Jane is a 48-year-old female who presented to our clinic with complaints of fatigue, irregular menstruation, headaches, low libido, difficulty sleeping, and weight gain. After conducting a thorough medical history and physical exam, blood work revealed that Jane was low in progesterone, estrogen, and testosterone. She was started on a regimen of intradermal pellet bioidentical hormone therapy and within three months, Jane’s symptoms had improved dramatically.
Synthetic vs. Bioidentical Hormones
Hormones, including progesterone, estrogen, and testosterone, are chemical messengers that are secreted in the bloodstream and exert their effects on various tissues and body systems. Bioidentical hormones are those that have been manufactured to be molecularly identical to those produced in the human body—typically sourced naturally from substances such as wild yams. It is important to note that “bioidentical” does not refer to the source of the hormone, but rather the chemical structure of the hormone itself. This distinction is important, as conventional or synthetic hormones such as those used in traditional hormone replacement therapy are not molecularly identical to the hormones produced by the human body, and, as such, do not convey the same actions and effects as naturally occurring hormones. Bioidentical hormone replacement therapy, or BHRT, is used to treat a wide variety of concerns, most notably post-menopausal symptoms such as hot flashes, irritability, and vaginal dryness. In men, BHRT testosterone treatment can improve sleep, mood, and libido and decrease muscle wasting.
Why Would I Need Hormone Therapy?
Many hormones, including estrogen, progesterone, and testosterone, decline naturally as we age. And although this decline is “natural” and part of the age-related process, with the general increase in lifespan, some women may spend up to 1/3 of their lives in a hormone-depleted state. Along with the symptoms associated with hormone decline such as hot flashes, vaginal dryness, and mood changes, declines in hormones are associated with risk factors for other diseases such as cognitive decline, decreased bone density, general inflammation, elevated blood pressure, and reduced glucose tolerance. In men, age-related declines in testosterone are associated with heart disease, atherosclerosis, neurodegenerative disorders, and decreased insulin sensitivity.
The Safety of BHRT
In 2002, the largest randomized clinical trial on hormone therapy in women aged 50–79 was published. The Women’s Health Initiative, or WHI, sent shock waves throughout the medical community, as its results originally demonstrated an increased risk of cardiovascular disease, blood clots, and breast cancer in patients undergoing traditional hormone replacement therapy. These results led to a dramatic decrease in the use of hormone replacement therapy. Newer studies and analyses of the original WHI data, however, have found several flaws with the research design.
For one, only one formulation of synthetic estrogen (conjugated equine estrogen, a hormone derived from horses) and one formulation of synthetic progesterone (medroxyprogesterone acetate) were evaluated. In addition, only the oral forms of these hormones were evaluated. When taking an oral form of hormone therapy, the hormone must first be processed and metabolized by the liver. This can significantly alter the chemical structure of the hormone, as well as its side effect profile. Other flaws in the research design include the limited enrollment of women under 60 years of age or fewer than 10 years from the onset of menopause. In addition, the study failed to look at other causes for its findings of breast cancer, heart disease, and blood clots, including smoking status and the presence of other chronic illnesses.
A Lobo et al. (2016) follow-up study reported that the findings of the original WHI have mostly been negated. Indeed, in 2020, the New England Journal of Medicine published a review article stating that in further analyses of WHI data, there was no significant increase of risk in estrogen and progesterone therapy among those initiating hormone therapy before the age of 60 or within 10 years of menopause. Additionally, Cochrane review data concluded that hormone therapy is associated with a reduction in cardiovascular disease and mortality.
More importantly, the WHI and several follow-up studies have failed to include bioidentical hormone therapy. Current data on bioidentical hormone safety suggests that treatment with these hormones is associated with a decreased risk of cancer, heart disease, and other medical conditions. Indeed, even women with a personal history of breast cancer may be candidates for bioidentical hormone therapy after careful evaluation with their clinician.
How Do I Take Bioidentical Hormones?
Bioidentical hormones are available in a variety of formulations, including topical creams and gel, transdermal patches, intradermal pellets, troches, and oral medications. Each formulation is dosed accordingly. For example, a patient may need to apply a topical cream every morning or evening, while another patient with intradermal hormonal pellets needs to have the pellets placed once every 3–6 months. It is best to have an in-depth conversation with your clinician about what formulation of bioidentical hormone therapy is right for you.
How Do I Know if I May Benefit from Hormone Therapy?
Prior to initiating hormone therapy, your clinician will perform a thorough history and examination, including blood, urine, or saliva testing to assess your hormone levels. However, symptoms that may suggest a hormonal imbalance may prompt a visit to your clinician. Common symptoms of estrogen imbalance include hot flashes, vaginal dryness, poor memory and concentration, insomnia, joint pain, acne, weight gain, fatigue, an increase in urinary tract infections, and fluid retention. Progesterone and testosterone imbalances in women can manifest as wrinkles, body aches and pain, loss of muscle tone, fatigue, decreased libido, anxiety, mood swings, depression, sugar cravings, headaches, brain fog, and irregular menstrual cycles. In men, symptoms of fatigue, loss of libido, depressed mood, muscle loss, insomnia, and erectile dysfunction are common symptoms of low testosterone.
Bioidentical hormone therapy provides women and men a holistic approach to treat a myriad of symptoms commonly associated with aging, including fatigue, brain fog, vaginal dryness, low libido, depression and anxiety, and sleep difficulties. When prescribed appropriately, bioidentical hormone therapy is associated with few adverse effects and is even associated with lower risk of certain cancers, heart disease, and osteoporosis.
Meghan Chafee, APRN, and Alina Schneider, APRN, practice at the Center for Holistic Healthcare in Glastonbury. They provide patients with a variety of BHRT options including topical creams and pellet insertion.
Visit us on the web at: ctrforholistichealthcare.com or contact us at 860.430.5300 for more information.