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Bioidentical Hormone Replacement Therapy

What are bioidentical hormones?

Bio-identical hormones are hormones that are derived from natural sources such as yams or soy.  The chemical structures of these natural compounds are identical to the structure of hormones produced by the human body. This differs from traditional synthetic hormones mass produced by pharmaceutical companies where the chemical structure of the hormone is not exact to the hormone produced by the woman’s ovaries. Structural differences of synthetic hormones likely explain some of the negative side effects reported by women who use traditional hormone therapy. Women who are struggling with hormone imbalance often find that bioidentical hormones blend better with their body than traditional synthetic hormones. One reason for this is because bio-identical hormone doses are titrated based on each woman’s individual hormone testing.

 

Are bio-identical hormones FDA approved?

To date, synthetic non-bio-identical estradiol, progesterone, and testosterone are FDA approved. These are chemically derived from plant and animal sources and differ in molecular structure from the hormones produced naturally by the ovaries. Bio-identical hormones are not FDA approved because they are derived completely from natural plant sources that can’t be patented. Bioidentical hormones are identical in molecular structure to the hormones a woman’s body produces. Only chemically altered substances can be patented; therefore, there are no profits to be gained from natural plant sources by large pharmaceutical companies who typically fund studies on hormone therapy.  In fact, pharmaceutical companies stand to lose money if word gets out that there are better and safer options for women. There is, however, an abundance of independent research that is not funded by big pharmaceutical companies that does support the safety of bio-identical hormone therapy.

 

Are bio-identical hormones safe?

Bio-identical hormones are identical in composition to the hormones found in women’s bodies and have been safely used in Europe and the United States for more than sixty years. There is an abundance of literature supporting that bio-identical hormone use is safe and effective for women.

Bio-identical hormones have few side effects than synthetic hormones. Pharmaceutical companies either use animal based hormone (from horses) or add an extra covalent bond to natural plant hormones in order to patent synthetic hormones. The difference in chemical structure likely explains undesired side effects of non-bio-identical hormone therapy as these hormones may not follow normal metabolic pathways and could be viewed as a toxin by the woman’s body.

One thing that we have learned from large scale studies is that hormones delivered in topical creams and patches appear to be safer than oral medications. This is because they bypass the liver and decrease potential side effects. This is the delivery method used for bio-identical hormones so this research supports that bio-identical hormones are a safer method to deliver hormones to women.

 

What about the Women’s Health Initiative Studies (WHI)?

Many women have concerns about the Women’s Health Initiative (WHI) studies and how those results relate to bio-identical hormone therapy. It is important to clarify that the WHI studies looked at synthetic hormones, which are quite different from bio-identical hormones. The literature can be confusing when reading these studies as often authors use the blanket term “estrogens” and don’t differentiate that there are different kinds of estrogen. Estriol is what is used in bio-identical hormone therapy and NOT associated with an increased risk of cancer or stroke. In fact, no adverse effects have been reported in over thirty years use of the natural plant based hormone, estriol, used with bio-identical hormone replacement. Progestins which are found in non-bio-identical hormones are NOT the same as natural progesterone. Progesterone has been shown to have a protective effect on breast tissue whereas synthetic progestins are associated with negative effects on breast tissue.

Many women worry about the connection of hormone use and breast cancer. Some theorize that hormones that are out of balance may actually increase a woman’s risk for breast cancer. For example, an “estrogen dominance” or imbalance of the estrogen to progesterone ratio may increase the risk of breast cancer. Excess estrogen can be made by the body from adipose or fat tissue. In addition, we are often exposed to hormones in our meat and dairy sources. This is why bio-identical hormone therapy has a distinct advantage as the dosing is prescribed based on the estrogen / progesterone balance or ratio.

The WHI studies on synthetic hormone therapy were halted three years early as it showed an increase in breast cancer and blood clots. In the WHI, it was the progestin arm of the study that was halted and found to increase women’s risk. In this study synthetic progestins were used orally. Progestins are chemically different than the bioidentical plant derived progesterone that is used in bio-identical hormone therapy. Synthetic progestins are not identical to the progesterone naturally produced in a woman’s body.  It is also important to note that bio-identical hormone therapy uses transdermal (or topical) application which is safer option than oral medication. Lastly, bio-identical hormones are prescribed in doses based on personalized testing showing exactly what the individual woman’s body needs. This is quite different from the one-size-fits-all approach of synthetic hormones. Because of these differences one cannot assume that the results of the WHI studies apply to bio-identical hormone therapy. The goal of bio-identical hormone therapy is to temporarily restore the woman’s youthful hormones as she works to make the necessary lifestyle changes and regain natural hormone balance.

 

Who should consider hormone testing?

Women at any age may be challenged with hormone imbalances. Examples of hormone imbalance in younger women include the following:

  • Irregular menstrual patterns
  • Heavy and/or painful menstrual periods
  • Endometriosis
  • PMS symptoms (mood swings, headaches, food cravings, acne, or gastric disturbances)
  • Polycystic ovarian syndrome
  • Decreased interest in sex

Examples of symptoms experienced by women in the perimenopausal or menopausal transition who may benefit from bio-identical hormones include the following:

  • Hot flashes
  • Night sweats
  • Mood swings
  • Insomnia
  • Anxiety
  • Depression
  • Forgetfulness
  • Decreased interest in sex

What treatments will I receive in conjunction with bio-identical hormone therapy?

At Whole Health Associates each woman’s treatment plan is individualized to meet her needs. A comprehensive approach to care is essential to understand the underlying causes of hormone imbalance. We may recommend salivary testing to analyze the balance of hormones available in your body including: cortisol, DHEA, estradiol, estriol, estrone, melatonin, progesterone, and testosterone. The transition into menopause can also be affected by lifestyle choices and areas of imbalance in the body. Other areas to be explored include the following:

  • Thyroid function – The thyroid is a small gland that is located in the lower part of the neck near what some people call the Adam’s apple. This gland is responsible for the body’s metabolism. The thyroid can be overactive or underactive creating a variety of symptoms such as: dry skin, hair loss, constipation, weight gain or loss, racing heart rate, anxiety or depression, fatigue, heavy menstrual periods, and heat or cold intolerance. Many women have low thyroid hormones (hypothyroidism) that are missed when providers do not check a full thyroid panel. These subtle imbalances in thyroid hormones can aggravate menopausal symptoms.
  • Adrenal fatigue – The adrenal glands are two tiny glands that sit on top of your kidneys. The role of the adrenal glands is to produce hormones that help you respond to daily stressors. Many of us live with excessive daily stress that exhausts our adrenal glands leading to dysfunction. If your adrenal glands are depleted you are more likely to struggle with menopausal symptoms and hormonal imbalances. Symptoms of adrenal fatigue include the following: disrupted sleep and energy patterns, fatigue, weight gain, muscle or joint pain, new onset of allergies or chemical sensitivities, sweet and salt cravings, and a noticeable decrease in the ability to handle stress.

Stress causes the body to release a hormone called cortisol. Small amounts of cortisol are useful and healthy for our bodies but continual stress and high cortisol leads to exhaustion. The adrenal glands also produce the hormones adrenaline (epinephrine) and DHEA.  Adrenaline is often referred to as the “fight or flight” response and is critical when we are in a crisis to act swiftly. However, when produced excessively in response to daily stress causes fatigue.

DHEA (dehydroepiandrosterone) is made in both the adrenal gland and the brain. This hormone leads to the production of the sex hormones. A balance in the cortisol and DHEA levels is essential for the woman’s body to function optimally.  Our goal is to support you in ways to manage your stress levels and adrenal glands as necessary.

  • Nutritional deficiencies – If you enter menopause depleted of essential nutrients, you may struggle with hormonal imbalances. Our goal is to help identify what nutrients your body lacks and develop a plan to return balance. A nutritional plan will consist of the implementation of low glycemic healthy food options with emphasis on a plant based diet. Creating this plan may involve laboratory testing and targeted supplementation to restore your body to health as quickly as possible.
  • Environmental exposures – Many women suffer with imbalance due to environmental exposures in their daily home or work life. Examples of toxins include lead, mercury, and cadmium. Toxicity symptoms can cause immune and nervous system dysfunction which can indirectly affect estrogen metabolism and menopause symptoms. If indicated, steps will be taken to identify exposures and minimize the effects. This program would include the use of specific foods and nutrients to encourage detoxification.
  • Exercise patterns – In order for our hormones to function optimally daily movement is essential. Exercise reduces stress, improves sleep and mood, optimizes brain function, and increases insulin sensitivity. All of these elements improve hormone imbalance and contribute to creating health.

The paradigm is starting to shift and bio-identical hormone therapy is now considered a form of preventative medicine. Women are living twice as long as they did one hundred years ago and with age there is a natural decline in hormones. Correcting hormone imbalance is essential to health and well-being as long term imbalance can impact the immune system and accelerate aging. Our current lifestyles further cause a decline in hormones due to the increase of daily stress, poor dietary and exercise habits, and increased environmental toxin exposures. Treatment plans at Whole Health Associates encompass a complimentary blend of options including nutritional counseling, cleansing detoxification programs, targeted supplementation, stress reduction, exercise recommendations, and if indicated bio-identical hormone or conventional pharmacological therapy.  Ideally, hormones are only prescribed temporarily until lifestyle changes restore the body to its natural balance. It is our belief that women’s bodies have the wisdom to heal and correct imbalances when provided healthy fuel and nurtured properly.

Comments 4

  1. I would like to know if Doctors of this clinic take Medicare?
    And if not how much they charge per session?
    Thank you.

  2. It’s good to know that there is a sufficient amount of literature available that proves bioidentical hormones are safe for women. My wife has been having some health problems induced by too little estrogen in her system post-menopause. What tests would a doctor run in order to determine whether or not bioidentical hormone therapy would be beneficial for my wife?

    1. Hello, There are multiple ways to monitor hormones in women. Typically I start with serum blood testing to get a basic snapshot of her baseline hormone levels. Once a woman has started on bio-identical hormones, I prefer to screen periodically with saliva testing as this allows me to individualize her dosing more carefully. I also sometimes use urine hormone testing as this allows me to evaluate how a woman is actually metabolizing her hormones. This insight is quite helpful if I suspect she has some genetic traits that impair her hormone metabolism. – Elizabeth Jensen, APRN

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