Why I Prescribe and Use Bio-Identical Hormones

by Dr. Elizabeth Jensen

As a women’s healthcare provider, I have had a complete change of heart in my opinion of bio-identical hormone therapy. I was educated in the traditional medical model and taught that bio-identical hormone therapy was unsafe and “not evidenced based” and therefore should not be offered to patients. I had met women over the years that had sought out the care of providers that offered bio-identical hormone therapy and many reported wonderful results but the idea of learning more about it was always daunting. I had no idea how to prescribe bio-identical hormones or how to interpret or use salivary tests as guides. Honestly, it was just easier to prescribe traditional synthetic hormones made in a laboratory and follow their cookie cutter approach.

It was clear to me that synthetic hormones were not the magic bullet and that many women continued to suffer with symptoms despite the hormones I prescribed. In addition, women had many fears around hormone use, particularly a fear of breast cancer. On follow up visits I would often find that many women discontinued using synthetic hormones I prescribed. Many complained of breast tenderness, mood swings, bloating, spotting or headaches. When the Women’s Health Initiative Studies were released providers also became fearful of prescribing synthetic hormones and around this time I really began to focus on diet, nutrition and lifestyle approaches to help women balance their hormones. Essentially many of my patients just had to “suck it up” and deal with their menopausal symptoms.

Bioidentical Hormones Hormone Therapy and Perimenopausal Symptoms

Over time, I began to whole heartedly believe that hormonal symptoms were entirely a lifestyle issue. I thought that if I could guide women to pay more attention to their nutritional state and exercise programs that their symptoms would no longer be an issue but I was wrong. Clearly a healthy diet, supplements and exercise improved women’s symptoms but unfortunately it did not resolve and balance hormone symptoms for many women. I found that many women were just too exhausted to completely overhaul their lifestyle when they were in the midst of struggling with sleep issues, hot flashes, anxiety etc. I realized that many women needed to restore their hormonal balance first in order to get the energy and motivation to make the much needed lifestyle and nutritional adjustments to create health.

This belief really hit home when I became one of those perimenopausal women. Here I was a fifty year old woman who did everything right. I ate a mostly organic plant-based diet, worked out daily, took a daily handful of the highest grade supplements available, practiced mind-body and positive thinking, and suddenly found myself sleep deprived, anxious, and struggling with hot flashes. I had no idea that being robbed of something so vital and privileged as a good night sleep could wear one down to such a dysfunctional state. For months, I would fall asleep exhausted by 10 o’clock, only to wake up sweating a few hours later and then toss and turn for hours afterwards. I would find my heart raced like I had a few too many cups of coffee and I worried about the most random meaningless things. I could not turn my mind off. I tried everything: magnesium, melatonin, valerian, hops, ashwaganda, meditation, affirmations, journaling, breathing techniques, and even yoga inversions prior to going to bed: but to no avail, I still found that my most beloved sleep number bed was my dreaded enemy. I just didn’t know how I could continue to serve women as a health care provider when I could barely remember where my keys were. I was so sleep deprived that I was forgetting things. It scared me. Never in a million years would I have imagined that I would be “out of balance” enough to consider hormone balancing. It was a blow to my ego.

I prided myself as one who truly believed in the power of the human mind and natural medicine. Even though I had practiced conventional women’s health in a gynecology office for years my roots were ingrained in natural medicine. As a teen I watched my father struggle with brain cancer and I vowed that if I ever were diagnosed with cancer I would run for the hills and LIVE rather than spend my last days struggling with the side effects of our current treatments. I took my vow to the next level and chose to live my life as clean and healthy as possible to hopefully avoid getting cancer in the first place. Taking care of my mind and body was always a priority.

I became a nurse with a strong interest in women’s health and worked in the delivery room. I soon was teaching childbirth and breast-feeding classes and my path led me to pursue Nurse-Midwifery. I was passionate about empowering women to have a gentle safe non-medicalized birth experience. I believed in my soul that birth was a spiritual event that needed to happen in a culture of reverence. My own children were born at home, breast-fed, sugar free, Nintendo free, and bundled up and taken to my naturopath when they were ill. Every step on my personal path of nurturing my family was non-conventional.

I later went on to get my Clinical Doctorate in Nursing, specializing in vulvovaginal pain disorders and received a grant from the National Vulvodynia Association to open a dedicated Vulvovaginal Service. I was soon serving women from all over Connecticut. Many had suffered for years with disorders such as: vulvodynia, vestibulodynia, lichen sclerosus, lichen simplex chronicus, lichen planus and other atypical or recurrent vaginal infections. It was this work that brought my attention back to the importance of a healthy lifestyle and hormone balance. Many of the women I served with vulvar disorders struggled with weight issues, poor dietary habits, and nutritional deficiencies. Most struggled with adrenal fatigue from their long-term battle with autoimmune disorders and pain. It was not uncommon to see these women also have a common thread of co-morbid conditions in their history such as: migraines, temporal mandibular joint pain, anxiety, depression, irritable bowel syndrome, interstitial cystitis, and fibromyalgia. Almost always their pain stories were influenced in some way by hormonal shifts. Either their pain started at a time when their body was going through a hormonal change or their cycle in some way impacted their pain levels. I began to wonder if hormone imbalance was a part of the puzzle that I had not considered.

I was trained to prescribe the traditional pharmacological treatments for vulvar pain including tricyclic antidepressants, anticonvulsants, selective serotonin norepinephrine reuptake inhibitors and multiple topical therapies. Unfortunately, these medications that address neuropathic pain often have negative side effects and only address the symptoms rather than the underlying cause. Sadly this area in women’s health is poorly understood and the causation is still under investigation. It was the women’s stories of hormonal involvement that initially prompted my interest in exploring bio-identical hormones. Yet, I had never dreamed that I would consider them for my own use!

I soon joined a study group with other local providers that offered bio-identical hormone services to women. I was shocked to find out how much research there is supporting the safety and benefits of bio-identical hormones and inspired by their stories of how women were feeling so much better on bio-identical hormones. Soon, I was devouring the literature, attending conferences, webinars and excited to learn more. I was clear to me that I had just opened the door to an option that not only would help the women I served but could help me.

I quickly became my own guinea pig and started myself on bio-identical progesterone. I had learned that many women in perimenopause struggle with decreasing progesterone levels and perhaps this was all that I would need to regain the balance I so desperately needed. I ordered a low dose progesterone cream that was packaged in what is called a “topiclick” container. Each night, I would click the container and exactly 0.25 cc of a blended natural progesterone cream would trickle out and I would massage this cream into rotating sites on my body such as, the inside of my arms or behind my knees. Within one week, my sleep problems significantly improved. I was still waking up from time to time but without the racing heart and anxiety and I could gratefully fall back asleep. Within two weeks, I was completely back to my normal rest patterns and sleeping through the night. My energy slowly restored and I was not as forgetful. I could not believe the difference. For me, this was a slam dunk cure after several years of sleep issues. I have since started prescribing bio-identical hormones for other women and the results continue to astound me.

I now have gone full circle from being a non-believer to a believer in the benefits of bioidentical hormone therapy. Every day in my office women of all ages describe common symptoms of hormone imbalance from premenstrual syndrome, polycystic ovarian syndrome, painful menses, hot flashes, night sweats, to mood swings. It is quite common for women to experience a decline in hormone levels with our current dietary habits, lifestyle, stress levels, and environmental exposures and we have been given the tools in nature to restore these imbalances. Correcting these imbalances may not only resolve these symptoms but improve our vitality and keep us youthful.

I am convinced that bio-identical hormones are a form of preventative medicine. Our lifespan is increasing and women now live twice as long as we did one hundred years ago. If we’re in this for the long haul we might as well look and feel the part. Fifty is the new thirty and the baby boomers today desire to look and feel better than ever. Bio-identical hormones help keep our skin young, mind sharp, bones strong, and keep us feeling sexy. Combined with a healthy diet, regular exercise and balanced lifestyle we can have a greater sense of well-being. I certainly don’t presume that there is one cure for all as I have learned that we all have our own path to wellness but I do find it exciting to have a new option to explore with women as they strive to create health.