What are the risks and benefits of using bioidentical estrogen birth control pills?

Bioidentical Estrogen Birth Control Pills: Risks and Benefits

Bioidentical estrogen birth control pills are not FDA-approved for contraception, and conventional combined hormonal contraceptives with synthetic hormones remain the recommended option for birth control due to their established safety and efficacy profiles. 1, 2

Understanding Bioidentical Hormones

Bioidentical hormones are derivatives of plant extracts chemically modified to be structurally similar to human endogenous hormones. Despite marketing claims, the FDA considers "bioidentical hormone replacement therapy" a marketing term rather than a formally defined drug classification 1. Key points:

• No bioidentical hormone therapy has FDA approval for contraceptive use
• Safety and effectiveness of bioidentical hormones for contraception have not been evaluated through FDA's drug approval process
• No randomized trials have studied bioidentical hormones for contraception or prevention of chronic conditions 1

Risks of Hormonal Contraceptives

All estrogen-containing contraceptives, whether bioidentical or synthetic, carry similar risks:

Cardiovascular Risks

• Combined oral contraceptives increase risk of venous thromboembolism 3-4 fold (up to 4 per 10,000 woman-years) 1
• Baseline incidence of venous thromboembolism in adolescents is up to 1 per 10,000 woman-years 1
• Current combined oral contraceptive use is associated with increased risk of:
  • Myocardial infarction (RR 1.7,95% CI 1.5-1.9) 1
  • Ischemic stroke (RR 1.6,95% CI 1.3-1.9) 1

Risk Factors That Increase Concern

• Smoking significantly increases thromboembolism risk 3
• Obesity increases myocardial infarction risk (OR 0.59 to 5.1) 1
• Hypertension dramatically increases risk (OR 3.1 to 14.5 for myocardial infarction) 1
• Dyslipidemia increases myocardial infarction risk (OR 25,95% CI 6-109) 1
• Women with migraines using estrogen-containing contraceptives have increased ischemic stroke risk (OR 2.08 to 16.9) 1

Cancer Risks

• Estrogen use may stimulate breast cell proliferation 4
• If breast cancer is present, estrogen can increase its growth rate 4
• Estrogen-progestin therapy increases breast cancer risk 2

Benefits of Hormonal Contraceptives

Contraceptive Benefits

• Combined oral contraceptives have a perfect-use failure rate of 0.3% (typical use: 9%) 1

Non-Contraceptive Benefits

• Decreased menstrual cramping and blood loss
• Improvement in acne
• Protection against endometrial and ovarian cancers 3
• Beneficial for conditions like:
  • Anemia
  • Severe dysmenorrhea
  • Endometriosis
  • Abnormal uterine bleeding
  • Bleeding disorders 1

Comparing Bioidentical vs. Synthetic Hormones

While proponents claim bioidentical hormones are safer, scientific evidence is limited:

• Lack of well-controlled studies examining:

  • Route of administration
  • Pharmacokinetics
  • Safety
  • Rationale for mixtures and ratios of bioidentical estrogens 5

• Some physiological data suggest potential differences:

  • Progesterone may have different cardiovascular effects than synthetic progestins 6
  • Estriol may have different physiological effects than estradiol or conjugated equine estrogens 6

However, these theoretical benefits have not been confirmed in randomized controlled trials for contraceptive use.

Practical Considerations

For women seeking hormonal contraception:

1. FDA-approved combined hormonal contraceptives remain the standard of care
2. Progestin-only pills are an option for women who cannot use estrogen-containing methods 7
3. Consider non-hormonal methods for women with contraindications to hormonal methods
4. Women over 35, especially smokers, should carefully weigh risks and benefits of any estrogen-containing contraceptive 3

Common Pitfalls to Avoid

• Do not assume "natural" or "bioidentical" means safer - these terms lack scientific validation for contraceptive use
• Avoid relying on saliva tests or blood sera levels to customize hormone dosing, as this contradicts evidence-based guidelines 5
• Do not use bioidentical hormones for contraception due to lack of efficacy data
• Remember that pregnancy carries higher thromboembolism risk (10-20 per 10,000 woman-years) than hormonal contraceptives 1

In conclusion, while bioidentical hormones may have theoretical advantages, there is insufficient evidence to recommend them over conventional hormonal contraceptives for birth control purposes. Women should consult with healthcare providers to select the most appropriate contraceptive method based on their individual health profile and needs.