Hormone replacement therapy

Bioidentical hormones — are they right for you?

by Marcelle Pick, OB/GYN NP

In recent shows, Oprah has brought bioidentical HRT onto center stage. As a result, we’re now deluged with calls about bioidentical hormones. The basic question women ask is, “Are they for me?”

This isn’t the first time we’ve seen a sudden spark of interest in bioidenticals. In her books, Ageless, The Sexy Years, and Breakthrough, and in media appearances to promote them, Suzanne Somers describes how bioidentical hormones relieved her menopause symptoms. She also makes it clear that she intends to stay on them for the rest of her life.

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

So let’s explore what we’ve learned about bHRT and help you determine for yourself if it’s a good option for you.

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. By contrast, synthetic hormones are intentionally different. Drug companies can’t patent a bioidentical structure, 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 in the kind of hormone replacement therapy typical of synthetic hormones. This is often a one-size-fits-all dosage regime.

In our practice, we have had the greatest success with an individualized approach. We begin with laboratory tests of hormone levels (a so-called “hormone panel”). When warranted, we then prescribe a precise dosage of bioidentical estrogens, progesterone, testosterone, and/or DHEA that is prepared at a registered compounding pharmacy. Each patient is then 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 first step to 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. We have found that about 85% can 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 as the foundation to her health.

In our Personal Program for Hormonal Imbalance, we’ve developed a three-pronged approach that supports a woman’s hormonal pathways upstream of where problems arise and develop into full-blown symptoms requiring stronger hormonal replacement therapy. (Our dietary guidelines are based on the latest research in clinical nutrition and dietary endocrinology.) Our Essential Nutrients fill in the nutritional gaps so common in our modern diet. And our Herbal Equilibrium offers phytocrine support to rebalance all three of the major sex hormones most prone to disharmony in perimenopause and menopause: estrogen, progesterone, and testosterone.

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

Either way, it’s important that the hormones be used in addition to the combination approach outlined above. Note that Suzanne Somers and Oprah are among this minority — they began with a healthy diet and lifestyle that supported the endocrine system, but still experienced intractable symptoms.

We don’t recommend that any hormones be used long-term unless essential for symptom relief, 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 than synthetic hormones?

We long ago concluded that the answer to this question is yes. But that doesn’t mean bioidentical hormones are perfect.

The great appeal of bioidentical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing side effects. Synthetic hormones are quite strong and often produce intolerable side effects. Moreover, the compounded bioidentical hormones can be matched individually to each woman’s needs — something that’s just impossible with mass-produced products.

Are bioidentical hormones safer than synthetics?

European medical studies suggest that yes, bioidentical hormones are safer than synthetic versions. This makes perfect sense. But we must be cautious here, because they have not been well studied, especially for long-term use. And in any case, we recommend that women never think of any drug as completely safe.

Let us note here that the WHI studies on the effectiveness and health risks of HRT were based on synthetic/equine-based hormones, and the average age of the women at enrollment was 63. These details did make a difference in their risk — read our article on the risks of HRT for our perspective on these studies.

Can bioidentical hormones be used for breast cancer patients?

The pendulum has swung so far that today, 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 such women are given anti-estrogen drugs.

Dr. Dixie Mills, who co-developed Women to Women’s Personal Program, feels that we just do not have enough data to rule out HRT in every case, and prefers to look at each woman’s particular situation, history, pathology, and blood work.

Dr. Mills has breast cancer patients who, like Suzanne Somers, use low-dose bioidentical hormones by choice. These women have researched the issues, discussed them with their healthcare provider, and made a well-informed decision for themselves. (For more insight on this topic, see Dixie’s articles on estrogen and breast cancer and progestins and breast cancer.)

Case study

Janet was a 54-year-old woman who came to us with severe menopausal symptoms. We changed her diet to increase her protein and vegetables and reduce carbohydrates, added a pharmaceutical-grade nutritional supplement, and did a complete blood hormone panel.

At her first follow-up visit six weeks later, Janet definitely felt better, but she still suffered too many hot flashes and sleepless nights. Our next step would have been to increase her soy intake, but Janet wanted immediate relief and chose to try bioidentical hormone replacement therapy.

After reviewing 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, declaring she hadn’t felt this good since her early 30’s.

More than a year later, 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.

So — are bioidentical hormones for you?

At Women to Women, our goal is to help inform women about their options so that they can make the choice that’s best for them. A woman’s hormonal balance is ideally in a dynamic equilibrium that shifts 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 equipped and programmed for balance and wellness. So we recommend beginning with the gentlest form of support possible to allay your discomfort and tweaking it as you go. We’ll support you in any way we can, each step of the way. The good news is that women can feel incredibly well right through menopause.

 

Original Publication Date: 03/24/2004
Last Modified: 03/11/2010
Principal Author: Marcelle Pick, OB/GYN NP