Bioidentical Hormone Therapy
As the human body ages, it naturally slows down a little. While you may not experience any symptoms of menopause until you are in your 50s or even your 60s, you'll likely experience changes due to the aging process in your younger years. These signs can appear in women as young as 35. Menopause is your body's way of telling you that you reached the end of your reproductive journey. It means that you can no longer have biological children.
Menopause can also be associated with a number of symptoms, most importantly changes in menstruation. Every woman’s symptoms are different for every woman and include any of the following:
Vaginal dryness
Hot flashes
Chills
Night sweats
Sleep problems
Irregular periods
Mood changes
Weight gain and slowed metabolism
Thinning hair and dry skin
Loss of breast fullness
Generalized aches and pains that make it hard for you to have fun with your loved ones and to do all your favorite activities.
Weight gain for no explained reason linked to body producing fewer calming hormones to regulate metabolism.
The severity of symptoms is directly linked to how well a person has adapted to stress and the demands she/he has placed on their body over the span of their life. The severity of hormones being out of balance is directly linked to how disconnected a person with their mind, body, and spirit where as the body ages it can no longer mask the distress it has been under for a long time.
It is easy to simply test sex hormones after menopause or when a man has reached middle age, and then supplement with hormones based on inevitable deficiencies. However, this approach is akin to placing a bandaid on the problem, rather than getting to the root cause. Sometimes it is the only option, after other testing and treatments have been tried; and sometimes, it does in fact improve health outcomes. But if your goal is achieving optimal well-being, looking at how your whole body functions is always the safest and most effective approach to permanently resolve your symptoms.
What is BHRT?
Bioidentical hormone replacement therapy (BHRT) is is the use of hormone therapy that is considered to be equivalent to the hormones that our body naturally produces (aka., bioidentical). Conventional hormone replacement therapy (HRT) on the flip side uses synthetic chemicals which are not considered bioidentical -- an exact mimicry of the hormones our body naturally makes. Both BHRT and HRT include estrogen, testosterone, and progesterone, the hormones associated with reproduction stopping, and prescribed to decrease your symptoms.
Some of the products prescribed include lotions, gels, tablets, and creams that manufacturers design for home use. Creams, gels, and lotions are safe to use right on your skin. You'll follow the recommendations on the package to apply the proper dose and then gently massage it into your skin.
Not all people feel comfortable treating themselves at home, which is why some physicians also offer injections for those who want to use these hormones. Instead of taking a pill or applying lotion to your skin, you can schedule an appointment and come into the office for your injection. The number of injections or appointments that you need will depend on your symptoms and the dosage that is right for you.
What Are the Pros and Cons of hormone therapy
Advocates of BHRT believe our body can more easily assimilate these exogenous “bioidentical” hormones and benefit a great deal more than with conventional HRT. They are also considered a safer alternative to synthetic hormones associated with an increased risk for hormone-induced cancers (i.e., breast, uterine), cardiovascular complications, high blood pressure, headaches, acne, and digestive issues. Synthetic hormones can also wreak havoc on your libido and make it difficult or impossible for you to feel sexually aroused.
BHRT may help decrease bone loss in the short term, but not necessarily with long-term use. By better regulating hormonal balance, BHRT can help increase energy and mental clarity in the short term.
It is important to be prudent with prescribing any type of hormone replacement therapy in people with known risk for developing hormonal cancers such as those with a family history or genetic predisposition, it is equally important to note that the studies that showed increased cardiovascular risk generally only tested Estrogen in combination with Progestins (a synthetic version of progesterone), rather than Progesterone, and therefore only tell us about the risk of non-bioidentical hormone therapies (aka., synthetic chemicals). As a result, the cardiovascular risk of BHRT is not truly known. It's also important to note that cardiovascular risk is related to initiation of hormone replacement only at the onset of menopause. We know now the sooner treatment is initiated, the lesser the cardiovascular risk, and in fact, cardio-protective aspects of hormone replacement might be observed when starting HRT immediately following menopause. All in all, there are potential benefits to BHRT when compared to conventional HRT, as illustrated by both research and patient accounts.
Ultimately, hormone replacement is not recommended for long term use since it does not address the root cause. Functional medicine approaches menopausal hormonal changes from a unique lens since it also looks at symptoms of hormonal imbalance linked to both the adrenal gland, liver, and thyroid which can mimic sex hormone imbalance symptoms such as:
hot flashes
night sweats
fatigue
insomnia
weight gain
As the ovaries stop producing sex hormones (estrogen, progesterone, and testosterone), the adrenal glands become responsible for the majority of hormonal production. While it is inevitable that the ovaries will stop producing hormones at some point in our life, it is not inevitable that a person will experience extreme symptoms as a result. The health of our adrenal glands is an important determinant of menopausal symptoms. In addition to sex hormones, the adrenal glands are also responsible for producing several other hormones in the body, including cortisol. Cortisol is a hormone that is produced in response to acute and chronic stress -- physical, emotional, and environmental. In addition, both cortisol and sex hormones are produced from the same substrate (chemical precursor): cholesterol. This means there are two rate limiting steps to producing appropriate post-menopausal hormones:
The amount of Cortisol our body is generating in response to stress is linked to how much cholesterol is being turned into cortisol versus into sex hormones.
Thyroid function changes in relationship to circulating sex hormones, and also changes with age.
The overall health of our adrenal glands and thyroid plays key roles in menopause. For example, if a person has been under high levels of stress for a long period of time, it will naturally cause cholesterol circulating in the bloodstream to be increasingly used to produce the stress hormone cortisol and shift away from sex hormone production. This deficient in optimal sex hormone levels caused by a chronic demand for cortisol can cause menopausal symptoms. In this case, it is significantly more effective to figure out how to cut down drastically on the physical, emotional, and/or environmental insults which are causing the body to demand more cortisol production than to just presume hormonal replacement is the key solution.
It is also more important to address the health of the thyroid gland than to jump to presuming HRT is the answer to treating various symptoms since otherwise, it will cause the thyroid to be further neglected and worsen the overall long-term health prognosis for the patient.
As a result, a functional medicine provider will most often test adrenal health, thyroid function and sex hormone levels. Depending on the specific patient’s overall presentation, the practitioner may also recommend testing for elevated levels of inflammation, food intolerances, and environmental toxins, as these also impact hormone production and metabolism in the body.
It is easy to simply test sex hormones after menopause, and then supplement with hormones based on inevitable deficiencies. However, this approach is akin to placing a bandaid on the problem, rather than getting to the root cause. Sometimes it is the only option, after other testing and treatments have been tried; and sometimes, it does in fact improve health outcomes. But if your goal is achieving optimal wellbeing, looking at how your whole body functions is always the safest and most effective approach to permanently resolve your symptoms.
AUTHOR
Dr. Payal Bhandari M.D. is one of U.S.'s top leading integrative functional medical physicians and the founder of SF Advanced Health. She combines the best in Eastern and Western Medicine to understand the root causes of diseases and provide patients with personalized treatment plans that quickly deliver effective results. Dr. Bhandari specializes in cell function to understand how the whole body works. Dr. Bhandari received her Bachelor of Arts degree in biology in 1997 and Doctor of Medicine degree in 2001 from West Virginia University. She the completed her Family Medicine residency in 2004 from the University of Massachusetts and joined a family medicine practice in 2005 which was eventually nationally recognized as San Francisco’s 1st patient-centered medical home. To learn more, go to www.sfadvancedhealth.com.