Bio-identical hormonal replacement is a topic we as naturopathic doctors get plenty of questions about – their safety, and efficiency.
We’ve been told over the years that hormone replacement therapy is bad and harmful – isn’t this true?
In 2002, there was a study conducted by the Women’s Health Initiative, looking at the health benefits of hormones in women. This study was famously stopped early, as we saw an increase risk of breast cancer, strokes and heart attacks, and cognitive concerns such as impaired memory. Up until that point, many women were already on synthetic hormones, which caused women to stop their hormones, and doctors stopped prescribing them. This lead to a lot of confusion. What do we do? Women were still experiencing hot flashes, insomnia, anxiety, decreased libido, impaired memory, so a lot of them were prescribed either an anti-depressant or sedatives such as the benzodiazepines, in hopes of managing menopausal symptoms.
There are two important things to note with this study – they used oral hormones, synthetic hormones, and the average age in this study was early 60’s, although the average age of menopause’s around 51 years.
So… Are bio-identical hormones safe?
When we are using the body-identical forms of estrogens and progesterone, yes they certainly can be used safely – and can greatly improve quality of life. When we’re using the synthetic versions – premarin and medroxyprogesterone acetate (MPA) – this is where we run into issues. We have seen an increased risk of breast cancer in using MPA and premarin, compared to premarin alone, which was a reason for why we were originally timid about prescribing progesterone. However, we know synthetic progestins like MPA are not comparable to body-identical progesterone – the structure is not comparable between the two.
In 2012, NAMS (North American Menopause Society) stated support of the initiation of hormone therapy for treating menopausal symptoms around the time of menopause, and supporting bone health in women susceptible to osteoporosis. When given in healthy women aged 50-59 years, the risks are much smaller, compared to starting it later.
Speaking specifically to the safety of estrogen, it really does depend not the age of which we start estrogen, how we are administrating it, and the form used.
Where do bio-identical hormones come from? What are they made of?
Bio-identical hormones are plant-based, in that they are man-made from plants such as soybeans or wild yams. They are most identical to our naturally producing estrogens and progesterone. What is important, is that bio-identical estrogen and progesterone are biologically and chemically the same as our naturally occurring estrogen and progesterone.
How do you know if your levels are low?
Typically serum (blood) test to determine your basic levels – FSH, LH, estradiol, progesterone, DHEA, and total testosterone, as the bare minimum for an initial work-up. We can test via urine or salivary samples, however blood tends to be both a cheap and reliable test for these markers.
What may you feel if your progesterone is low?
Usually progesterone dips before estrogen does, and in such cases we can support by using body-identical progesterone first. We typically see an increase in anxiety, difficulties maintaining sleep, feeling more irritable or noticing more depression. These symptoms can be related to the beneficial effect progesterone naturally has on the GABA receptor in our brains – the calming neurotransmitter. We can also see more bloating and water retention with progesterone deficiency, as well as migraines prior to the period, heavy – sometimes with clotting – periods, and even a history of miscarriages, as it is related to whether or not you ovulated.
What may you experience with low estrogen?
This is where we can see more hot flashes, changes with mood, vaginal dryness and changes with libido, as well as an increased risk of osteoporosis, as estrogen is supportive of bone health. Other symptoms may include brain fog or changes with memory, thinning hair, and an increased risk for cardiovascular disease.
A proper assessment is necessary – what is safe and effective for one women, won’t be for all.
When it comes to hormones, its important to weigh out the risks and benefits, as what might be therapeutic for one women, may be harmful to another – based on family and personal medical history. In such case, I strongly advise being properly assessed by your healthcare provider qualified in prescribing hormones, both safely and effectively. For some women, BHRT can be the difference for greatly improving quality of life.
Have a question? We’d love to hear from you – firstname.lastname@example.org.
Dr. Alison Gottschalk, ND
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