Bioidentical Hormone Replacement Therapy

Bioidentical Hormone Replacement Therapy for perimenopause and postmenopause. 

If you have been experiencing the emotional and physiological changes of the menopausal transition, you might have heard about, or considering hormone replacement therapy. Or you might be experiencing symptoms that you haven’t even related to perimenopause, like shoulder pain, irritable bowel syndrome, recurrent urinary tract infections, brain fog, anxiety, insomnia, weight gain in different areas of your body or lack of libido. Maybe you’ve read about the benefits or are considering it because you have heard the anti-aging potential and you want to feel and look your best as you get older. Whatever led you here, trust it, there are so many advances in medicine that can help you.

There is so much new science related to bio-identical hormone replacement therapies and hormone optimization. As we know, cellular health and mitochondrial support is the foundation to healthy aging—because hormones are the great communicators in our bodies, and help each cell to function optimally and full-fill its functions.

You do NOT need to wait until you are ‘peri-menopausal’ to start. 

The evidence shows that the earlier hormones are initiated, (within physiological levels),the better the outcomes. Estradiol, progesterone, and testosterone are protective of bones, heart, skin & hair, digestion, metabolism, muscles and joints, and the brain. Earlier intervention can help not only alleviate symptoms, but also protect against the conditions of aging like heart disease, dementia and diabetes.

Menopause is literally just one day —the day it has been 12 months since you had a period.  But most women’s hormones begin to fluctuate and decline at much younger ages, leading to a host of seemingly unrelated symptoms that can range from immune dysfunction, musculoskeletal pain and mood disorders. 

Many women assume bio-identical HRT is only for menopause or post-menopause, but symptoms can happen at much earlier ages. Women can experience symptoms like high cortisol, gastrointestinal problems, anxiety, insomnia, acne, hair loss, wrinkles, dry skin and weight gain. These symptoms aren’t typically recognized as menopausal symptoms, so women don’t think of their hormones as possibly being the cause of, or contributing to their condition.

Women continue to be confused about what is happening in their bodies, and what their providers are telling them. And lab testing often is misleading in the early stages as hormone levels fluctuate dramatically. Traditionally trained providers often tell women that they are too young to be experiencing menopausal symptoms, so we brush it off and this

Women should prioritize keeping their estradiol, progesterone, and testosterone at optimal levels throughout their lives. Just as we supplement vitamin D when it’s low or provide our bodies with essential nutrients, hormones should be no different. Instead of waiting until symptoms become severe, women should consider addressing hormonal imbalances at the first signs of ovarian fatigue or declining function.

What Are Your Options for HRT?

Not all HRT is created equal! The hormones that were used and studied in the Women’s Health Initiative were not bio-identical, and the synthetic Estrogens were delivered orally, which increased the risk of blot clots and strokes. The study was stopped early. We know now that bio-identical hormones such as estradiol, when delivered in a transdermal system, is very safe, and even protective for a vast amount of health conditions. 

What Are Bioidentical Hormones?

Hormones are chemicals produced by your endocrine glands that serve as messengers, telling particular cells of the body to do their jobs. Bioidentical hormones are hormones that contain the same molecular structure as the hormones made by your body.

Vital hormones that bioidentical hormone therapy can replenish include:

• Estrogen

• Progesterone

• Testosterone

Bioidentical hormones can be created by a pharmaceutical company or a compounding pharmacy, and differ from the conjugated estrogen and progestin formulas (non-bioidentical formulas) used in older forms of hormone replacement therapy. 

Bioidentical vs. Synthetic (Non-Bioidentical) Hormones 

While both bioidentical and non-bioidentical (often referred to as “synthetic”) hormones are made in a lab, the raw ingredients used are different. Bioidentical hormones are typically plant-based and are structurally identical to the hormones produced in your body.  The non-bioidentical hormones, however, differ chemically from the hormones your body naturally makes. In general, bioidentical hormones often have far better results with fewer risks of negative side effects.

Conditions that BHRT Treats

Hormones impact many important bodily processes, including metabolism, reproduction, growth, and sexual function. Perimenopausal or menopausal symptoms can take a toll on your day-to-day life, which is why hormone therapy may be helpful. 

Bioidentical hormone therapy can treat many symptoms, including the following:

• Mood swings and anxiety

• Hot flashes and vasomotor dysfunction such as fainting

• Vaginal dryness and atrophy of urogenital tissue

• Night sweats and nausea

• Fatigue 

• Memory loss

• Insomnia and early morning awakening

• Decreased interest in sex 

• Joint and muscle pain

Types of Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy comes in several different forms. The one that’s best for you will depend on the advice of your healthcare provider, as you may need to try more than one form before you identify the one that works best for you. 

Patches:

There are multiple patches containing estradiol that are placed on the skin and changed twice a week. This delivers a relatively steady of of estradiol through the skin, and can be a convenient option, or a good option for women with certain health conditions that make other forms of estrogen higher risk. 

Commercial Gel Products

BHRT gels are transdermal like the estradiol patch, which means they’re absorbed through the skin. Gels can help with hot flashes, night sweats, mood changes, and vaginal symptoms, and your healthcare provider will recommend the best treatment option for your symptoms.  

Vaginal Creams

Both commercial and compounded estradiol cream treats symptoms like vaginal dryness, itching, burning, painful sex, and frequent UTIs, also known as Genitourinary Syndrome of Menopause (GSM). 

Low dose vaginal creams contain a small dose of estrogen and are applied topically for the relief of GSM, and are not used to treat systemic symptoms such as hot flashes or night sweats. 

Higher dose creams can be used as replacement therapy and are applied to a thin skinned area daily. 

How Soon Does BHRT Start to Work?

Most women will start to feel better within a few days, much better in a week or two, and generally reach maximum symptomatic relief for any given dose and formulation within 4-6 weeks. 

It may take some time to identify the best dose for you and your symptoms. That said, some people experience relief from their symptoms as early as two days after they begin treatment.

Bioidentical Hormone Replacement Therapy Contraindications

People who have a history of or who experience the following should consult their healthcare provider:

• Breast cancer

• Porphyria

• Severe active liver disease

• Undiagnosed vaginal bleeding

However, transdermal estradiol in patch or gel form has not been shown to increase these risks just as bioidentical estradiol and progesterone have not been shown to increase breast cancer risk. 

Bioidentical progesterone, (oral micronized progesterone),  has never been shown to cause an increase in breast cancer risk.  Your healthcare provider will discuss your full medical history with you before recommending any kind of hormone replacement therapy. 

Possible BHRT Side Effects

While most side effects are minimal and subside after a few days to weeks, there are some possible side effects you should know about. 

You may experience the following:

• Nausea or Queasiness

• Bloating 

• Mood swings

• Breakthrough bleeding

• Breast tenderness

• Cramps

• Headaches

Your healthcare provider will likely recommend regular symptom evaluations to monitor your progress. That said, if you experience side effects that worsen or persist for a long period of time, contact your healthcare provider immediately. 

Common Myths About Bioidentical Hormone Replacement Therapy

Estrogen Causes Cancer

Breast Cancer: One of the myths out there is that estrogen is dangerous and can cause breast cancer. However, the reality is that current data indicates estrogen does not cause breast cancer. The preponderance of evidence suggests that using FDA-approved BHRT does not increase your risk of breast cancer over your baseline risk. 

In fact, in the WHI study, women only taking estrogen had a 30% decreased incidence of breast cancer.

Uterine Cancer: It is true that women with a uterus on MHT require progesterone to protect against the small risk of endometrial cancer that might develop from using “unopposed” estrogen.  

BHRT Can Delay Menopause

Unfortunately, BHRT cannot delay menopause. BHRT can help you manage menopause symptoms, which can make aging more enjoyable and also healthier. Starting BHRT early (within 10 years of menopause onset) is associated with decreased cardiovascular risk and prevention of many metabolic health issues. With the right hormone therapy, you can enjoy the privilege of aging without the uncomfortable side effects and with reduced risk related to the metabolic impact of low hormones. 

You Shouldn’t Start Bioidentical Hormone Replacement Therapy Too Young

In fact, starting BHRT earlier can have meaningful benefits, especially if you’re experiencing severe perimenopausal symptoms. Some studies show that there’s a critical window wherein if you begin BHRT earlier, you’re more likely to have more positive results, reducing symptoms and possibly avoiding further health complications that crop up with age.

You Can Be on BHRT For Too Long

You can continue BHRT for as long as you and your doctor are happy with the results. Your healthcare provider will continue to monitor your symptoms and any side effects to determine the best dose, formulation and duration of therapy.  There is not a magical age when you have to discontinue BHRT.

Herbs and Vitamins Are Safer Than Hormone Treatments

While certain herbs and vitamins may help alleviate some perimenopausal and menopausal symptoms, there is a lack of data to confirm their effect. In addition, the lack of regulation around their distribution and raw ingredients can make it difficult to find the proper dose and formulation. 

With FDA-approved BHRT, your healthcare provider can recommend an exact dose and formulation backed by evidence-based guidelines to treat your current symptoms.