Bioidentical Hormone Therapy

NAMS 2022–2023 position statements conclude hormone therapy decreases all morbidity and all mortality in appropriately selected women. Oral estrogen delivery is avoided entirely in favor of transdermal patch or intravaginal application to bypass first-pass liver metabolism. The Women's Health Initiative studied synthetic hormones, not bioidentical hormones, so its findings do not transfer directly to bioidentical hormone therapy. Upon re-evaluation of WHI data, the initial finding of increased breast cancer risk was not upheld; the revised analysis showed no increased risk above individual baseline. The breast cancer signal in the WHI was limited to the synthetic progestin arm, not the bioidentical progesterone arm. Because bioidentical hormones share an identical chemical structure with endogenous hormones, the body's enzymatic machinery processes them through established metabolic pathways. Women using synthetic progestin in oral contraceptives for 15 or more years have a 39% increased risk of breast cancer. Women more than 10 years into menopause without prior hormone therapy face uncertain cardioprotective benefit from initiating HRT, though cognitive support may still apply.…