After my blog post on PCOS, I received numerous questions regarding Bio-Identical Hormone Replacement therapy. What is it? Why do it? Is it safe? I hope this can answer most of those questions.
Bio-Identical hormone replacement (BHRT) therapy is a safe and effective treatment, when prescribed by an experienced physician. It's simply a way to replace sex hormones (estrogen, progesterone, testosterone) for both women and men. The hormones are applied topically to the body, and are administered in varying doses throughout the month.
These hormones are NOT synthetic.
They are derived from a botanical source, such as yams. Bio-Identical means that the topical estrogen and progesterone which is being rubbed into the skin has the same structural and chemical make-up as the hormones produced by our bodies. The body recognizes structurally-similar estrogen, and knows what to do with it. These compounded hormones bind to hormone receptor sites in the same way that our own hormones do.
Who needs this treatment?
Up until menopause and andropause (male menopause), our bodies should make adequate amounts of hormones—and then we age.
Countless patients tell me that they feel a change in their body after the age of 40 or 45. Sometimes they experience fatigue, decreased energy, low sex drive, sleep disturbance, unexplained weight gain, cloudy memory, irritability, or anxiety (to name just a few of the symptoms). Other common changes include an increase in blood pressure, cholesterol suddenly over 200, and sugar at the high end of normal, and some mild bone loss according to bone density tests.
These symptoms aren’t exclusive to middle-aged or older women. In fact, they are increasingly common in younger men and women. There are many reasons why a younger woman would be prescribed hormones in my office: long term oral contraceptive use causing menses to disappear, PCOS, painful, heavy or irregular periods, uterine fibroids, benign pituitary adenomas, or severe PMS (to name a few). Young men may have low testosterone levels due to head trauma or sports injuries, marijuana use, or post-viral syndromes, etc.
Concern over bio-identical hormones
Many women who come to me have a general fear of any hormone replacement therapy. Sometimes this concern is precipitated by their physicians, but mostly it's fed by misleading information in the mainstream media.The largest-and most cited study is The Women's Health Initiative, a 15-year research program to address the most common causes of death, disability and poor quality of life in postmenopausal women: cardiovascular disease, cancer, and osteoporosis.
All of the women in the study had been given hormone replacement therapy, and it found that women who had been given estrogen were more likely to have heart disease risk factors such as high blood pressure, high blood cholesterol, diabetes, and obesity compared to those who'd been given estrogen-plus-progestin (a synthetic form of progesterone).
Here's the problem with that study. They did not use natural estrogen and progesterone. They used synthetic estrogen derived from the urine of pregnant horses, and synthetic progesterone. Those synthetics that were taken by mouth had to be processed through the liver, which we know to be quite harmful.
These compounds DO NOT resemble the hormones that your body naturally produces. The body doesn't know what to do with those products or how to break them down.
In addition, the synthetic hormones that were used were given in the same daily dose. Hello! Our bodies do not do that normally! A woman's body is used to varying level of hormones at different times of the month. That's what a woman's body knows and understands!
After the study was abruptly terminated due to some frightening outcomes, the recommendations that followed were: hormones are bad, women should not use hormones for any extended period of time, and only if absolutely necessary.
So, the gynecologists packed up their tents, and women were taken off the harmful synthetic hormones, but NEVER placed on anything else. The information on safety is so limited for the general public. People are bombarded with warning alerts on the dangers of hormone use. FDA-approved forms of estradiol come with a long-list of deleterious side effects. It's difficult for the doctors to decipher it. How on earth is the general public supposed to manage?
Unfortunately, the traditional medical world has failed the patients who are truly in need of Hormone Replacement Therapy. I have found in my practice, for both men and women, that cycled bioidentical hormone replacement is the only system that works for symptoms and safety. It's all that I prescribe from an ethical standpoint.