Bioidentical hormones: an evidence-based review for primary care providers.
Level 5 - mechanism / opinion, no new human data
Narrative review of literature from 1999 to 2009 without systematic review or meta-analytic pooling
What was done
The authors conducted a literature review of studies published between 1999 and 2009 via Medline and Ovid search engines to evaluate the safety and efficacy of bioidentical hormone replacement therapy for menopausal symptoms. A Google search of popular media was also conducted to contextualize patient perceptions.
What was found
No quantitative data, effect sizes, or confidence intervals are reported in the abstract. The authors report that randomized trial evidence supports the prescription of only estropipate, estradiol, and progesterone for menopausal symptom relief. 17β-Estradiol, estropipate, and oral progesterone are FDA-approved, with estradiol noted to have potential cardioprotective effects and fewer blood pressure adverse effects compared to conjugated equine estrogens. Estriol and dehydroepiandrosterone lack FDA approval, though estriol relieves menopausal symptoms and DHEA has mixed sexual dysfunction findings with small-scale studies indicating bone mineral density improvement. Compounded bioidentical hormones and salivary hormone testing lack standardization and should be avoided.
Why it matters
This review distinguishes FDA-approved bioidentical hormones with randomized trial evidence from unstandardized compounded bioidenticals and salivary testing for primary care management of menopausal symptoms.
Limits
The abstract reports no numerical results, sample sizes, or count of reviewed studies. The design is a narrative literature review rather than a formal systematic review or meta-analysis.
Cited by
- supports There is no FDA-approved drug product containing estriol in the United States.