Bioidentical hormone therapy: Nova Scotia pharmacists’ knowledge and beliefs

  • Anne M. Whelan
  • Jean-Pierre Thebeau
  • Tannis M. Jurgens
  • Eileen Husrt


Objectives: To investigate Nova Scotia (NS) pharmacists’ knowledge and beliefs regarding the use of bioidentical hormones (BHs) for the management of menopause related symptoms.

Methods: Using Dillman’s tailored design methodology, an invitation to complete the web-based questionnaire was emailed to pharmacists in NS as part of the Dalhousie College of Pharmacy Continuing Pharmacy Education Department’s (CPE) weekly email update. Data was analyzed using descriptive statistics.

Results: Of approximately 1300 e-mails sent, 113 pharmacists completed the questionnaire (response rate 8.7%). The majority of respondents (94%) knew that BHs were not free from adverse drug reactions. More than 50% were aware that conjugated equine estrogens and medroxyprogesterone acetate were not examples of BHs. For seven of eleven knowledge questions, 33-45% indicated that they did not know the answer. When asked about their beliefs regarding BHs, many believed that BHs were similar in efficacy (49%) or more effective (21%) than conventional hormone therapy (CHT) for vasomotor symptoms. Most respondents also believed that both BHs and CHT had similar safety profiles. Additionally, responding pharmacists indicated that more education would be helpful, especially in the area of safety and efficacy of BHTs compared to CHT.

Conclusion: NS pharmacists knew BHs were not free of adverse effects, however knowledge was lacking in other areas. This may reflect the level of coverage of this topic in pharmacy school curriculums and in the pharmacy literature. Results indicate a need for additional education of NS pharmacists with respect to BHs, which could be accomplished through modification of undergraduate pharmacy programs and supplementary CPE.


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1. Maclennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004;(4):CD002978.

2. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17(2):242-255.

3. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006;(4):CD001500.

4. Wells G, Tugwell P, Shea B, Guyatt G, Peterson J, Zytaruk N, Robinson V, Henry D, O'Connell D, Cranney A; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev. 2002;23(4):529-539.

5. Reid RL, Blake J, Abramson B, Khan A, Senikas V, Fortier M. Menopause and Osteoporosis Update 2009. [SOGC Clinical Practice Guideline No. 222] J Obstet Gynaecol Can. 2009;31(suppl 1):S1-S64.

6. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333.

7. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCroix AZ, Lane D, Langer RD, Lasser N, Lewis CE, Manson J, Margolis K, Ockene J, O'Sullivan MJ, Phillips L, Prentice RL, Ritenbaugh C, Robbins J, Rossouw JE, Sarto G, Stefanick ML, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S; Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004;291(14):1701-1712.

8. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280(7):605-613.

9. Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M, Hsia J, Hulley S, Herd A, Khan S, Newby LK, Waters D, Vittinghoff E, Wenger N; HERS Research Group. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. 2002;288(1):49-57.

10. Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA. 2004;291(1):47-53.

11. Hing E, Brett KM. Changes in U.S. prescribing patterns of menopausal hormone therapy, 2001-2003. Obstet Gynecol. 2006;108(1):33-40.

12. Ettinger B, Grady D, Tosteson AN, Pressman A, Macer JL. Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy. Obstet Gynecol. 2003;102(6):1225-1232.

13. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 2004;11(1):11-33.

14. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin no. 28: Clinical Management Guidelines for Obstetrician-Gynecologists. Use of botanicals for management of menopausal symptoms. Obstet Gynecol. 2001;97(6 suppl):1-11.

15. Adams C, Cannell S. Women's beliefs about "natural" hormones and natural hormone replacement therapy. Menopause. 2001;8(6):433-440.

16. Kaufert P, Boggs PP, Ettinger B, Woods NF, Utian WH. Women and menopause: beliefs, attitudes, and behaviors. The North American Menopause Society 1997 Menopause Survey. Menopause. 1998;5(4):197-202.

17. Somers S. Ageless: The Naked Truth About Bioidentical Hormones. New York: Crown Publishing Group; 2006.

18. Boothby LA, Doering PL. Bioidentical hormone therapy: a panacea that lacks supportive evidence. Curr Opin Obstet Gynecol. 2008;20(4):400-407.

19. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA. 1995;273(3):199-208.

20. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?. Postgrad Med. 2009;121(1):73-85.

21. Girouard LG, Holm RC. The role of natural progesterone in natural hormone replacement. Int J Pharmaceut Compounding. 2001;5(3):218.

22. Paoletti JE. The physiological role and use of estriol . Int J Pharmaceut Compounding. 2009;13(4):269.

23. Boothby LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause 2004;11(3):356-367.

24. Sood R, Shuster L, Smith R, Vincent A, Jatoi A. Counseling postmenopausal women about bioidentical hormones: ten discussion points for practicing physicians. J Am Board Fam Med. 2011;24(2):202-210.

25. Chervenak J. Bioidentical hormones for maturing women. Maturitas. 2009;64(2):86-89.

26. Cirigliano M. Bioidentical hormone therapy: a review of the evidence. J Womens Health (Larchmt). 2007;16(5):600-631.

27. Curcio JJ, Wollner DA, Schmidt JW, Kim LS. Is bio-identical hormone replacement therapy safer than traditional hormone replacement therapy?: a critical appraisal of cardiovascular risks in menopausal women. Treat Endocrinol. 2006;5(6):367-374.

28. Derzko CM. Bioidentical hormone therapy at menopause. Endocrinology Rounds. 2010;9(6):1.

29. Fugh-Berman A, Bythrow J. Bioidentical hormones for menopausal hormone therapy: variation on a theme. J Gen Intern Med. 2007;22(7):1030-1034.

30. Sites CK. Bioidentical hormones for menopausal therapy. Womens Health (Lond) 2008;4(2):163-171.

31. Bio-Identicals: Sorting myths from facts. Available at: Accessed 08/15/ 2012.

32. Whelan AM, Jurgens TM, Trinacty M. Defining bioidentical hormones for menopause-related symptoms. Pharm Pract. 2011;9(1):16-22.

33. Bhavnani BR, Stanczyk FZ. Misconception and concerns about bioidentical hormones used for custom-compounded hormone therapy. J Clin Endocrinol Metab. 2012;97(3):756-759.

34. Trinacty M, Whelan AM, Dr., Jurgens TM, Dr. Definition of bioidentical hormones. Can Pharm J. 2010;143(sp2):S17.

35. Iftikhar S, Shuster LT, Johnson RE, Jenkins SM, Wahner-Roedler DL. Use of bioidentical compounded hormones for menopausal concerns: cross-sectional survey in an academic menopause center. J Womens Health (Larchmt). 2011;20(4):559-565.

36. Speroff L, Fritz M. The clinical gynecologic endocrinology and infertility. 8th Edition ed. 2001 Market Street Philadelphia, PA 19103 USA: Lippincott Williams & Wilkins; 2010.

37. Dimaggio JL, Reed-Kane D. Patient satisfaction with pharmacist intervention and consultation in HRT. Int J Pharmaceut Compounding. 2003;7(4):258.

38. Yuksel N, Siyam T, Steyn A, Prochnau T. Pharmacists' beliefs about bioidentical hormone therapy. Can Pharm J. 2010;143(5):e3.

39. Pharmacists in Canada, 2010- National and Jurisdictional Highlights and Profiles. Ottawa, Ont.: Canadian Institute for Health Information; 2011.

40. Sheehan K. E-mail Survey Response Rates: A Review . J Comput-Mediat Commun. 2001;6(2).

41. Jorgenson D, Lamb D, MacKinnon NJ. Practice change challenges and priorities: A national survey of practising pharmacists. Can Pharm J 2011; /;144(3):125-131.

42. Marra F, Kaczorowski JA, Marra C. Assessing pharmacists' attitudes regarding delivery of the pandemic influenza vaccine in British Columbia. Can Pharm J. 2010;143(6):278-283.

43. McCullough KB, Formea CM, Berg KD, Burzynski JA, Cunningham JL, Ou NN, Rudis MI, Stollings JL, Nicholson WT. Assessment of the pharmacogenomics educational needs of pharmacists. Am J Pharm Educ. 2011;75(3):51.

44. Law AV, Okamoto MP, Brock K. Ready, willing, and able to provide MTM services?: A survey of community pharmacists in the USA. Res Social Adm Pharm. 2009;5(4):376-381.

45. Pollard SR, Clark JS. Survey of health-system pharmacy leadership pathways. Am J Health Syst Pharm. 2009;66(10):947-952.

46. Lounsbery JL, Green CG, Bennett MS, Pedersen CA. Evaluation of pharmacists' barriers to the implementation of medication therapy management services. J Am Pharm Assoc. 2009;49(1):51-58.

47. Ulbrich TR, Dula CA, Green CG, Porter K, Bennett MS. Factors influencing community pharmacists' enrollment in a state prescription monitoring program. J Am Pharm Assoc. 2010;50(5):588-594.

48. Bellanger RA, Shank TC. Continuing professional development in Texas: survey of pharmacists' knowledge and attitudes: 2008. J Am Pharm Assoc. 2010;50(3):368-374.

49. Goodwin SD, Kane-Gill SL, Ng TM, Melroy JT, Hess MM, Tallian K, Trujillo TC, Vermeulen LC. Rewards and advancements for clinical pharmacists. Pharmacotherapy. 2010;30(1):114.

50. Conaway E. Bioidentical hormones: an evidence-based review for primary care providers. J Am Osteopath Assoc. 2011;;111(3):153-164.

51. Benster B, Carey A, Wadsworth F, Vashisht A, Domoney C, Studd J. A double-blind placebo-controlled study to evaluate the effect of progestelle progesterone cream on postmenopausal women. Menopause Int. 2009;15(2):63-69.

52. Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol. 1999;94(2):225-228.

53. Schüssler P, Kluge M, Yassouridis A, Dresler M, Held K, Zihl J, Steiger A. Progesterone reduces wakefulness in sleep EEG and has no effects on cognition in healthy postmenopausal women. Psychoneuroendocrinology. 2008;33(8):1124-1131.

54. Wren BG, Champion SM, Willetts K, Manga RZ, Eden JA. Transdermal progesterone and its effect on vasomotor symptoms, blood lipid levels, bone metabolic markers, moods, and quality of life for postmenopausal women. Menopause. 2003;10(1):13-18.

55. Kells J, Dollbaum CM. Saliva tests, Part 1: Clinical use, elements of testing, and guidelines for posttreatment interpretation. Int J Pharmaceut Compounding. 2009;13(4):280.

56. Kells J, Dollbaum CM. Saliva tests, Part 2: Salivary hormones, hormone replacement pharmacokinetics, and the importance of timely testing. Int J Pharmaceut Compounding. 2009;13(5):392.

57. Stephenson K. The salivary hormone profile in the clinical evaluation of women. Int J Pharmaceut Compounding. 2004;8(6):427.
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