Bioidentical Hormone Replacement Therapy

Recent studies including the World Health Initiative( WHI) have resulted in a significant controversy for physicians and the millions of women who are in the menopausal phase of life. Traditional Hormone Replacement Therapy (HRT) has been brought under scrutiny as more studies bring into question it’s efficacy and safety. Once thought as a preventative measure for potential heart disease, traditional HRT is no longer recommended for this purpose. With growing concern about a possible link between estrogen use and breast cancer and the known link between unopposed estrogen use and pre cancer and cancer of the uterus, women are looking for alternatives to traditional HRT.
Symptoms of the menopause often include:

• Hot flashes - sudden waves of heat that can start in the chest and work their way up to the neck and face. They are more common in the evening and during hot weather. They can hit as often as every 60 minutes. Each one can last from 15 seconds to 30 minutes - five minutes is average. Seventy-five to eighty percent of women going through menopause experience hot flashes, some more bothered by them than others. Sometimes heart palpitations accompany hot flashes.
• Vaginal dryness - this results from hormone changes. The vaginal wall also becomes thinner. These problems can make sexual intercourse painful or uncomfortable and can lead to irritation and increased risk for infection.
• Loss of sexual desire
• Loss of bladder tone which can result in stress incontinence (leaking urine when you cough, sneeze, laugh or exercise)
• Headaches, dizziness
• Mood changes lack of concentration, memory lapses
• Tension, anxiety, depression
• Skin and hair changes. Skin is more likely to wrinkle. Growth of facial hair, but thinning of hair in the temple region
• Muscles lose some strength and tone
• Bones become more brittle, increasing the risk for osteoporosis
• Irritability
• Insomnia
• Fatigue

When symptoms are mild to moderate, herbs and botanicals are often helpful. Most likely to help are a combination of increased isoflavones ( soy and other beans, flax seed, flax seed oil, isoflavones from soy or red clover sources) ,black cohosh, chasteberry, evening primrose oil or prescription herbs. In addition Acupuncture and Traditional Chinese Medicine have been quite successful in alleviating many of the symptoms of the menopause. Many menopausal women have also received benefits from yoga, exercise, massage and meditation.

However, sometimes the symptoms of menopause can be quite debilitating and not totally responsive to the above measures and hormone replacement is necessary. Treatment related side effects and the fear of increased risk of cancer and cardiovascular disease that is associated with traditional HRT have prompted significant interest in bioidentical hormone replacement therapy. Often mistakenly referred to as “natural” HRT, bioidentical hormones refer to synthetic or non synthetic hormones that are biochemically identical in structure and effect to hormones produced by the body. They are compounds that can be synthesized in the lab from a “natural” source such as soybeans (in the case of estrogens and testosterone), wild Mexican yam (in the case of progesterone), as well as from animals (pigs and horses) to exactly mimic the chemical structure of the naturally occurring compound it is supplementing or replacing. The bonding of a hormone to its receptor is determined by its molecular configuration, like a key is for a lock. We have learned that substitute synthetic hormones differ in their activity at the receptor level. In some cases, they will activate the receptor in a manner similar to the natural hormone, but in other cases the synthetic hormone will have no effect or will block the receptor completely. Thus, hormones that are not bioidentical do not provide the same total physiologic activity as the hormones they are intended to replace which can lead to increase cardiovascular and cancer risks as well as unwanted side effects.

Plant derived bioidentical hormones are not commercially available and must be prepared by a compounding pharmacist and prescribed by a licensed health care provider. Commonly prescribed hormones are Estrogen ( Estradiol, Estrone, Estriol), Progesterone, Testosterone and Dehydroepiandosterone (DHEA). Their dosages can be customized to meet individual needs based on serum and saliva testing and can be prepared in capsules, sub-lingual drops, creams, suppositories and pessaries depending on patient preference.

The popularity of bioidentical HRT is rapidly growing as more women are researching their alternatives to traditional HRT. Along with complimentary modalities such as botanicals, acupuncture, massage, yoga and exercise, bioidentical hormones provide women with a choice other than suffering with menopausal symptoms or traditional hormone replacement therapy.

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