What Are Bio-Identical Hormones?
Suzanne Somers brought bio-identical hormones onto center stage. In her books, Ageless and The Sexy Years, and in media appearances to promote them, she described how bio-identical hormones relieved her menopause symptoms. She also makes it clear that she intends to stay on them for the rest of her life. She continues to be a wonderfully positive spokesperson for lifestyle change and wellness.
Oprah also stepped forward in the past to educate women about the importance of first educating themselves about the body’s changes in the peri-menopausal and menopausal years and then secondly making a decision to improve their lives by managing any symptoms they may be having. She has also become a proponent for bio-identical hormone replacement!
The basic question women ask is, “Are they for me?” Let’s explore what we’ve learned about bioidentical hormone replacement therapy (BHRT) in the years we’ve used it in our clinical practice, and help you answer that basic question for yourself.
Bio-identical hormones start as extracts from soy or yams and are then manufactured in the lab to have the same molecular structure as the hormones made by your own body. In contrast, pharmaceutical companies can’t patent a bio-identical structure, so they invent synthetic hormones like Premarin, Prempro and Provera, the most widely used examples. These synthetic hormones are manufactured to be intentionally different in their molecular structure so they are “unique” and can be patented – and make money – LOTS of money!
Unfortunately, synthetic hormones have several problems – first, they generally come in fixed doses that are “one size fits all”, and we all know that each of our body’s are unique! Second, and the major problem with changing the molecular structure of a hormone and making a synthetic chemical is that they frequently cause unwanted, and often dangerous, changes in the body – proven in the Women’s Health Initiative Study – increases in cancer, dementia, and other bad side effects!
Although bioidentical hormones have been around for years, most practitioners are unfamiliar with them.
In our practice, we have had the greatest success with an individualized approach.
We practice scientific medicine and never guess where your levels might be by clinical symptoms as this is as useless as trying to guess your cholesterol level or your blood pressure!! We begin with laboratory tests of hormone levels, adrenal function, thyroid levels, and vitamin D. We frequently do testing for adrenal and hormone levels through Saliva. This is a more sensitive method of testing and actually measures the unbound or active hormones in the central part of your body rather than the bound or inactive hormone levels circulating in your blood. When warranted by test results, we then prescribe a precise dosage of bio-identical progesterone, estrogen, testosterone or DHEA that we feel are necessary and sufficient to balance your levels. Sometimes these are combined into one cream that is made specifically for each individual at a compounding pharmacy.
Each patient is then monitored carefully through regular follow-up hormone levels to ensure we get symptom relief at the lowest possible dosage to maintain long-term safety. In the initial stages, we will do a hormone panel every three months. Once balance is restored, we may only do one panel a year at an annual visit.
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, or necessarily safer if not monitored regularly!
The great appeal of bioidentical hormones is that they are natural, and our bodies can metabolize them as it was designed to, minimizing side effects. Synthetic hormones are quite strong and often produce intolerable side effects. Moreover, the compounded bio-identical 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?
With proper scientific monitoring the answer is yes!
European medical studies suggest the same – bio-identical hormones are safer than synthetic versions. This makes perfect sense. Why would a human want to use hormones derived from horses whose hormone composition is completely different? Unfortunately there are also patients who try to manage this on their own by buying hormone creams on the internet and get into trouble with side effects, and long term who knows what may be the adverse outcomes – even Suzanne Somers developed breast cancer! Did this need to happen? I can’t say, but I do think careful monitoring is critical to long term safety. The first tenet of my Hippocratic oath is “First Do No Harm” and I hold that tenet as sacred!
Further, there are physicians who prescribe bioidentical hormones just as they did synthetic ones – without measuring values, and this can lead to problems as well! I have seen women who have come to me from other physicians with levels of estrogen that were sky high – similar to synthetic hormones – and this puts them at the same risk for cancer and other bad outcomes!
No physician would prescribe male hormone replacement without measuring levels before and during therapy, much less prescribe insulin or cholesterol lowering medication – without first measuring levels!! It makes absolutely no sense to me to try to prescribe and manage female or stress hormones without measuring and following appropriate levels – you are just guessing!!
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 pharmaceutical-grade nutritional supplements, and did a complete hormone evaluation.
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 was to add bio-identical hormone replacement therapy.
After reviewing her hormone panel we placed Janet on a combination of bio-identical estriol (the weakest one of the three forms of estrogen), DHEA and progesterone, all in cream form. Six weeks later Janet came back for another follow-up. “I feel fabulous,” she said, explaining she hadn’t felt this good since her early 30’s.
A year later Janet still feels great. She’s carefully compliant with her diet and exercise regime, and takes her bio-identical hormones faithfully. Her latest hormone panel shows she’s still in balance and there is 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 balanced, but it’s a very effective solution.
What do I recommend?
The great majority of women can re-balance their hormones without the use of drugs. We have found that about 85% can find relief through an approach that combines medical-grade nutritional supplements, gentle bioidentical hormone support, preferably in a compounded form personalized to their needs by an experienced practitioner, and dietary and lifestyle changes. We recommend that every woman start with this combination approach as a foundation of health.
What about bio-identical hormones for breast cancer patients?
The pendulum has swung so far that today, very few doctors will prescribe any type of HRT — synthetic or bio-identical — 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.
I feel that we just do not have enough data to rule out HRT in every case, and I prefer to look at each woman’s particular situation, history, pathology and blood work. Often when hormones are measured these women have markedly elevated natural estrogen levels – either from over production, or from poor estrogen metabolism. This places them at a very high risk for a recurrence in the second breast!
A guided approach to improve diet, exercise to encourage weight loss, and the addition of nutritional supplements to improve estrogen metabolism and liver excretion to normal levels while balancing estrogen and progesterone levels often relieves symptoms as well as lowering the risks of the elevated hormone levels long term!
I feel another vital element in breast cancer survivors is to evaluate for stored environmental toxins that are the root cause of all cancers – these include heavy metals like Lead and Mercury, BPA from plastic beverage bottles, pesticides from residue in foods or spraying our lawns for dandelions or our houses for bugs, and even household toxins like fluoride from drinking water and chlorine in tap water and household cleaners.
Some breast cancer patients, like Suzanne Somers, continue to use low-dose bio-identical hormones by choice. These women have researched the issues, discussed them with their doctor, and made a well-informed decision for themselves. Bio-identical progesterone use in breast cancer can actually be preventive!
Are Bio-Identical Hormones Right for You?
At Renew, our goal is to help inform you about your options so that you can make the choice that’s best for yourself. Hormonal balance is a dynamic equilibrium that shifts from day to day, week to week, and through the years, influenced by multiple life events. When you give your body the support it needs it can heal 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 you can feel incredibly well through menopause and beyond.
I plan to be in great shape and feeling well in my 90’s as many of my patients now do – I invite you to join us!!