Bio-Identical Hormone Replacement Therapy

Bioidentical hormones are defined as “chemical substances that are identical in molecular structure to human hormones.” The term “natural” is not to be confused with the term “bioidentical”. “Natural” most often refers to plant or herbal-based products. Although bioidentical hormones are produced from plants (usually wild yams and soy), these plants are pharmaceutically processed to make bioidentical hormones which are indistinguishable from the hormones produced in the body.

There are many possible dosage forms for bioidentical hormones. Most commonly, bioidentical hormones are applied topically (to the skin) in a cream or gel form. Hormones can also be applied vaginally in cream or suppository form. Oral bioidentical hormones can also be prepared in capsule form by compounding pharmacies in personalized doses. There are also some bioidentical hormone preparations which are commercially available in oral, topical (gel, patch), and vaginal (cream, tablet) forms.

Synthetic hormones are those which are not identical to those produced by the human body. Most commonly Premarin (conjugated estrogen derived from pregnant horse urine) and Provera (synthetic progestin) come to mind when thinking of synthetic hormones used in hormone replacement therapy. Premarin and Provera (the combination product of these two medications called Prempro ) were used in the Women’s Health Initiative (WHI) study in 2002 which demonstrated increased risk of heart attack, stroke, blood clots, and breast cancer with synthetic estrogen and progestin.

Cortisol is the main hormone that is released by the body (specifically by the adrenal glands above the kidneys) in response to stress. Cortisol imbalance (i.e. high or low cortisol levels) over time can lead to symptoms such as fatigue, morning sluggishness, muscle aches and pains, foggy thinking, memory lapses, irritability, weight gain, sleep disturbances, loss of scalp hair, insulin resistance, and other. As you may notice, some of these symptoms can also be related to sex hormone imbalance. That is why an extensive knowledge in these areas is imperative in order to restore hormone balance and saliva testing can help to figure out the puzzle. Stress-reduction techniques and optimizing diet and supplementation are key to restoring adrenal health.

In 2002, the WHI study was stopped early due to observations that women treated with synthetic hormones (estrogen and progestin) had an increased risk of heart attack, stroke, blood clots, and breast cancer. Not surprisingly, after these results were released, the number of women using hormone replacement therapy decreased significantly. Some doctors are presently still reluctant to prescribe hormone therapy (of any kind) because of this study. However, in some cases, bioidentical hormone therapy may be appropriate for some women suffering from significant hormone imbalance symptoms (common symptoms listed below), which can have a considerable effect one’s quality of life on a day-to-day basis.

Let’s start by pointing out that not all hormones are safe for every woman. The benefits vs. risks of hormone therapy should always be discussed in detail with one’s doctor to determine if hormone therapy is appropriate. Reviewing personal and family medical history is of the utmost importance when determining the safety of hormone therapy in any patient. For example, estrogen therapy is not recommended for those with a history of breast cancer.

A 10 year observational safety study done in France showed no increase in the risk of stroke, heart attack, or breast cancer in women who used bioidentical estrogen (estradiol) combined with progesterone (De Lignieres, B., et al. (2002). Combined Hormone Replacement Therapy and risk of Breast Cancer in French Cohort Study of 3175 women. Climacteric, 5:332-340). There was another study published which supports the safety and efficacy of bioidentical hormones concluding that, “Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal derived counterparts” (Holtorf, K. (2009). The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgraduate Medicine, 121(1):1-12). To view click on the link at the bottom of this page.

There are three types of bioidentical estrogens: estradiol (E2), estriol (E3), and estrone (E1). An example of a nonbioidentical estrogen medication is Premarin, which are tablets derived from conjugated equine urine. Progesterone is bioidentical (this is not to be confused with progestins, which are synthetic). Testosterone, DHEA, and pregenolone are also bioidentical hormones.

Yes, a prescription from a licensed physician is necessary for all bioidentical hormones including estrogen, progesterone, and testosterone.

If you and your doctor decide that it is right for you, hormone therapy can improve many symptoms commonly associated with menopause and general hormone imbalance. Of course not all women experience the same symptoms when it comes to hormone imbalance (and not to the same extent for that matter). However, there are some symptoms that are commonly associated with hormone imbalance. Menopausal and perimenopausal symptoms can include hot flashes, night sweats, foggy thinking, memory lapses, fatigue, sleep disturbances, irritability, mood swings, depression, anxiety, decreased libido, weight gain, and vaginal dryness. Bioidentical hormones can also be helpful for premenopausal women with irregular menstrual cycles, premenstrual syndrome, polycystic ovarian syndrome, uterine fibroids, and other hormonal conditions. Other than improving quality of life, bioidentical hormone therapy may also have health protective benefits such as preventing bone loss, maintaining muscle mass, and preserving brain function.

Note: It is important to note that many of these symptoms can also be related to other conditions (such as thyroid and other endocrine disorders just to name a few), so it is essential to work closely with your physician to rule out other causes.

As with any medication, the benefits vs. risks should always be carefully considered with your doctor. To minimize the possibility of side effects related to bioidentical hormone therapy, it is ideal to use saliva testing to determine your hormone levels prior to starting treatment to ensure that appropriate (personalized) doses are used. As mentioned under “What Evidence is there that Bioidentical Hormones are Safe?”, there are studies that show that bioidentical hormones may be safer and associated with significantly fewer side effects than synthetic hormones. Of course, possible side effects are also dependent on which type(s) of hormones are used and awareness of them along with regular monitoring will assist in achieving the goal of optimal hormone balance.

The initial one-on-one consultation lasts approximately one hour. This time is spent reviewing the patient questionnaire (including treatment goals, medical history, and symptoms inventory). The fee also includes a personalized hormone report including possible bioidentical hormone therapy recommendation along with lifestyle and supplement suggestions, if applicable. If bioidentical hormone therapy is recommended, this cost also includes a report to your physician to request a prescription. Unfortunately, this service is not currently covered by Manitoba Health or most third party (private) insurance plans. Costs are available upon request.

There are different types of saliva test kits available. Costs vary, but the most common saliva tests used begin at $220 + tax. The type of saliva test which would be most beneficial to a specific individual is usually determined during the one hour personalized BHRT consultation. The most common saliva test used test for estrogen (estradiol), progesterone, testosterone, DHEA-S, and cortisol. Saliva testing is not covered by Manitoba Health or most third party (private) insurance plans.

Since every person is unique, the benefits of bioidentical hormone therapy may be noticed at different points during the initiation period. This will usually also depend upon important patient lifestyle factors including stress level, diet, sleep patterns, exercise habits, concomitant health conditions, which types/dose of hormones are being used, etc. In general, however, some people begin to notice results within a few weeks after starting bioidentical hormone therapy, while most notice benefits between about three and six months.

This answer will depend upon the individual using hormone therapy. In general, it is ideal to use hormones at the lowest possible dose for you and for the shortest possible duration. One key factor determining length of treatment will be symptom management. If you stop using your hormone therapy and symptoms are still present, therapy may need to be continued. Ultimately, the goal is to balance hormones and once this is achieved, it may be possible for some people to gradually decrease their dose of hormones and eventually discontinue therapy altogether. Again, this is person-specific.

Please contact us by email at tachebhrt@mts.net or call us at (204) 233-3469.