What is the truth about bioidentical hormones?

Bioidentical hormones[1] have gained popularity and notoriety with many celebrity endorsements, but often the scientific basis for their recommendation is lacking. Bioidentical is meant to be interpreted as "biologically identical" or "the same as the body has." Some pharmaceutically produced vaginal cream products, such as estrace cream or Vagifem tablets (Novo Nordisk Pharmaceuticals), are bioidentical because they contain estradiol, which is similar to the estrogen naturally produced in your body. Suzanne Somers's recent book The Sexy Years identified bioidentical hormones as safer alternatives to conventional pharamaceutical products that can decrease the effects of aging and promote energy, sexuality, and youthful appearance among other claims. Mass marketing and media have at times, unfortunately, duped women into believing that compounded estrogen products such as Bi-est (80% estriol + 20% estradiol) and Tri-est (80% estriol + 10% estradiol + 10% estrone) are safer hormones and have no health risks or adverse problems, such as breast cancer risks.

Most compounded products are not subjected to rigorous clinical testing for consistency, purity, safety, or efficacy. If you use bioidentical compounded products, it is important for you to know that they are subject to the same risks as conventional pharmaceutical hormonal therapy. A detailed review of more than 40 years of medical research on estriol, however, found no evidence that it is medically safer or breast protective. In addition, there is no scientific evidence to support the use of salivary gland hormone testing in women; there is no evidence that these values have any biological meaningfulness. There is no relationship between salivary levels and serum or blood levels, and there is large variability in salivary hormones, which are dependent on diet, time of the day, specific hormone tested, and other variables.

Both the North American Menopause Society ( menopause.org) and the American College of Obstetricians and Gynecologists (acog.org) have come out with strongly worded positions statements against recommended compounded hormonal products. The Food and Drug Administration[2] also has stated that estriol is a misbranded drug because of unsubstantiated claims of efficacy, superiority, and bioidentity. Of interest, estriol is presently classed as an unapproved new drug under Section 505 of the Federal Food, Drug, and Cosmetic Act. It is important to ask questions about bioidentical hormones and their consistency and purity.

There are risks involved in all hormonal products and compounded products are not immune to serious health concerns.

How do fibroid tumors, tubal ligation, and endometriosis affect sexual function?

Fibroids[3] are benign (not cancerous) tumors that originate from smooth muscle cells of the uterine muscle. They can be within the uterine wall, on a stalk (pedunculated), protrude into the abdominal cavity, or be on the inside and affect the uterine cavity where a baby grows. Studies on fibroids, or uterine myomas, and sexual function are often conflicting; some indicate that women with fibroids have more sexual complaints, more painful intercourse, and lowered sexual interest, whereas other studies do not support these findings.

You may experience many symptoms from fibroids, including abnormal uterine bleeding, pressure, chronic pelvic pain, and gastrointestinal symptoms. All of these symptoms can influence your sexual interest. About 20-40% of all women have fibroids and are experiencing some sexual complaints. It is best to get a comprehensive evaluation by a gynecologist or sexual medicine specialist. If your pain can be linked to your fibroids, sometimes surgical intervention can be helpful, but it depends on where the fibroids are located. You may need a pelvic ultrasound so that you and your healthcare provider can get a clearer picture of where the fibroids are located. Fibroids can be removed with hysteroscopic techniques (where a small tube is inserted into the uterus through which the provider can operate using small instruments and thereby remove the fibroids), with laproscopic techniques that are minimally invasive, or by making an abdominal incision.

Where the fibroid is located can also possibly affect sexual pain. If the fibroid is large and affecting other pelvic or genital structures, it can be uncomfortable during penetration. If the fibroid is small, it is likely that it will not affect sexual function. If you have fibroids and think they are contributing to your disinterest in sexuality or are playing a role in sexual pain, seek medical attention and get a transvaginal ultrasound to properly assess position, size, and number of fibroids. A variety of treatment options is available including less aggressive medical treatment such as medications like nonsteroidal anti-inflammatories and gonadotropin-releasing hormone (GnRH) agonists, as well as surgical interventions.

Tubal ligation, or permanent irreversible sterilization through surgical technique, has not been extensively studied when it comes to sexual function. It is unlikely to change sexual interest or pleasure, and the majority of women who undergo this procedure experience positive sexual effects as a result of the freedom from fear of unwanted pregnancy. Most scientific studies on tubal ligation conducted in the United States and Europe report no effects on sexual intercourse.

It is estimated that up to 10 million women suffer from endometriosis, a condition that occurs when the normal lining of the uterus has migrated to other areas of the pelvic region. It is associated with severe chronic pain and also painful intercourse on deep penetration. Other complications can include abnormal bleeding and severe pain. Although the cause of endometriosis is not specifically known, there are multiple treatment options including medications (anti-inflammatory medications such as ibuprofen [Advil or Motrin] or oral contraceptive pills). Stronger medications such as narcotics can influence the sexual response cycle. Surgical ablation or removal of the endometriosis may be helpful. Some women do eventually need a hysterectomy, or removal of the uterus, ovaries, and Fallopian tubes. Endometriosis has been linked to sexual pain and painful intercourse, so if you are experiencing sexual pain, it may be a good idea to be assessed for this gynecological syndrome.

Perhaps the most controversial topic of debate that has been discussed in the field of sexual medicine is that of oral contraceptive and its influence on female sexual function.

  • [1] Hormonal preparations usually of animal or plant origin that have a similar structure to naturally occurring human hormones.
  • [2] Federal agency that protects public health by regulating the safety and efficacy of food, medical products, biotechnology, and cosmetics. No drug or device can be sold on the market unless it has undergone vigorous scientific testing and passed the strict regulations of the FDA.
  • [3] A benign tumor arising from smooth muscle cells of the uterus.
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