Bioidentical Hormone Replacement Therapy


 

Bioidentical Hormone Replacement Therapy (BHRT) is designed to help women (and men) find relief during transitional years through peri-menopause and menopause/andropause. "Bioidentical" means that the hormones being used are precisely identical to those made by your own body. In practice, these are derived from plant tissues and scientifically engineered to be as desired (Estrogen, Progesterone, etc) as creams, gels, pellets, etc. 

Synthetic Hormones (ie the conventional "hormones") do NOT precisely match the hormones your body produces - sometimes it is quite different (ie Premarin is actually horse URINE containing equine (horse) estrogen and equine estrogen metabolites as a mixture). Medroxyprogesterone (ie "Progestin") is not precisely the same as your body's progesterone and is metabolized differently in your body than your own progesterone. 

Since Conventional Hormones (ie Synthetic) do NOT match the precise structure of your own (endogenous) hormones, this increases the risk of several potentially fatal diseases, especially when combined with medroxyprogesterone (progestin). 

The Women's Health Initiative (WHI) study, done in 2002 demonstrated that the combination of synthetic estrogen + medroxyprogesterone (progestin) = higher risk of breast cancer, coronary artery disease, stroke, and blood clots. Yikes!!

The WHI rightfully frightened physicians and patients and so many stopped using synthetic HRT (hormone replacement therapy). Statistics the following year showed a drop in overall breast cancer rates as well as estrogen-sensitive breast cancer rates. 

Lesson learned? FoundationMED ONLY uses BHRT (bioidentical hormones) and used physiologic dosing (ie amounts that your body naturally produces) rather than the high doses often found in hormone protocols.

 

Benefits of Bioidentical Hormone Replacement Therapy (BHRT)

Benefits of bioidentical hormone therapy can far outweigh the risks with proper risk monitoring and management. Bioidentical hormones are commonly used to treat symptoms of hormone imbalance - symptoms such as HOT FLASHES, NIGHT SWEATS, LOSS of LIBIDO, fatigue, weight gain, mood swings, irritability, less stamina and more. By using BHRT rather than conventional synthetic hormones, you also experience far fewer adverse reactions.

  • Reduced/eliminated Hot Flashes and Night Sweats
  • Reduced Vaginal Dryness
  • Reduced Endometrial Cancer risk
  • Reduced Breast Cancer risk
  • Improved Libido
  • Reduced Osteoporosis risk
  • Better Muscle Mass/Strength
  • Improved Cholesterol Levels
  • Reduced Alzheimers risk
  • Better Mood, Concentration and Memory

 

FoundationMED and Bioidentical Hormone Therapy

Sure - all of us have seen the flashy websites and ads promising to "cure" aging, and improve a large list of symptoms with hormones. And it is quite true that providing hormones for menopausal women can be very helpful. The devil, as they say, is in the details - details that commonly go unaddressed.

Hormones are what I consider "leveraged" - what I mean by this is that hormones are very powerful and interact in multiple complex ways within your body

Using hormones, you can (and often do) obtain fabulous symptom reduction but at what cost? Frankly, it is not difficult to prescribe hormones or surgically make an incision and insert pellets under the skin. It is far more challenging to properly assess and address the myriad other factors that come into play when you add hormones.

Hormones physically can be provided in various ways - skin creams, under-skin pellets, injections, pills, troches, labial cream. Each method has advantages and disadvantages and must be carefully considered. For these and other reasons we do not use pellets, injections, or any form of oral estrogen, and focus on labial cream and oral progesterone as appropriate.

Your hormone therapy will be specifically tailored to your personal physiology, and take into account numerous physiological functions such as your methylation status, estrogen metabolic status, as well as the status of other associated hormones, your general detoxification function and status, as well as external influences such as unknown exposure to hormone-mimetics and other toxins. In addition, your prescribing FoundationMED physician will be monitoring and actively reducing cancer risk at all stages of hormone implementation.

Once a year goes by without menstrual bleeding, menopause is said to be present. In menopause, estrogen and progesterone levels are dramatically decreased (but are not completely gone). Incredibly, the peri-menopausal period can start up to 15 years before actual menopause is seen.

It is clear that hormones play a crucial role in physiologic processes that maintain health and wellness (homeostasis). 

Hormones are proteins that are produced by endocrine organs such as the pituitary, adrenal, thyroid, testes, and ovary.

Imbalances in the true end-organ sex hormones - estrogen, progesterone, and testosterone very often lead to rather distressing symptoms and disease. 

  • Symptoms may include hot flashes, mood swings, anxiety, depression, insomnia, bloating, hair loss, memory problems, sexual indifference and many more.
  • Diseases include osteoporosis, cardiovascular disease, and dementia. As an example, it has been shown that susceptibility to cardiovascular disease, which dramatically increases with menopause, is significantly reduced with proper hormonal balancing.

 

Estrogen is made in the ovaries but is also made in the corpus luteum, adrenal glands, and fat cells. Once the ovaries stop producing estrogen on a regular basis, the adrenal glands become the main source of estrogen (primarily as E1). 

Estrogen is actually available in 3 forms - estrone (E1), estradiol (E2), and estriol (E3). The production of the various forms of estrogen and estrogen metabolism depends on your age, cycle, genetics, and other factors. Suffice it to say that the various estrogens have different potencies and effects. 

In menopause, the absolute levels of estrogen and progesterone are affected, but it is also important to consider the relative levels of estrogen as it relates to progesterone (i.e. estrogen dominance vs estrogen deficiency). Failure to attend to the proper balance of estrogen to progesterone can lead to worsening symptoms. 

Estrogen, progesterone, and testosterone do not act in a vacuum but intimately interact with other hormone systems such as the thyroid and adrenals (cortisol). Hormones must be considered a web with rather complex interconnections that must be properly monitored and adjusted as needed. Remembering that systems such as the methylation system are intimately involved in the detoxification system reminds us that it is important to consider hormone use in the context of a systems approach rather than to treat hormone therapy as an isolated therapy.

Proper monitoring and management of hormone therapy is paramount. 

Estrogen is metabolized into substances that may increase the risk of breast cancer (if not properly identified and managed). If you are currently on hormone therapy (or even if you are not) you should be aware if your metabolic products of estrogen metabolism are within a safe range (easily measured with a urinary estrogen metabolite test). Sadly, monitoring such data is not the norm. Equally important is the status of your detoxification systems, your toxin exposures (even if unwittingly) and so on. 

Adding estrogen (hormone therapy) when your estrogen is being metabolized in such a way as to increase your breast cancer risk is obviously something that should not be done - but if you are not assessing and addressing your estrogen metabolism, how will you even know you are at risk?

Thus, it is important to identify and correct any questions about proper estrogen metabolism and detoxification sufficiency prior to (or concurrently with) adding estrogen therapy. Focusing solely on hormone implementation is not recommended - patients are strongly advised to make sure you are being treated and appropriately monitored by a properly trained physician.

Not all hormones are alike. Bioidentical hormones are, well…. identical to the hormones your body produces. This seems to be an appropriate approach (and it is the one that we strictly adhere to - using only bioidentical hormones) but many are still being treated with hormones that are not bioidentical (such as Premarin - derived from horse urine, and medroxyprogesterone - Provera - a chemical analog of progesterone that is absolutely NOT the same as your own progesterone).

The Women's Health Initiative study showed the risks involved with artificial progesterone (Provera), and artificial estrogen (Premarin). 

In addition, hormones should be used within their physiologic ranges to minimize risk. There is very little data available concerning the risks of using long-term higher-dosed hormones.

It is our contention that symptomatic improvement without the excess risk (seen with non-bioidentical hormone treatment) is attainable but is complex and requires proper monitoring of multiple factors as outlined.

We feel that it is important to appreciate that BHRT (bioidentical hormone replacement therapy) needs to be properly integrated into a comprehensive approach. There are multiple metabolic systems that interrelate with hormones and influence their levels, potential toxicities and effects.

 

Thus: Bioidentical Hormones 

+ Physiologic Dosing 

+ Proper Monitoring of Hormone Metabolism 

+ Risk Abatement protocols 

+ Basic Functional Medicine Principles 

= Better Balanced/Lower Risk Hormone Therapy and Happier Patients. 

 

Our patients feel better, age more gracefully, and have more control of their lives when their hormones are appropriately balanced/managed and risk is actively minimized.

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