Hormone replacement therapy

Bioidentical hormones — are they right for you?

by Dixie Mills, MD, FACS

Celebrities like Oprah Winfrey and Suzanne Somers have brought bioidentical HRT onto center stage. Whenever a talk show, book, blog or news magazine highlights bioidentical hormones, we’re deluged with calls about bHRT. Women may not have heard about this option for menopause symptoms, and many are asking, “Is bHRT right for me?”

We’ve used bioidentical hormone replacement therapy for nearly 25 years in our clinical practice, and many patients have had great success with it. But there are many different forms of bioidentical HRT that work in a variety of ways. Because each woman responds according to her unique physiology, we’ve found the best results when treatment is customized to the individual needs of the patient. It’s also important to understand that while bHRT works well for some women, others need more support — or different kinds of support — to get the same relief.

Just what are “bioidentical hormones”?

Bioidentical hormones are manufactured in the lab to have the same molecular structure as the hormones made by your own body. This makes them unlike synthetic hormones which are intentionally made to be different. That’s because drug companies can’t patent a bioidentical structure to make it exclusively theirs, so they invent synthetic hormones that are patentable (Premarin, Prempro, and Provera being the most widely used examples).

Though bioidentical hormones have been around for years, most practitioners are unfamiliar with them. There are several branded versions now available for use though their one-size-fits-all dosage regime is very similar to that of synthetic hormones. But in our practice, we use an individualized, patient-centered approach. We begin by testing hormone levels (hormone panel) and when warranted, we prescribe a precise dosage of bioidentical estrogens, progesterone, testosterone, and/or DHEA. These formulations are prepared at a registered compounding pharmacy and each patient is monitored carefully through regular follow-up hormone panels to ensure she gets symptom relief at the lowest possible dosage. In the initial stages, we will do a hormone panel every three months. Once balance is restored, we’ll do one panel a year at the time of the annual exam.

Is bHRT the only way to achieve hormonal balance?

Bioidentical hormones can work wonders, but they aren’t necessarily the first place to turn when hormonal imbalance is a problem. In our experience, the great majority of women can rebalance their hormones without the use of drugs, and even without HRT — in any form. About 85% of the women we work with find relief through a natural approach that combines medical-grade nutritional supplements, gentle endocrine support, and dietary and lifestyle changes.

We recommend that every woman start with this combination approach to create a solid foundation for her health. In our Personal Program for Menopause, we’ve developed a three-pronged approach that supports a woman’s hormonal pathways “upstream” of where problems arise. This can head off full-blown symptoms that could require the stronger and more invasive hormonal replacement therapy. With dietary guidelines that are based on the latest research in clinical nutrition and dietary endocrinology, the Program provides:

• Essential Nutrients to fill in the nutritional gaps left by our modern diet.
• Herbal Equilibrium with plant-based support to rebalance the three major sex hormones most likely to fluctuate in perimenopause and menopause: estrogen, progesterone, and testosterone.

Even with this foundation, a minority of women will need to temporarily add prescription-strength hormone supplements for complete relief, at least through a transition period. For this, we recommend bioidentical hormones, preferably in a compounded form personalized to their needs by an experienced practitioner. If you can’t find a practitioner to prescribe compounded bHRT, there are now numerous trademarked bHRT options that conventional practitioners can prescribe.

Either way, it’s very important that any hormones be used in addition to the combination approach outlined above. Note that celebrities like Suzanne Somers and Oprah who’ve talked openly about bHRT began with healthy diets and lifestyles that supported their endocrine systems, but still experienced intractable symptoms.

We don’t recommend that any hormones be used long-term unless essential for symptom relief and quality of life, and then only with a complete risk assessment. We also don’t support the idea that bioidentical hormone therapy should be used indefinitely as some kind of “fountain of youth.”

Are bioidentical hormones “better” and safer than synthetic hormones?

We long ago concluded that the answer to these questions is yes. But bioidentical hormones aren’t perfect. Synthetic hormones are quite strong and often produce intolerable side effects but bioidentical hormones are natural, and our bodies can metabolize them, which minimizes side effects. Compounded bioidentical hormones can also be matched to each woman’s needs — which is just impossible with mass-produced products.

European medical studies suggest that bioidentical hormones are safer than synthetic versions. But because they have not been well studied, especially for long-term use, we recommend that women never think of bHRT or any drug as completely safe.

Can bioidentical hormones be used for breast cancer patients?

Very few practitioners will prescribe any type of HRT — synthetic or bioidentical — for women who have had breast cancer or even a family history of breast cancer. In fact, many are given anti-estrogen drugs.

As a breast-health expert who co-developed Women to Women’s Personal Program, I think that we just do not have enough data to rule out HRT in every case. So I prefer to look at each woman’s particular situation, history, pathology, and blood work.

I’ve had breast cancer patients who, like Suzanne Somers, use low-dose bioidentical hormones by choice. These women have researched the issues and discussed them with their healthcare providers in order to make well-informed decisions for themselves.

Case study

Patient: Janet, 54-years old, with severe menopausal symptoms.

Recommendation: After a complete hormone panel, we suggested diet changes to increase protein and vegetables, and reduce carbohydrates, and added a pharmaceutical-grade nutritional supplement, and did a complete blood hormone panel.

Follow-up visit at six weeks: Janet definitely felt better, but still suffered too many hot flashes and sleepless nights. We wanted to increase her soy intake, but Janet wanted immediate relief and chose bioidentical hormone replacement therapy.

We reviewed her hormone panel, we placed Janet on a combination of bioidentical estradiol (one of the three forms of estrogen), testosterone, DHEA and progesterone, all in cream form. Six weeks later Janet came back for another follow-up. “I feel fabulous,” she said, and declared she hadn’t felt this good since her early 30’s.

Follow-up visit at one year: Janet still feels great. She’s carefully compliant with her diet and exercise regime, and takes her bioidentical hormones faithfully. Her latest hormone panel shows she’s still in balance, and there is currently no need to adjust her dosages.

Not every patient is as easy to help as Janet. Sometimes we have to adjust the formulas three to five times to get it right. But for women whose quality of life is profoundly diminished by menopausal symptoms, bHRT is a very effective solution.

And so — are bioidentical hormones for you?

Ideally, your hormonal balance is dynamic, shifting from day to day, week to week, and through the years. When you give your body the support it needs, it can effectively reset itself, because it’s programmed for balance and wellness.

We recommend beginning with the gentlest form of support possible to relieve your most distressing symptoms, and then adjusting as you go.. The good news is that you can feel wonderful throughout your midlife transition.

 

Last Modified Date: 08/01/2012
Principal Author: Dixie Mills, MD, FACS