What are ERT, HRT and Bioidentical Hormones?

A few of the most widely used and talked about medical treatments for menopausal symptoms are Hormone Replacement Therapy (HRT), Estrogen Replacement Therapy (ERT) and Bioidentical Hormone Replacement Therapy (BHRT). Although these treatments vary, their common purpose is to aid the body in regaining hormonal balance due to the decreased hormone production that occurs during menopause. Below are how they differ:

Estrogen Replacement Therapy (ERT):

Estrogen Replacement Therapy refers to the use of estrogen alone to treat menopausal symptoms. ERT is the standard hormone replacement therapy for women who have had a hysterectomy.

The most commonly prescribed ERT in the United States includes mixtures of several forms of estrogen. Estrogen can be taken in several ways-pills or tablets, vaginal creams, vaginal ring inserts, implants or shots and adhesive patches.

Risks associated with ERT include stroke, breast cancer, endometrial cancer, gallstones and ovarian cancer. Lesser side effects include headache, nausea, vaginal discharge, weight gain and spotting of the skin, particularly on the face.

Hormone Replacement Therapy (HRT):

Hormone Replacement Therapy is used to treat menopausal symptoms that occur from fluctuating levels of natural hormones in the body, particularly estrogen.

HRT actually evolved from ERT. Based on research that found estrogen alone increased the risk of endometrial cancer, progestin - a natural or synthetic form of progesterone - was added to keep the endometrium from thickening. This significantly reduces the risk of endometrial cancer, a cancer of the lining of the uterus.

HRT is not appropriate for all women. If you decide to take HRT you should have a number of initial tests which may include:

• Breast examination
• Internal pelvic examination
• Blood pressure
• Thyroid function
• Body mass index (BMI) measurement
• Blood Pressure test, Cervical smear and breast screening every year regularly during HRT treatment

HRT is derived from synthetic-or man-made-hormones. Although one can choose from a variety of HRT brands, the drugs are mass-produced as universal dosages, versus bioidentical hormones, which are customized for each patient. Recently, the National Institutes of Health (NIH) Consensus Panel from the State-of-the-Science conference released a statement confirming that hormone replacement therapy poses serious health risks. Some health risks that have been associated with HRT include breast cancer, heart attack and stroke.

Bioidentical Hormone Replacement Therapy (BHRT):

BHRT stands for Bioidentical Hormone Replacement Therapy (also known as natural hormone replacement). The hormones are taken from yams and/or soy. Once they are extracted from their natural source, the hormones are made to be identical to the moleculer structure of the ones produced by your body.

HRT differs from BHRT in the type of hormones used. Any type of hormone may be prescribed in HRT. Most commonly, doctors use hormones extracted from the urine of pregnant horses or hormones assembled in a laboratory. Neither is identical to the molecular structure of a woman's hormones. Insufficient relief or unpleasant side effects can occur due to ineffective hormone ratios or mismatched chemical structures.

For many years, physicians have been prescribing Bioidentical Hormone Replacement Therapy as an alternative to a synthetic hormone. An advantage of this therapy is that it can be customized-for strength and dosage-in order to achieve hormonal balance through the lowest dose possible.

BHRT treatment involves the use of several different hormones: estrone, estradiol and estriol and, and where appropriate, progesterone and testosterone.

The first step to BHRT is to have a complete hormone analysis. In addition to the test results, factors such as height, weight and body composition are used in order to create a personalized formula. The effects are monitored and the formula can be adjusted, as needed, until the individual has achieved relief.

Availability of BHRT services varies from state-to-state. Contact your health insurance or health care provider for more information. Further studies need to be conducted to determine what risks, if any, are associated with bioidentical hormone therapy.

Most of the medical community views BHRT in the same category as ERT and HRT when it comes to the level of risk. There is also the view that lack of standardization and FDA supervision in BHRT is a negative aspect associated with this menopausal hormone treatment option.