Q: There are some scary warning labels on estradiol products and Prometrium. Are these risks for real? Are compounded hormones less risky?

A: To answer simply, all hormone replacement therapy has theoretical risks — as does any form of drug therapy. Items made by compounding pharmacies don’t come with FDA warnings, but the potential risks still apply. Unfortunately, most research hasn’t made the distinction between bioidentical and synthetic hormones, so all FDA-approved estrogen and hormone replacement products come with the same scary warnings seen on the synthetic HRT products like Prempro — and because most studies are undertaken without consideration to different delivery methods, the warnings don’t reflect our most current understanding of these distinctions, showing a big difference in risk profiles between bioidentical and synthetic hormones.

To reduce the potential risks we suggest the use of lower-potency, natural hormones for the shortest time possible, and recommend forms of delivery through the skin (transdermally), beneath the tongue (sublingually), and transvaginally. This permits more of the hormone molecules to enter the blood stream and reach the cells that need them without passing first through the digestive system and liver. Currently, it seems estrogen delivered through the skin does not cause an increased risk of cardiovascular events, and using any form of HRT for less than five years does not markedly increase the risk of breast cancer.

But this is only what we can extract from the current literature. Ongoing research on HRT continues to reveal the risks and benefits of HRT. The theoretical risks are why many women really want to avoid HRT or get off HRT if possible, which is one reason we developed our Hormonal Health Programs.