Abstract
BackgroundIn recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women.MethodsWe analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process.ResultsAlthough women’s individual motivations varied, two overarching themes emerged: “push motivations” that drove women away from conventional HT and from alternative therapies, and “pull motivations” that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention.ConclusionsThis study finds that women draw upon a range of “push” and “pull” motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.
Highlights
In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, Food and Drug Administration (FDA) approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products
While many other participants expressed interest in CBHT, our analysis focuses on the experiences and rationales of the 21 women who had used it
Women’s individual motivations varied, several themes emerged across CBHT users that can broadly be categorized into two overarching categories: (1) “push motivations” that drove women away from conventional hormone therapy or from alternative therapies, and (2) “pull motivations” that attracted women to compounded hormone therapy, in particular
Summary
In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products. Since the discovery of sex hormones in the late nineteenth century, women’s relationship with hormone therapy (HT) for menopause has endured a series of paradigm shifts [1, 2] It has been framed as a panacea for menopausal symptoms and the diseases of aging [3,4,5,6,7,8], as well as a source of risk [9,10,11]. Since compounded bioidentical hormone therapy (CBHT) emerged and continues to be a popular alternative to manufactured, Food and Drug Administration (FDA)-approved HT [18, 19]—despite concerns voiced within conventional medicine [20,21,22] and the availability of new lower-dose and “bioidentical” products that carry FDA approval
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