Bioidentical Hormone Replacement Therapy in Women
Bioidentical hormone replacement therapy, or BHRT, typically consists of several forms of estrogen, progesterone and some androgens. Laboratory testing and an extensive medical evaluation are used to formulate these components in the precise doses needed by each patient. Throughout the process of treatment, we closely monitor our patients’ levels to ensure that proper hormone levels are maintained, and will make adjustments to the dosage as necessary.
The following is a breakdown of the key chemicals in a BHRT regimen, along with some facts about them:
- The three primary variants of estrogen are estrone, estradiol, and estriol, or E1, E2, and E3, respectively. These three main types function very differently in the body, and each carries its own unique yet synergistic benefits.
- Supplementation with these compounds can reduce menopausal symptoms such as vaginal dryness and thinning of the vaginal walls.
- Returning hormones to a physiologic balance can decrease blood pressure and reduce arterial plaque.
- Proper estrogen balance can lower blood pressure.
- Statistically significant reductions in cases of Type 2 diabetes mellitus have been observed with balanced supplementation.
- Improvements in mood and sleep pattern
- Heightened energy levels, focus, and productivity
- Reduction in menopause-related bone loss
Together, the three forms of estrogen make up the core of any treatment referred to as “estrogen replacement therapy”, or ERT. It is important that these compounds be bio-identical, as synthetic varieties can cause unwanted and harmful side-effects.
Healthy hormone levels can reduce the incidence of vaginal and urethral infection, and improve embarrassing problems like incontinence. Vaginal dryness and pain during intercourse are also frequently improved through treatment with bioidentical hormones.
It is not only the total quantity of estrogen that changes with age, the levels of the three types alter in relation to each other as well. Pre-menopause is typically marked by a reduction in estriol and estrone, leaving estradiol the primary form present during this phase. Estradiol is produced chiefly in the ovaries. After menopause, this balance shifts, leaving estrone the most prevalent variety. This form of estrogen is produced by chemical reactions.
C-reactive protein, or CRP, is the principal biological indicator of cardiovascular health. When levels are too high, it is suggestive of acute risk of complications. Oral ERT, when not bio-identical, increases quantities of CRP through first-pass hepatic metabolism. Metabolites of this treatment have been connected with an increased incidence of breast cancer. In spite of this, synthetic hormones such as conjugated equine estrogen are the most frequently prescribed hormone replacement treatments, and ill-informed patients have been left to suffer the consequences. Non bio-identical hormones are not worth the risk; it is essential that molecularly accurate estrogens (Bioidentical Hormones) be used in treatment. We use only bioidentical hormones in our replacement therapies.
Bio-identical estradiol, delivered transdermally (through the skin), has been shown to have little to no effect on CRP, both in short and long-term evaluations of the treatment’s safety. Bio-identical estrogen treatments can also reduce the risks of certain cancers, and have been shown to have potential in the treatment of arthritis and multiple sclerosis.
- Can enhance bone mineral density.
- Is often prescribed in conjunction with estrogen to provide a more balanced hormonal profile.
- Superior to synthetic progestins in preventing endometrial hyperplasia, which may be caused by estrogen dominant hormonal imbalances. Synthetic varieties also negate some of the benefit of estrogen supplementation in correcting cholesterol problems.
- Works in conjunction with bio-identical estrogen to improve overall health, including blood cholesterol and lipid profiles.
- Can improve cases of myocardial ischemia, or the loss of blood flow to the heart as a result of arterial blockage. Synthetic versions of progesterone, such as medroxyprogesterone acetate, are ineffectual in this regard.
- Supplementation of naturally endogenous progestogens such as 17-alphahydroxyprogesterone caproate have also been used to successfully reduce the instance of premature birth in pregnant women. Progesterone supplementation has also been effective in the prevention of postpartum depression and postnatal illness.
- A Mayo Clinic study of women having previously taken micronized synthetic progestins found that subjects reported a 34% average increase in overall satisfaction when taking bio-identical progesterone. Anxiety, depression, and hot flashes were reported to have improved by larger margins. Instances of breakthrough bleeding were also reduced substantially.
- When combined with estradiol, progesterone has been found to have protective effects against coronary artery vasospasm. Medroxyprogesterone acetate does not. This is one of many unfortunate cases where the most commonly prescribed treatment is not necessarily the best.
In some cases, pregnenolone is also used in BHRT. This endogenous chemical is a precursor of many important hormones in the body.
Perimenopause is the period leading up to menopause, or the natural state of permanent infertility. Women may begin experiencing perimenopausal symptoms at different ages, and the phase may continue for as long as a decade before menopause actually occurs. During this period, the foregoing statements on progesterone are of particular relevance, as it is usually the most lacking hormone at this stage. Hormones may fluctuate wildly during perimenopause, and careful monitoring of blood hormone quantities is of paramount importance to ensure a balanced and complimentary dosage.
During perimenopause, lack of progesterone can lead to a condition known as estrogen dominance, which raises cancer risks. In addition to alleviating these risks, evidence has been presented that progesterone supplementation can raise bone mineral density in women experiencing osteoporosis.
Androgens, such as testosterone, are not only for men. They play a vital role in the health of women as well. Women receiving balanced androgen supplementation experience:
- Enhanced libido
- Lowered cholesterol levels
- Improved calcium retention and stronger bones
- Heightened levels of mental alertness and energy
- Protection against obesity and diabetes
- Increased immune function
The two chief androgens employed in female hormone replacement therapy are dehydroepiandrosterone (DHEA), and testosterone. ERT alone is often an incomplete treatment without the introduction of these hormones into a woman’s HRT regimen. This is because androgen production falls along with other hormones as a result of hysterectomies and the natural process of menopause. In order for HRT to affect an appropriate balance, these androgens must be replaced too. Like progestin, bio-identical androgen supplementation has been shown to reduce the risk of breast cancer and other malignancies. Recipients of bio-identical hormone replacement have a significantly lower chance of developing cancer than their untreated peers.
In spite of this, it is important that all factors be evaluated before hormone replacement therapy commences. All individuals have somewhat different chemical profiles, and we take careful precautions to ensure that our patients receive the correct treatment, and in the correct doses, before any schedule of supplementation commences. We approach all patients individually and personalize treatments for them.
Surveys have conclusively demonstrated that the vast majority of women prefer the bio-identical hormones to synthetic ones. In spite of media smear campaigns, the superiority of hormones matching those naturally found within the body are self-evident. Claims that bio-identical hormones are in any way pseudoscientific or merely equal to synthetic hormones can usually be traced back to the marketing campaigns of companies that profit from the sale of synthetic varieties.
Symptoms and signs of hormonal imbalance include:
- PMS, or premenstrual syndrome
- Weight gain
- High blood pressure
- Unstable mood
- Muscle loss
- Decreased libido
- Dysmenorrhea (painful intercourse)
- Vaginal dryness and thinning of the vaginal walls
- Night sweats
- Breast tenderness
- Problems with focus and concentration
- Painful joints
- Hot flashes
- Insomnia (sleep difficulties)
- Symptoms of perimenopause
- Low sex drive
Unlike patentable synthetic versions, bio-identical hormones are perfect molecular matches for the substances naturally endogenous to the body. Due to their lack of profitability to major drug companies, they receive little attention in the mainstream media. Bio-identical hormone replacement is an effective measure for improving the quality of life in individuals lacking proper natural hormone levels. Such deficiencies can be caused by the aging process, by invasive surgery such as a hysterectomy, by various diseases.
Molecular biology is an exact science, and even the slightest inaccuracy in chemical form will produce vastly different results in practical use. A synthetic hormone with a similar (but different) structure to its natural equivalent is not a safe or effective solution; hormonal supplements must be perfect matches to produce optimal results in human patients. To put the matter in lay terms, chemical reactions in the body depend greatly on how molecules fit together. The slightly altered chemical structure of patented synthetic hormones causes them to fit differently within receptor sites than natural versions, producing unreliable and often damaging results to the body.
Objective researchers and non-biased studies have long-held that bio-identical hormones are significantly better than synthetic versions. While bio-identical hormones are processed primarily from plant sources, they are perfect molecular matches to natural human hormones. This means that they also metabolize normally, producing a variety of health-promoting byproducts. Because these substances are completely natural, they cannot be patented and are thus rejected by many large pharmaceutical companies. Synthetic varieties, often derived from horse tissue, are not perfect molecular matches and thus pose serious health risks to human patients, but these are the hormones produced by most pharmaceutical companies.
While some studies have highlighted these facts superbly, many others have been conducted without regard to hormone replacement dosages or the exact chemical structure of the supplements employed. This has led to a great deal of misinformation being published about the efficacy of hormone replacement therapy overall. The media and drug companies are a big part of the problem in providing misinformation to patients about hormone restoration therapy. Take Premarin, for example-a medication prescribed for women who have undergone a hysterectomy or been through menopause. Premarin stands for “Pregnant Mare’s Urine.” In other words, freeze-dried horse urine. And for twenty years it was the number one drug prescribed in this country. It’s called ‘standard of care.’ But it’s really horse urine and not good for women.
One pivotal study, which turned out to be completely flawed, was The World Health Initiative, which was ended prematurely in 2002. The study examined the value and effect of hormones on women-except no hormones were used in this study. Hormones are naturally occurring substances in the human body that are released from one organ affecting another organ somewhere else in the body. This study used oral Premarin, or horse estrogens, and Provera, which is progestin, a chemical created in a lab decades ago, that has properties said to protect the uterus, but has since been shown to be a toxic chemical in women.” These are not considered bio-identical hormones, which is what should be used in hormone replacement therapy. Also the women used in the above mentioned study were in their late sixties and seventies and they already had advanced coronary artery disease. They called off the study because women were shown to suffer negative effects from the ‘hormone treatment.’ The media quickly interpreted the results to mean that hormones were bad for women and should be discontinued immediately. But truly all we learned from this study was this: If you’re a woman in your seventies, don’t take oral horse urine and toxic chemicals … a brilliant revelation. Of course, bioidentical estradiol, estriol, progesterone, and testosterone administered transdermally in a 50-year-old woman is a whole different ball game and now really is the true standard of care.
So what about the current controversy over hormone replacement therapy? “Synthetic and natural are not always opposites. You can make a synthetic natural hormone-bio-identical to what’s inside you-by building on an ingredient in wild yams to create progesterone, and from there, other natural hormones. But, wild yams on their own will never turn into progesterone, so beware of manufacturers who try to sell you a product with wild yam in it. You can eat it, drink it, bathe in it, and it’s never going to do what these lab-created hormones can do.”
One common practice is the addition of chemical side chains to an otherwise bio-identical hormone to make it patentable as a drug. This makes the substance profitable for a pharmaceutical firm to take to market, but can lead to serious health consequences for patients. The low profit potential of bio-identical hormones to large companies is also a reason for the lack of major studies on their efficacy – there is little institutional funding to bring about such studies. It is also an unfortunate fact that the results of studies can often be relied on to reflect the vested interests of the organization paying for the study. We can sort out all the misinformation out there and do what is right for you.
Testosterone Levels in Women
Most people associate testosterone with masculinity. Although it is classified as one of the androgens, it is actually a vital hormone for both men and women. Both produce and use testosterone, and both men’s and women’s testosterone levels peak during youth and decline with age.
Testosterone is a hormone secreted by the ovaries, adrenal glands and testes. It serves many purposes,ranging from sexual functions to findings that it can help control blood sugar and may also have an anticoagulant effect. Testosterone’s role in building muscle mass and bone density is important for women facing aging-related disorders such as osteoporosis and cardiovascular disease.
Testosterone’s most apparent purpose for both men and women is sexual. Many post-menopausal women lose interest in sexual activity, primarily due to diminished testosterone levels. Researchers report that women who receive testosterone replacement therapy after menopause experience an increase in sexual drive and response, frequency of sexual intercourse, number of sexual fantasies, and level of sexual arousal.
Accumulating medical evidence suggests testosterone plays an important role in cardiovascular health, especially in protecting against atherosclerosis and heart disease. Natural testosterone has been shown to lower blood pressure and it may increase the good HDL cholesterol while reducing total cholesterol. It improves circulation and slows tissue breakdown typically associated with aging.
Recent research suggests that testosterone may increase the bone’s ability to retain calcium. Women who experience very rapid bone loss are typically deficient in both estrogen and testosterone. It appears that both testosterone and estrogen independently improve bone density.
Testosterone contributes to our overall muscle tone. Prior to menopause many women experience the embarrassment of a leaky bladder. This problem may be related to diminished testosterone levels, because the pelvic muscles are particularly dependent on testosterone. Many women find that testosterone replacement, combined with Kegel exercises, strengthens and tones those muscles.
Most women begin to experience symptoms of testosterone deficiency after menopause, when their testosterone levels generally decline by about 50%. However, a variety of conditions can cause a decline long before menopause. Some of these conditions include childbirth, endometriosis, birth control pills, ovarectomy, depression, and abuse of alcohol and narcotics. Additionally, some medications may interfere with the bioavailability of testosterone, such as Provera, Prozac and Zoloft or other antidepressants, and some antipsychotic medications.
Typical symptoms experienced by women with low testosterone levels include decreased libido and other sexual complaints. Further signs of deficiency include a general lack of energy, loss of muscle tone and diminished overall vitality. Orgasms may be absent or significantly decreased. Sexual fantasy maybe significantly decreased or absent.
It is important to understand that symptoms of testosterone deficiency may arise even when a laboratory test indicates a “normal” level. The reason is that most lab tests do not address the amount of “free” testosterone available to deliver the desired benefits. “Free” testosterone refers to the amount of circulating testosterone that is most biologically available. In addition, the presence of other hormones can influence the levels of free testosterone.
Most of the research on testosterone replacement has focused on men. Many physicians still hesitate to prescribe testosterone replacement for women because of the potential virilizing side effects. While excessive doses of testosterone can lead to “masculine” characteristics, a typical woman’s dose should be so small that these effects are rare. Additionally, many of the reported side effects from testosterone are those associated with synthetic testosterone-like drugs, not natural bio-identical testosterone. While side effects are uncommon, they can include acne and hair growth.
Natural, or bio-identical, hormones have a molecular structure identical to the hormones that the body produces. Even though they may be synthesized in a laboratory they cannot be distinguished from those the body produces, and the body treats them as such. Synthetic drugs, on the other hand, are similar in molecular structure but are not exactly the same as the natural molecule. Because synthetic drug molecules differ from natural molecules, the body treats them differently, which can lead to side effects.
Today several options for testosterone replacement therapy exist. Many physicians believe that natural testosterone replacements are generally safer than and just as effective as synthetic testosterone. Natural testosterone replacement is available as custom compounded creams, gels, capsules, tablets, lozenges, suppositories, injections, and implanted pellets.
One way to help maintain, and possibly increase, testosterone levels is by reducing excess body fat. Weight- training can stimulate increases in the body’s testosterone levels in both males and females. Avoid excessive alcohol consumption.
No matter what form of replacement is administered, it is important to tailor the treatment to your specific needs. In women, this can be a complicated task because testosterone replacement frequently involves other hormones as well. To find out if you are experiencing symptoms of low testosterone, call our office at 305 332-7234 as Dr Mahl and his Associates has been trained to diagnose and treat inadequate testosterone levels.