What Is Bioidentical Hormone Replacement Therapy
Bioidentical hormone replacement therapy is the use of hormones to help resolve symptoms related to hormonal imbalance or decline in hormone production tied to aging. Certain hormone treatments are called bioidentical or sometimes natural because the types of hormones used are chemically identical to those produced by the human body.
Specific hormones that BHRT aims to increase or balance include those tied to reproduction and youth, such as estrogen , progesterone, and sometimes testosterone, dehydroepiandrosterone and adrenal hormones. During the years leading up to menopause, and then through this transition, a womans body produces less of these hormones , which may lead to symptoms like fatigue, hot flashes/night sweats, vaginal dryness and thinning bones. Various hormone therapy products are used to overcome these symptoms, some of which have been approved by the FDA and are available by prescription through health care providers, but many of which have not.
BHRT treatments include creams, lotions, injections, gels, sprats or tablets that have the goal of raising hormone levels back up to a more youthful state. Examples of popular bioidentical hormone replacement therapy products now on the market include Estrace, Premphase, Prempro, Activara and Vivelle-Dot, just to name a few .
What Are The Risks In Taking Hormone Replacement Therapy
Side-effects with HRT are uncommon. They may include the following:
- In the first few weeks some women may develop a slight feeling of sickness , some breast discomfort or leg cramps. These tend to go within a few months if you continue to use HRT.
- HRT skin patches may occasionally cause irritation of the skin.
- Some women have more headaches or migraines when they take HRT. This is usually reduced by using patches or gel rather than taking tablets.
A change to a different brand or type of HRT may help if side-effects occur. Various oestrogens and progestogens are used in the different brands. If you have a side-effect with one brand, it may not occur with a different one. Changing the delivery method of HRT may also help if you have side-effects.
There has been a lot of media attention to the risks of taking HRT. HRT can increase your risk of developing certain problems but this increase in risk is very small in most cases. These include:
Clots in the veins . This is a blood clot that can cause a deep vein thrombosis . In some cases the clot may travel to your lung and cause a pulmonary embolism . Together, DVT and PE are known as venous thromboembolism. Women who take combined HRT as tablets have an increased risk of developing a clot. You are more likely to develop a clot if you have other risk factors for a clot. These include being obese, having a clot in the past and being a smoker.
Who Shouldn’t Take Hormone Therapy
Hormone therapy is not usually recommended if you:
- Have or had breast cancer or endometrial cancer.
- Have abnormal vaginal bleeding.
Less common side effects of hormone therapy include:
- Fluid retention.
- Skin discoloration .
- Increased breast density making mammogram interpretation more difficult.
- Skin irritation under estrogen patch.
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What Are The Options For Treatment
Estradiol replacement is available in the form of pills, capsules, creams, gels, patches, and subdermal pellet therapy.
Testosterone replacement is available in the form of injections, creams, gels, and subdermal pellet therapy.
Dr. Garcia ONLY offers hormone replacement in the form of Estradiol and Testosterone Pellet Therapy. Why? because no other form of hormone replacement treatments can achieve the same steady blood levels 24 hrs a day, 7 days a week, for 4 to 6 months at a time. PERIOD. In fact, this is the closest form of hormone replacement therapy that mimics how your ovaries produced hormones.
Does Having Or Not Having A Uterus Make A Difference In Deciding What Type Of Hormone Therapy I Should Take
Yes, it does.
If you still have your uterus:
Progesterone is used along with estrogen. Taking estrogen without progesterone increases your risk for cancer of the endometrium . During your reproductive years, cells from your endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial cancer by making the endometrium thin. If you take progesterone, you may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously.
If you no longer have your uterus :
You typically won’t need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.
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Supporting A Healthy Hormone Balance
Our surroundings are constantly waging chemical warfare on our bodies, and it is imperative that we give our bodys functional systems the best chance they have at winning the battle. Chemicals known as endocrine disruptors are found in everyday objects such as toys and plastics, so they are difficult to avoid. Nonetheless, there are many ways we can support our hormones both before and after replacement therapy.
How To Avoid Transfer Of The Topical Hormone Creams To Others
Make sure to wash your hands well after applying your hormone creams. It is important to avoid transfer of the creams to your spouse, children, pets and others you may touch. In general, washing your hands well with hot water and soap will be sufficient. Scrubbing around the fingernails is almost important.
Avoid using estrogen and other hormone creams during sexual intercourse. Breast enlargement can occur in men regularly exposed to estrogen. Taking a shower and washing off hormone creams from the skin before sex is important to avoid transfer.
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What Are The Risks Of Hrt
The health risks of HRT include:
- Increased risk of endometrial cancer For women who have had a hysterectomy , this is not a problem
- Increased risk of breast cancer with long-term use
- Increased risk of cardiovascular disease
- Increase in inflammatory markers
- Increased risk of blood clots and stroke, especially during the first year of use in susceptible women
All women taking hormone replacement therapy should have regular gynecological exams . The American Cancer Society also recommends that women over age 50 should:
Causes Of Constant Menstrual Bleeding
A woman of childbearing age typically has a monthly period with menstrual flow lasting from 2 to 7 days. In some women, menstrual bleeding may be irregular, occurring either intermittently or continuously throughout the month. This abnormal bleeding pattern has several possible causes and is often due to hormonal problems. Although most underlying problems are not serious, a few may be cause for concern. If you experience prolonged bleeding or menstrual irregularity, talk with your doctor.
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Choosing The Right Hrt For You
It is important to find the correct HRT to help your symptoms.
A low dose of HRT hormones is usually prescribed to begin with. If you need to, you can increase your dose at a later stage.
Once you’ve started HRT, it’s best to take it for a few months to see if it works well for you. If not, you can try a different type or increase the dose. It’s really important that you talk to your GP if you have any problems with HRT.
Benefits Of Hormone Replacement Therapy
For many healthy adults who are experiencing moderate or severe menopausal symptoms, there are benefits to using hormone replacement therapy that may override potential risks of this treatment.
Medical experts note that the benefits of HRT can include:
- Relief from moderate to severe hot flashes
- Relief from vaginal dryness and discomfort
- Prevention of bone loss and bone fractures
- Protection against colorectal cancer
In addition, the American College of Obstetrics and Gynecologists notes that otherwise healthy people who are experiencing early menopause or estrogen deficiency may find HRT beneficial.
Hormone replacement therapy is recommended on an individual basis. It’s important to speak with a healthcare provider about the potential benefits and risks of HRT based on factors like your symptoms, medical history, and overall health.
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- Menopausal symptoms can be managed with education, lifestyle changes, support and hormone replacement therapy , also known as menopausal hormone therapy .
- In the early postmenopausal years, HRT is an effective therapy for menopausal symptoms. In most women with moderate to severe symptoms, the benefits outweigh the small increases in risk.
- The long-term use of HRT has some benefits, but also has some risks.
- The current role of HRT is for menopausal symptom relief, at the lowest effective dose and for the shortest duration required for the control of bothersome menopausal symptoms.
- The decision to use HRT, and for how long it should be used, must be based on individual assessment and needs.
The Risks And Benefits Of Balancing Cortisol
Your adrenal glands are located above your kidneys in your body. These tiny glands produce several different hormones including your stress hormones, cortisol and cortisone. Cortisone is the storage form of cortisol. Most patients have taken synthetic forms of cortisol in the form of anti-inflammatory medications, such as prednisone . Prednisone is synthetic and much more potent than your natural cortisol. If you are taking prednisone or a similar medication, it is important to work with your doctor if you wish to change your dose as stopping too quickly can be life-threatening.
In general, most patients with adrenal problems fall more into a grey area where there levels are considered normal but need improvement. To determine the best approach to balancing adrenal gland function a number of lab tests may be used.
Loss of cortisol in the urine has been associated with increased severity in autism and other health problems. Urine allows us to see how the hormones are breaking down in your body over a 24 hour period. Blood and saliva can be useful but are just snapshots of hormone levels.
These data suggest that altered cortisol excretion pattern and high level of corticosteroids in urine may probably be a consequence of altered hypothalamic-pituitary-adrenal axis function, which may contribute to the pathogenesis and affect the severity of autism.36
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Added Benefits Of Hrt
HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:
- diabetes taking HRT around the time of menopause reduces a womans risk of developing diabetes
- osteoporosis HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures, but it is not usually recommended as the first choice of treatment for osteoporosis, except in younger postmenopausal women
- bowel cancer HRT slightly reduces the risk of colorectal cancer
- cardiovascular disease HRT has been shown to reduce cardiovascular disease markers when used around the time of menopause.
About Hrt After Menopause
Postmenopausal hormone replacement therapy is a treatment used to help women relieve symptoms provoked with the end of ovarian hormone production.
Postmenopausal hormone treatment is usually prescribed as estrogen-only or a combination of estrogen and progesterone. To this day, doctors are hesitant to prescribe women androgens, such as testosterone.
There are various factors that may play a role in which treatment regimen women will undergo, including, but not limited to, medical history, diagnostic test results, symptoms experienced, and personal preferences.
Types of postmenopausal hormone therapy include oral administrations of pills or tablets vaginal insertions, including suppositories or creams as well as subcutaneous options, such as patches and gels among others.
HRT after menopause is not recommended for those who started perimenopause after the age of 45 and are not suffering from symptoms. It is also not for those who have a history of breast, ovarian, or uterine cancer blood clots strokes liver disease or unexplained vaginal bleeding.
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Menopause Symptoms And Hrt
Menopause symptoms that may be relieved by HRT include:
- hot flushes and night sweats
- vaginal dryness
- hair loss or abnormal hair growth
- dry and itchy eyes.
Other therapies, including vaginal oestrogen products, antidepressants or other medications, may be used depending on the symptoms and risk factors. Seek advice from your doctor.
Estrogen And The Cardiovascular System
Scientists are still learning about the actions of estrogen in the body. Studies have shown that estrogen affects almost every tissue or organ system, including the heart and blood vessels. Estrogens known effects on the cardiovascular system include a mix of positive and negative:
- Increases HDL cholesterol
- Promotes blood clot formation, and also causes some changes that have the opposite effect
- Relaxes, smooths and dilates blood vessels so blood flow increases
- Soaks up free radicals, naturally occurring particles in the blood that can damage the arteries and other tissues.
Estrogen probably affects the cardiovascular system in other ways that are as yet undiscovered. New research continues to give scientists and physicians more information and raise more questions about this important and controversial hormone.
Over the years, evidence was accumulating that suggested estrogen also helped protect women against heart disease. With heart disease is the number one killer among women over age 65, this is an important issue. Women develop heart disease 10 years later than men, but by age 65, their risk is equal to that of men.
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Who Can Take Hrt
Most women can have HRT if they’re having symptoms associated with the menopause.
But HRT may not be suitable if you:
- are pregnant it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50
In these circumstances, alternatives to HRT may be recommended instead.
Shortage Of Some Hrt Products
There are ongoing supply problems with some HRT products. For some products this is because of irregular supply while for others it’s a longer-term shortage. There are lots of different reasons why medicines can be in short supply. Work is happening with the pharmaceutical manufacturers who make the medicines to help the situation.
If your pharmacy cant supply the specific HRT product you’ve been prescribed, they may supply an alternative product. This will usually have the same ingredient, but may be made by a different manufacturer. Your pharmacy might also reduce the amount they provide you with to help ensure that as many woman as possible can get access to their required medication.
Disruptions in the availability of HRT will be worrying if it has been prescribed for you. However, there are always alternative options. If you are concerned about this contact your GP, pharmacist or specialist doctor to discuss the best treatment options for you.
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What Are Some Commonly Used Postmenopausal Hormones
The following list provides the names of some, but not all, postmenopausal hormones.
Estrogen
- Pills, Brand names: Cenestin®, Estinyl®, Estrace®, Menest®, Ogen®, Premarin®, Femtrace®.
- Creams, Brand names: Estrace®, Ogen®, Premarin®.
- Vaginal ring, Brand names: Estring®, Femring® .
- Vaginal tablet, Brand names: Vagifem®. Imvexxy®
- Patch, Brand names: Alora®, Climara®, Minivelle®, Estraderm®, Vivelle®, Vivelle-Dot®, Menostar®.
- Spray, Brand name: Evamist®.
- Modest improvement in joint pains.
- Lower death rate for women who take hormone therapy in their 50s.
Progesterone Also Helps With Menopause
One of the most troublesome symptoms of menopause is delayed or interrupted sleep.
ability to think clearly during the day.
This study also confirmed the results of earlier trials that showed progesterone had the ability to reduce the severity of night sweats, which can awaken people from an otherwise sound sleep.
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Is It Possible To Have Periods During Postmenopause
Menopause is recognized as a time when a woman finishes ovulating. As this in turn means the uterus lining no longer periodically thickens and sheds, it isn’t possible for woman to have a period.
During the phase known as the menopausal transition – a time that can last anywhere between two and ten years – experiencing sporadic periods is not a cause for concern. For example, while it can appear that the menstrual cycle has ended, bleeding might still be experienced as irregularly as six months after a previous bleed.
Venous Thrombosis And Hrt
Venous thromboses are blood clots that form inside veins. Women under 50 years of age, and women aged 50 to 60, face an increased risk of venous thrombosis if they take oral HRT. The increase in risk seems to be highest in the first year or two of therapy and in women who already have a high risk of blood clots. This especially applies to women who have a genetic predisposition to developing thrombosis, who would normally not be advised to use HRT.
Limited research to date suggests the increased risk of clots is mainly related to combined oestrogen and progestogen in oral form, and also depends on the type of progestogen used. Some studies suggest a lower risk with non-oral therapy or tibolone.
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How To Get Started On Hrt
Speak to your local GP practice if you’re interested in starting HRT.
You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first. However, a blood test to measure your hormone levels may be carried out if you’re aged 40 to 45. Blood tests may also be carried out to help diagnose suspected premature menopause if youre under 40 and have menopausal symptoms.
Your GP can explain the different types of HRT available and help you choose one that’s suitable for you.