Bioidentical hormone replacement therapy or BHRT is the use of supplemental doses of steroid hormones that are identical in chemical structure to endogenous naturally produced human hormones.  BHRT is typically prescribed to relieve the symptoms caused by the peri-menopausal and post-menopausal state.  This differs from the conventional hormone replacement therapy which typically uses animal or synthetic hormones whose structure is foreign to the human body. 

The Women’s Health Initiative was a large randomized controlled trial studying the effects of the common synthetic estrogen/progestin combination Prempro (Premarin and Provera).  This study showed an increased risk of cancer, blood clots, stroke  and cardiovascular disease.  Because of this trial, most women were taken off of all estrogen and progestin hormones.  Bioidentical hormones are natural and not patentable by the pharmaceutical industry and because of this large trials have not been performed.  

Typically, BHRT is prepared as a topical cream or lipophilic gel that contains both estradiol and estriol   Estradiol is the primary estrogen that provides all the major benefits of symptomatic relief of the peri-menopausal and post-menopausal state.  Estriol is a very weak estrogen that is believed to be protective against breast cancer.  Topical estrogen avoids the first pass effect through the liver which markedly decreases the conversion of estradiol into the more cancerous causing form of estrogen, estrone.  This  also eliminates the risk of blood clots which is a major risk of oral estrogen therapy.   Progesterone is required in all patients that still have a uterus in order to decrease the risk of uterine cancer.  Oral bioidentical progesterone is typically better tolerated than synthetic progestins and eliminates the increased cardiovascular risk associated with the progestins.  BHRT must be individually tailored as women vary tremendously in their hormonal requirement and must be monitored to provide maximum safety.  There is no “one dose fits all” regimen with BHRT.  

We at Human Performance Longevity Center are dedicated to providing the most up to date and effective treatment for women who are suffering from peri-menopausal and post-menopausal symptoms.

Brian K Arcement, M.D. FSCAI
Interventional Vascular Cardiology
Board certified Internal Medicine
Cardiology, Interventional Cardiology
Diplomat American Board of Anti-Aging Medicine