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Menopause – BioIdentical Hormones Risk

Jennifer R. Berman, MD Jennifer R. Berman, MD February 17, 2021


"Hormone replacement therapy, bio-identical hormones, or synthetic hormones is safe and effective. But as I said earlier, there are risk factors. So you have to weigh the risks as well as the benefits, as well as your own personal risk factors. There is no head-to-head study comparing bio-identical hormones to synthetic hormones, one being safer than the other. I personally prefer and only prescribe bio-identical hormones because I feel that the side effects are less, patients tolerate them better. I also feel that the side effects are less when it's delivered transdermally through the skin and the form of a patch, as opposed to orally. When patients take oral estrogen, and there are bio-identical combination estrogen and progesterone pills for hormone replacement therapy, but oral estrogen increases SHBG, which is a protein in the blood, steroid hormone binding globulin, that binds to testosterone that makes us also less bio-available and can impact libido or sexual desire making your low libido worse.

This is the same protein that's affected by hormonal contraceptives. So women, many women, on hormonal contraceptives can experience low libido due to elevated SHBG in the blood. So hormonal contraceptives, the birth control pill orally and hormone replacement therapy orally can impact SHBD and cause low libido or exacerbate symptoms of low libido. It's also, if taken orally, metabolized in the liver, which has other risk factors. So I prefer to deliver estrogen through the skin. I prefer bio-identical hormones because I feel in my own clinical experience, personal experience and the research that I've read and choose to believe there are less side effects with bio-identical hormones than conventional synthetic hormones. That's not to say one is better than the other, or one is more risky than the other. It's just my personal opinion."

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