How Do You Know if Bio-Identical Hormone Therapy is Right for You?
By Dr. Lisa Maddalena
What is a Bio-identical Hormone Therapy (BHRT)
Bioidentical hormone therapy refers to hormone replacement using hormones that are made to be identical to those produced naturally in the human body. Since they are identical to what we produce side effects are greatly reduced, our body is still encouraged to produce some of our own natural hormones, and risk of use is extremely low.
Some examples of bioIdentical hormones include Estriol, Estradiol, BiEst (which is a combination of Estradiol and Estriol) and Progesterone.
BioIdentical hormones are often compounded by a compounding pharmacist but are also commercially available under names such as Estrogel, Vagifem, Estradot, and Prometrium among other less commonly prescribed preparations. There are many different reasons why your Naturopathic Doctor or Gynecologist may prescribe a commercially available preparation over a compound and visa versa. It all depends on your specific symptoms, the severity of symptoms and the preparations available. Everyone is different and therefore a customized BHRT prescription is recommended for your specific hormone imbalance.
What is Hormone Replacement Therapy (HRT) and How is it Different from BHRT?
HRT refers to synthetic and animal derived hormones called conjugated equine estrogen and progestin. Often referred to as Premarin and Medroxyprogesterone acetate (MPA).
The major “Nurses Health Study” of the 1990’s was famously halted due to the findings of increased breast cancer in women on combination premarin and MPA. However, also found an increased quality of life, decreased risk of osteoporosis and 44% decreased risk of cardiovascular disease.
The breast cancer risk found in this study was later linked more closely with the MPA use as women who were taking Premarin on its own did not have the same reported risk. In addition, the Premarin only group had the same, if not more benefit. Since this was discovered, made many practitioners are afraid to use the hormone Progesterone, however studies have shown that bioidentical progesterone is much different than MPA in both risk and side effects. This is because MPA has a different structure than Progesterone making it a completely different hormone according to the body.
Slight differences in hormone structure makes a BIG difference in the body.
Types of Hormone Imbalance That Can Be Improved with BHRT
- Progesterone Deficiency:
- Anxiety and irritability, insomnia, depression, bloating and water retention, weight gain, thyroid dysfunction, migraine (especially just before menses), very heavy and/or frequent periods or sometimes absent periods.
- Increased risk of female cancers especially endometrial and cervical.
- Estrogen Deficiency
- Hot flashes and/or night sweats, brain fog/memory loss, vaginal dryness and atrophy, mood swings, thinning skin and hair, weight gain, insulin resistance, low libido.
- Increased risk of osteoporosis, cardiovascular disease and Alzheimer’s’ disease.
Appropriate Assessment of Hormone Imbalance: Determining Need
- Used most often as first line of assessment for LH, FSH, Estradiol, Progesterone, free and total Testosterone and DHEA.
- ALWAYS the BEST test for testosterone and DHEA.
- If still having a period LH, FSH and Estradiol should be tested on day 3 of cycle. Estradiol, Progesterone, free and total Testosterone and DHEA should be tested on day 21 of cycle.
- In almost all cases a full thyroid panel will be added as the thyroid is often affected by changes in other hormones
Urine Metabolites “DUTCH” testing
- Used most often as a second line assessment of all of the hormones mentioned above.
- Also tests the hormones metabolites telling us about detoxification and other breakdown products.
- Can also tell us about melatonin and cortisol
- No longer recommended for testing of Estradiol, Progesterone, Testosterone or DHEA.
- Still used for assessment of Cortisol and Melatonin.
BUT IS IT SAFE?….
- Breast Cancer Risk:
- 1997 article found no increased risk in breast cancer but a possible decreased risk in total mortality.
- A 2001 study stated “when one evaluates the sum total of data in the world of literature regarding HRT and breast cancer it is difficult to ascertain that any substantial clinical risk exists with the use of HRT and Breast Cancer.”
- A follow up study in 2002 showed a decreased risk in death from breast cancer in women that are on hormone replacement.
- Endometrial Cancer
- There is a risk of endometrial cancer if hormones are prescribed incorrectly in women that have a uterus. This is avoided by always prescribing progesterone with estrogen in appropriate dosage. As well as testing progesterone after taking it for 3 months to ensure that blood levels are sufficient to ensure protection.
- Risk of not prescribing
- A 2009 article concluded that women who enter menopause before 45, either surgically or naturally, are at an increased risk of morbidity and mortality.
It is normal to lose your period with menopause but it is not normal to suffer with hot flashes, mood swings, insomnia, weight gain, vaginal dryness and low libido. If your quality of life has been effected by these symptoms, BioIdentical hormones can be life changing. If prescribed properly, they can significantly reduce symptoms of menopause and peri-menopause without risk. In addition, appropriate timing of treatment with estrogen can result in protection against osteoporosis, heart disease and potentially age-related memory loss.
Book your consultation with Dr. Lisa Maddalena today to get started.
The sooner you start BHRT after your period is gone, the more benefit you have with chronic disease prevention.