in sex, sweating at night, irritability, feeling tense or nervous, and hot flushes (between 5.8 and 1.9-fold reduction).

    There’s also a number of evidence that it can help improve skin by making it more soft, supple and reduces wrinkles.

  8. Salivary testing—Salivary testing is highly recommended by most online compounding pharmacy resources that provide information about BHT.

    Baseline testing is recommended. It is suggested to repeat testing for 2 to 3 months, and then annual testing to assess efficacy.

  9. Estradiol (E2)—17β-Estradiol is by far the most studied bioidentical estrogen.

    This has been approved by the FDA for the management of many menopausal symptoms, vulvar or vaginal atrophy, hypoestrogenism, and prostate cancer.

  10. Estriol (E3)—The efficacy of estriol in relieving menopausal symptoms as well as HRT does, has been established in small-scale clinical trials.

    In a 1978 study by Tzingounis et al, 36 out of 52 postmenopausal women established estriol's positive effect on broader menopausal symptoms.

  11. Progesterone (P4)—Two branded forms of bioidentical progesterone are approved by the FDA.

    There is still limited evidence that progesterone may have some neuroprotective properties.

  12. Testosterone—The use of testosterone in women has been controversial.

    In 814 women over a 52-week span, the largest efficacy study to date tested the use of testosterone to treat hypoactive sexual desire disorder.

  13. Dehydroepiandrosterone (DHEA)—Dehydroepiandrosterone has been available in health food stores and in supplement aisles of drug and grocery stores for decades but is now gaining more popularity as a bioidentical hormone.

    Researchers are still conducting studies to prove some of its benefits.

  14. cBHRT products are not recommended by the BMS; they are not evidence based for effectiveness and safety and because rBHRT options are available.

    These cBHRT products have not been clinically tested for efficacy and protection against placebo or traditional HRT in randomized clinical trials.

  15. There is insufficient evidence to justify multiple serum and saliva hormone tests often claimed to precisely individualise cBHRT.

    Via a series of complex serum and saliva tests, some HCPs who prescribe cBHRT claim to be able to determine the specific requirements of each individual woman.

  16. Claims for the benefits of cBHRT have been largely extrapolated from studies of conventional rBHRT.

    It has been indicated by menopause specialists that to separate controlled hormone therapy from the compounded varieties, rBHRT should be referred to as 'body identical'.

  17. rBHRT studies have demonstrated some advantages over other types of HRT, particularly those with androgenic progestogens.

    Scientific evidence for the possible benefits, relative to other forms of traditional HRT, of controlled bioidentical hormone replacement therapy (rBHRT).

  18. Further data from larger studies on major cardiovascular and breast endpoints are required to confirm the potential benefits of rBHRT.

    The exact duplicates of human hormones produced in a traditional manner by the pharmaceutical industry and approved by regulators such as the MHRA in the UK are Supervised Bioidentical Hormone Replacement Therapy.

  19. Hormone therapy is the most effective treatment for menopausal symptoms such as hot flashes and vaginal dryness.

    If women experience vaginal dryness or intercourse pain, low doses of vaginal estrogen are the recommended treatment.

  20. Hot flashes generally require a higher dose of estrogen therapy that will have an effect on the entire body.

    The recommended period of use for this combined procedure is typically five years or less, although the length of time may be individualized for each woman.

  21. Women who have had their uterus removed can take estrogen alone.

    Owing to the apparent greater protection of estrogen alone, the amount of time women can safely use estrogen therapy can be more versatile.

  22. Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings.

    While with any form of hormone therapy, the chances of blood clots and strokes increase, the risk is uncommon in the 50 to 59 age group.

  23. An increased risk in breast cancer is seen with 5 or more years of continuous estrogen/progestogen therapy, possibly earlier.

    After hormone therapy is halted, the risk declines. The use of estrogen alone in the Women's Health Initiative trial for an average of 7 years did not raise the risk of breast cancer.

  24. Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms.

    In the decision to use hormone therapy, your personal reason for your decision is important.

  25. The two main sex hormones — estrogen and testosterone — have wide-ranging effects in the body.

    These hormones are released primarily by the ovaries (estrogen) and testes (testosterone) and affect not only your sexual function, but also, for example, your bones, brain, and blood vessels.

  26. Testosterone therapy is approved only for men who have testosterone deficiency caused by a disorder of the testicles, pituitary gland, or brain.

    This can cause symptoms such as reduced beard and body hair and muscle mass loss, as well as lack of interest in sex, low energy levels, and depressed mood, known as hypogonadism.

  27. BHRT may be an option to help people who have symptoms associated with hormone levels that are low or otherwise unbalanced.

    If you plan to undergo BHRT, use the lowest dose that is effective for the shortest possible time.

  28. Bioidentical hormones are defined as man-made hormones that are very similar to the hormones produced by the human body.

    These are then used as therapy for men and women who have low or out of control hormones of their own.

  29. Hormones are special chemicals made by parts of the body called glands.

    Almost all functions in the body are regulated by hormones.

  30. Common hormones that are matched are estrogen, progesterone and testosterone.

    A drug manufacturer pre-made several prescription formulations of bioidentical hormones. Other types are custom-made based on a doctor's order by a pharmacist.

  31. Customized bioidentical hormones are often advertised as being a safer, more effective, natural, and an individualized alternative to conventional hormone therapy.

    These arguments, however, remain debunked by any well planned, large-scale studies.

  32. There are many ways to get bioidentical hormones. These include pills, patches, creams, gels, shots and implanted pellets.

    Your doctor will determine which procedure will serve you best. Before you find one that works well for you, you might try more than one way.

  33. The bioidentical hormones that have been approved by the FDA have been tested for safety.

    They have passed the very strict standards of the FDA and have been shown to be safe for use by individuals.

  34. The term "bioidentical" means the hormones in the product are chemically identical to those your body produces.

    In fact, there may be no difference between the hormones in bioidentical medications and those in traditional hormone therapy.

  35. Traditional hormone therapies don't necessarily exclude natural hormones.

    For instance, certain FDA-approved products are derived from plants, such as Estrace, Alora, others containing estrogens, and Prometrium, a natural progesterone.

  36. The human steroid hormones are divided into the following 5 major classes: estrogens, progestogens, androgens, mineralocorticoids, and glucocorticoids.

    Estrogens and progestogens are the most important steroid hormones used for treating menopausal symptoms.

  37. The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.”

    This broad description does not discuss the products' manufacturing, source, or distribution methods and can therefore include custom-compounded products that are not FDA-approved as well as FDA-approved formulations.

  38. Numerous FDA-approved hormone preparations are available for the treatment of menopausal symptoms.

    This include those that meet the bioidentical concept and those that are obviously not bioidentical.

  39. Currently, FDA-approved products containing bioidentical estrogen and progesterone are available.

    In pills, patches, sprays, creams, gels, and vaginal tablets, bioidentical estrogen derived from plant sources (17β-estradiol) is accessible.

  40. The term progestogen refers to both progesterone and synthetic compounds that have progestogenic activity similar to that of progesterone.

    In non-pregnant women, the human ovaries and adrenal glands are responsible for progesterone development.

  41. Compounded medications require a written prescription from a licensed physician.

    Prescriptions completed in a compounding pharmacy are formulated, combined and packaged in accordance with the prescriber's specifications.

  42. Do regular exercise – regular physical activity can reduce hot flushes and improve sleep.

    If you feel nervous, irritable or depressed, it is also a good way of improving your mood. Exercises for weight-bearing will help keep your bones healthy.

  43. Have a healthy diet.

    A good diet will help guarantee that you don't add on weight and that your bones are healthy.

  44.  Stay cool at night.

    If you experience hot flashes and evening sweats, wear loose clothing and sleep in a comfortable, well-ventilated bed.

  45. Cut down on caffeine, alcohol and spicy food.

    They have all been known to trigger hot flashes.

  46. Try to reduce your stress levels to improve mood swings, make sure you get plenty of rest, as well as getting regular exercise.

    You could be helped to relax by exercises such as yoga and tai chi.

  47. Give up smoking if you smoke.

    Giving up will help minimize the risk of hot flushes and serious health problems such as heart disease, stroke, and cancer that may grow.

  48. Try vaginal lubricant or moisturiser if you experience vaginal dryness.

    There are many different kinds available for purchase from shops and pharmacies.

  49. Tibolone (brand name Livial) is a prescription medicine that is similar to taking combined HRT (oestrogen and progestogen).

    It's taken as a tablet once a day.

  50. Side effects of tibolone can include tummy (abdominal) pain, pelvic pain, breast tenderness, itching and vaginal discharge.

    The effects of tibolone are equivalent to those of HRT, which include an increased risk of stroke and breast cancer.

  51. There are 2 types of antidepressants – selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) – which may help with hot flushes caused by the menopause.

    They have not undergone clinical trials to assess, however many doctors agree they are likely to help, and your doctor will discuss with you the potential benefits and risks.

  52. Side effects of SSRIs and SNRIs can include feeling agitated, shaky or anxious, feeling sick, dizziness and a reduced sex drive.

    Most side effects will usually improve over time, but if they do not, you should see a GP.

  53. Clonidine is a prescription medicine that can help reduce hot flushes and night sweats in some menopausal women.

    It's taken as tablets 2 or 3 times a day.

  54. Clonidine can also cause some unpleasant side effects, including dry mouth, drowsiness, depression and constipation.

    The effects of clonidine can take 2 to 4 weeks to be apparent. If your symptoms do not change or you are having problematic side effects, talk to a GP.

  55. Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones.

    Practitioners assert that these hormones are a "natural" and safer alternative to traditional HRT medications.

  56. Several products are sold in health shops for treating menopausal symptoms, including herbal remedies such as evening primrose oil, black cohosh, angelica, ginseng and St John's wort.

    There is evidence to indicate that some of these remedies can help reduce hot flushes, including black cohosh and St John's wort, however scientific evidence does not support many complementary therapies.

  57. Although estrogen replacement had been linked to an increased risk of cardiovascular disease and cancers, a landmark new study demonstrates no rise in risk for women using topical estrogen for relief of genitourinary syndrome.

    The nearly 20-year follow-up analysis of 53,000 nurses, released in December 2018, found that low-dose vaginal estrogen does not increase risk despite its "black box" warning.

  58. Women typically begin to produce less progesterone in their 30s, then estrogen, then finally testosterone. In men, testicular function starts to decline in their 40s and testosterone production begins to diminish.

    It’s reality that hormones decline with aging.

  59. Hormone replacement therapy — while not a panacea — can do a lot to help people feel better and ward off some of the diseases and problems of old age.

    Though there are benefits of hormone replacement, there’s also some risk as well.

  60. The condition, known today as genitourinary syndrome (GSM), continues to progress as women grower older, especially after age 65.

    These symptoms can be treated successfully with topical estrogen.

  61. Topical vaginal estrogen treatment can produce great improvement in just eight to 12 weeks.

    It can be applied in different ways.

  62. Women who are not candidates for vaginal estrogens — those who’ve had breast cancer or a recent stroke — may consider non-estrogen lubricants such as Vitamin E suppositories or prasterone cream.

    Of course, these women need to consult with their doctors about the right therapy.

  63. About 40 percent of women will develop GSM after menopause.

    There are two categories of symptoms; genital and urinary tract.

  64. Advice on how to cope with the normal aches and pains of aging and how to remain energetic is plentiful.

    But those aches, pains and exhaustion may also signify a serious problem.

  65. Pain or a feeling of pressure in the chest should be evaluated immediately because it may signal heart problems.

    The first signs of men who have been diagnosed with heart disease are often identified as pain on the left side or crushing pain, as if an elephant were sitting on his chest. Women typically experience more subtle signs, however.

  66. We all feel exhausted occasionally, especially after a sleepless night or two.

    Profound fatigue, however, may suggest heart failure or a thyroid function problem that should be checked out.

  67. Head pain could be an indication that your blood pressure is not well controlled or it may be a sign of something more ominous, such as a brain tumor.

    It's time to see a physician when people who don't have a history of severe headaches.

  68. Head pain could be an indication that your blood pressure is not well controlled or it may be a sign of something more ominous, such as a brain tumor. Migraines, which can occur due to menopausal hormone changes in women, or stress-related headaches may indicate a need for lifestyle modification to reduce stress and relax. Some headaches may also suggest a need for an eye exam or a dental checkup.

    A visit to a physician is recommended for an accurate diagnosis.

  69. If you begin to notice numbness or tingling pain in your hands or feet, this could be a signal of nerve damage, possibly from diabetes, neuropathy or an indication of a pinched nerve. It may also be an indication of thyroid dysfunction.

  70. One of the most common complaints with aging is osteoarthritis. It typically affects the hands, knees or hips.

    Instead of sudden intense pain, the onset of osteoarthritis is gradual and usually perceived as a dull, achy pain.

  71. Menopause by definition is when a woman has not had a period for 12 months. On the other hand, perimenopause is when physiological changes occur that begin the transition to menopause (i.e., symptoms associated with menopause).

    For many women, the time leading up to menopause may be a stressful period of life.

  72. Remember that this is a natural part of the aging process; menopause isn’t a disease to be “cured.” It’s important not to get caught up in comparisons.

    Take note that every woman’s experience is different.

  73. Exercise has numerous benefits. Not only does it improve your mood, enhance your memory, boost your libido and support your bone strength, it also can help you sleep, provided you don’t exercise too close to bedtime.

    Try to get outside so that you can get some vitamin D from the sun naturally.

  74. If you don’t have good sleep, it’s almost impossible to treat anything else or have the energy to make helpful lifestyle changes. Over-the-counter medications or melatonin are not habit-forming and can be helpful.

    As these can be addictive, be careful with prescription sleep aids; address the risks with your doctor.

  75. To support bone health, make sure you are getting enough calcium and vitamin D even before you begin perimenopause.

    After our 30s, our bone density naturally decreases.

  76. For women experiencing vaginal dryness or pain during sex, over-the-counter water-based lubricants can help. They may also help reduce the incidence of UTIs.

    Prescription vaginal estrogen creams can be beneficial for extreme cases.

  77. Women suffering from intense hot flashes and night sweats are often surprised that selective serotonin reuptake inhibitors (SSRI) antidepressants may help. In addition to easing the physical symptoms, they also may improve the mental symptoms.

    Other off-label medications that can relieve symptoms include a medication for high blood pressure and a drug for neuropathy.

  78. Besides doing their obvious duty of preventing pregnancy when used correctly, the hormones in birth control pills help even out irregular periods and may balance mood swings, too.

    Have a birth control plan in effect, even though you do not use birth control drugs, since it is always possible to get pregnant during perimenopause.

  79. Hormone replacement therapy (HRT), replacing the declining estrogen and/or progesterone, is usually a last resort because studies have shown that HRT can increase a woman’s risk of breast cancer, heart attack, blood clots and stroke.

    Make sure you explore with your doctor the dangers and benefits of HRT.

  80. The study convincingly showed that hormones shouldn’t be taken long term for disease prevention.

    However, it did not directly address their short-term use to manage hot flashes and other symptoms of menopause.

  81. The risk of breast cancer, heart disease and other conditions varied depending on how old the woman was when she started the therapy and whether she took progesterone along with the estrogen.

    To avoid the endometrial lining from building up and eventually developing cancer, people with an intact uterus are also recommended to take progesterone.

  82. The WHI has found that women in the study who took estrogen and progesterone in combination had an increased risk of coronary heart disease, stroke, deep vein thrombosis and breast cancer, but women who took estrogen alone actually had reduced risks of coronary heart disease and breast cancer.

    There was a decreased risk of colorectal cancer, fractures, diabetes, and all-cause mortality for all women who took hormones.

  83. NAMS, the American Society for Reproductive Medicine, and the Endocrine Society all take the position that hormone therapy is appropriate for relief of hot flashes and vaginal dryness for most healthy women who are recently menopausal.

    Menopausal women's hormones are no longer referred to as "hormone replacement therapy," since the intention is not to substitute or permanently use what the ovary has previously created, but to treat menopausal symptoms, which can be crippling and destructive.

  84. Women can now choose pills, skin patches, vaginal delivery products and others. Vaginal estrogen is effective for treating vaginal dryness that interferes with sex.

    There are more choices for hormone therapies today than when the WHI study started.

  85. The word “bioidentical” refers to hormones that are similar to what the body naturally produces vs. ones derived from animal urine or produced synthetically.

    The Internet is full of researchers advocating "bioidentical" custom-compounded hormones.

  86. Testosterone is the most powerful androgen, a group of steroid hormones whose name is derived from the Greek words for "man-maker."

    As androgens are responsible for the large muscles, strong bones, deep voice, and pattern of hair growth that define the gender.

  87. Testosterone contributes to energy (and aggressiveness).

    It is essential for the sex drive, and plays a role in normal erections and sexual performance.

  88. As men age, things change. Bone calcium declines, muscle mass decreases, and body fat increases. Red blood cell counts decline.

    The average person becomes less sexually active and less energetic.

  89. Putting declining testosterone levels and diminishing male capacities together, it's easy to see why testosterone therapy is so appealing.

    Remember, however, that most men remain in the normal range throughout life despite steadily dropping hormone levels.

  90. The Testosterone in Older Men with Mobility Limitations (TOM) trial was designed to evaluate the efficacy and safety of testosterone therapy in men who seemed to need the hormone most.

    All participants were aged 65 years or older, had low or low levels of normal testosterone, and had limited ability to walk or climb stairs, suggesting muscle weakness.

  91. Testosterone replacement therapy is approved for men with testosterone deficiency, or hypogonadism.

    Men with hypogonadism can undergo replacement therapy with testosterone. Patients who have had prostate or breast cancer, unexplained elevated levels of PSA, prostate nodules or extreme BPH, increased amounts of red blood cells or abnormally viscous ('thick') blood, untreated obstructive sleep apnea, or severe heart failure are exceptions.

  92. Menopausal hormone therapy should not be used to prevent heart disease.

    Probably, the risk of a first heart attack, as well as breast cancer, is actually increased by estrogen plus progestin.

  93. Women with heart disease should not use menopausal hormone therapy to prevent the risk of further heart disease.

  94. The risk of blood clots is increased by such use. In the first year of treatment, it also raises the risk of heart attack.
  95. Ways to prevent heart disease and stroke include lifestyle changes and such drugs as cholesterol-lowering statins and blood pressure medications.

    Changes in lifestyles include not smoking, keeping a healthy weight, being physically active, and diabetes management.

  96. Another key lifestyle change is to follow a healthy eating plan that has a variety of foods.

    That includes - grains, especially whole grains, and dark green leafy vegetables, deeply colored fruits, and dry beans and peas.

  97. The postmenopausal years are a time when the risk for various conditions rises.

    Be sure to protect your health by having certain tests needed or recommended by your doctor.

  98. Your risk for heart disease, osteoporosis, breast cancer, and colorectal cancer may change over time. So remember to regularly review your health status with your doctor or other health care provider.

    It's also necessary to keep in mind that all of your questions can not be answered by your doctor or other health care provider.

  99. One in three American women dies of heart disease. Heart disease kills more American women than any other cause.

    It may also contribute to disabilities and reduce one's quality of life. And, the danger of heart disease is not taken seriously by many women.

  100. Menopause is a time when you need to get very serious about heart disease because that’s when your risk starts to rise.

    Risk factors are behaviors or habits that make it more likely for a person to develop an illness.

  101. The WHI observational study is also examining other forms of hormone therapy, including other estrogens, progestins, and SERMs.

    In menopausal hormone therapy trials, the WHI will continue to track women until 2010.


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