Natural Bioidentical Hormones are one of the key answers to the issues with aging. Our mission is to bring the cutting-edge technology of today and the tried and tested secrets of tradition for complete hormone balance and optimal health. We accomplish this by utilizing Bioidentical Hormones to fulfill that mission for you.
WHAT IS A “BIOIDENTICAL” OR “BIOEQUIVALENT” HORMONE?
Not all hormones are created equally. Bioidentical or Bioequivalent are terms that describe the technical molecular structure of hormones being an exact copy of what your body makes. Your body recognizes the hormone, and the potential for negative side effects are much less. The alternative is a “synthetic” hormone that has been often greatly altered chemically and affects the body differently with a larger chance of side effects and disease.
WHAT ARE THE DIFFERENT TYPES OF HORMONE REPLACEMENT THERAPY (HRT)?
There are numerous HRT delivery methods – each has its pros and cons:
CREAMS & GELS – These deliver hormones through the skin. One pro is that the hormone bypasses the liver and goes straight into the body. One con is that the levels can be very inconsistent.
PATCHES are a common route of HRT, with a patch placed on the skin to deliver hormones. The patch keeps levels consistent for around three to four days. The patch must be used twice weekly and can cause adhesive allergies.
HORMONE INTRAMUSCULAR INJECTION – One pro is the ability to adjust the dose frequently and in the hands of an experienced physician, the levels can in fact be kept consistent. One con is the need to inject multiple times a month.
ORAL forms of the hormones can also be compounded. One pro of an oral form is the high absorbability and the relative convenience of a daily pill. One con of oral forms is the tendency towards extreme variability in hormone levels, even with an experienced physician.
BIOIDENTICAL SUBCUTANEOUS HORMONE PELLETS – This is a less common, although burgeoning way to deliver hormone in the body. A doctor surgically places small pellets under the skin that deliver hormones constantly. The hormones are constantly and consistently delivered into the body in a steady stream. This means there is no need to take a pill or remember a cream or patch. One con is that the procedure, however easy, is still a surgical procedure and has a few days of needing to care for the insertion site, with minimal exercise and avoidance of bath tubs and swimming pools.
HOW WILL I BE MONITORED WHILE ON HRT?
Your doctor will do blood work and other tests to ensure your hormone levels are at the optimal range. You will likely have blood work done for your sex hormones two to three times a year, or more if your clinical situation calls for it. A doctor will closely monitor signs and symptoms with comprehensive questionnaires specific to the condition, allowing for an ongoing measurement for you and your doctor.
DOES BIOIDENTICAL HORMONE REPLACEMENT THERAPY CAUSE BREAST CANCER IN WOMEN?
No one has published a study demonstrating that bioidentical hormone replacement therapy causes breast cancer in women. In fact, a study called the French Cohort study demonstrated that bioidentical progesterone can decrease the risk for breast cancer.
Deciding About Hormone Therapy Use
Many women experience hot flashes, vaginal dryness, and other physical changes with menopause. For some women, the symptoms are mild and do not require any treatment. For others, symptoms are moderate or severe and interfere with daily activities. Hot flashes improve with time, but some women have bothersome hot flashes for many years. Menopause symptoms often improve with lifestyle changes and nonprescription remedies, but prescription therapies also are available, if needed. Government-approved treatments for bothersome hot flashes include hormone therapy (HT) containing estrogen, as well as a nonhormone medication (paroxetine). Hormone therapy involves taking estrogen in doses high enough to raise the level of estrogen in your blood in order to treat hot flashes and other symptoms. Because estrogen stimulates the lining of the uterus, women with a uterus need to take an additional hormone, progestogen, to protect the uterus. Women without a uterus just take estrogen. If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail.) Every woman is different—and you must make a decision about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare provider will be able to help you with your decision.
Hormone therapy is one of the most effective treatments available for bothersome hot flashes and night sweats. If night sweats are waking you throughout the night, HT may improve sleep and fatigue, mood, ability to concentrate, and overall quality of life. Treatment of bothersome hot flashes and night sweats is the principal reason women use HT. Hormone therapy also treats vaginal dryness and painful sex associated with menopause. Hormone therapy keeps your bones strong by preserving bone density and decreasing your risk of osteoporosis and fractures. If preserving bone density is your only concern, and you do not have bothersome hot flashes, other treatments may be recommended instead of HT.
As with all medications, HT is associated with some potential risks. For healthy women aged younger than 60 years with bothersome hot flashes who are within 10 years of menopause, the benefits of HT generally outweigh the risks. Hormone therapy might slightly increase your risk of stroke or blood clots in the legs or lungs (especially if taken in pill form). If started in women aged older than 65 years, HT might increase the risk of dementia. If you have a uterus and take estrogen with progestogen, there is no increased risk of cancer of the uterus. Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time. Some studies suggest that HT might be good for your heart if you start before age 60 or within 10 years of menopause. However, if you start HT further from menopause or after age 60, HT might slightly increase your risk of heart disease. Although there are risks associated with taking HT, they are not common, and most go away after you stop treatment. In general, HT is associated with fewer than 2 additional harmful events per 1,000 women per year. For example, the increased chance of breast cancer with HT use is 1 extra case per 1,000 women per year.
Potential side effects
Hormone therapy can cause breast tenderness, nausea, and irregular bleeding or spotting. These side effects are not serious but can be bothersome. Reducing your dose of HT or switching the form of HT you use often can decrease side effects. Weight gain is a common problem for midlife women associated with both aging and hormone changes. Hormone therapy is not associated with weight gain and may lower the chance of developing diabetes.
Hormone therapy options
Each woman must make her own decision about HT with the help of her healthcare provider. If you decide to take HT, the next step is to choose between the many HT options available to find the best dose and route for you. With guidance from your healthcare provider, you can try different forms of HT until you find the type and dose that treats your symptoms with few side effects.
Pill or non-pill
Hormone therapy is available as a daily pill, but it also may be taken as a skin patch, gel, cream, spray, or vaginal ring. Non-pill forms may be more convenient. Hormone therapy pills need to be taken every day, but skin patches are changed only once or twice weekly, and the HT vaginal ring is changed only every 3 months. Hormone therapy taken in non-pill form enters your blood stream more directly, with less effect on the liver. Studies suggest that this may lower the risk of blood clots in the legs and lungs compared with HT taken as a pill.
Estrogen alone or estrogen plus progestogen
If you have a uterus, you will need to take progestogen with your estrogen. Many pills and some patches contain both hormones together. Otherwise, you will need to take two separate hormones (eg, estrogen pill with progestogen pill or estrogen patch with progestogen pill). Taking both hormones every day usually results in no bleeding. Women who prefer regular periods can take estrogen every day and progestogen for about 2 weeks each month. Another option is to take estrogen combined with a nonhormone medication (bazedoxifene) to protect the uterus. If you do not have a uterus, you can take estrogen alone, without a progestogen.
Dose of estrogen
As with all medications, you should take the lowest dose of estrogen that relieves your hot flashes. You can work with your healthcare provider to find the right dose for you. It typically takes about 8 to 12 weeks for HT to have its full effect, so doses should be adjusted slowly. Even low doses of estrogen will preserve your bone density and reduce your risk of a fracture.
Stopping hormone therapy
There is no “right” time to stop HT. Many women try to stop HT after 4 to 5 years because of concerns about potential increased risk of breast cancer. Other women may lower doses or change to non-pill forms of HT. Hot flashes may or may not return after you stop HT. Although not proven by studies, slowly decreasing your dose of estrogen over several months or even over several years may reduce the chance that your hot flashes will come back. You and your healthcare provider will work together to decide the best time to stop HT. If very bothersome hot flashes or night sweats return when you stop HT, you will need to reassess your individual risks and benefits to decide whether to continue HT. Because there may be greater risks with longer duration of use and as you age, you and your healthcare provider will work together to decide what is the best option for you.
What is Custom-Compounded Therapy?
Consumers and some healthcare providers may think that the term bioidentical hormones refers to custom mixes (custom compounded) of one or more hormones in differing amounts, depending on an individual prescriber’s order. Consumers may also assume that custom-compounded hormone formulations contain FDA-tested and approved drugs and are therefore safe.
But neither of these is true. Many well-tested, FDA-approved hormone therapy products available at retail pharmacies meet the definition of bioidentical, that is, with the same chemical and molecular structure as hormones that are produced in the body. And although compounded formulations may contain the active ingredients in FDA-approved products, the formulations themselves have not been tested for quality, safety, and effectiveness. Some have been found to contain too much or too little of one or more hormones to be effective and safe, and they may not actually contain the prescribed amounts.
What’s more, a custom-compounded formulation will also contain other ingredients that either hold everything together (in the case of a rectal suppository, an under-the-tongue tablet, or an under-the-skin pellet) or provide a vehicle for applying the product onto the skin (such as a cream or gel) or into the body (such as a liquid for a nasal spray) that affect how the hormones are absorbed.
A few consumers may need custom-compounded products to avoid allergies to certain ingredients or to provide dosages or mixtures that are not available commercially. However, custom-compounded hormones can pose risks. They do not have government approval because individually mixed preparations have not been tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue. And there is no scientific evidence of the effects these combinations of hormones have on the body, either good or bad. Preparation methods vary from one pharmacist to another and from one pharmacy to another, which means that consumers may not receive consistent amounts of medication. In addition, inactive ingredients may vary, and there can be batch-to-batch differences. Reliable sterility and freedom from undesired contaminants are also concerns. What’s more, these preparations can be expensive because they are often not covered by insurance plans.
WHAT IS HORMONE TESTING
Testing hormone levels is not required to determine whether a woman has the “right amount” of hormones. The optimal hormone levels in postmenopausal women have not been established. How symptoms respond to a particular dose of hormones or nonhormonal menopause medication is the only reliable guide.
Saliva testing is often a part of custom-compounded “bioidentical hormone therapy” with hormones. But saliva testing is not only unnecessary; it has also has also not been proven to be accurate or reliable. Because hormone levels vary day to day as well as throughout the day, even a blood test cannot accurately reflect the body’s hormone levels.
The common hormone test that may be appropriate is for the level of follicle-stimulating hormone (FSH) to help determine if a woman is in menopause, especially for women who do not have a uterus and thus cannot tell by their menstrual pattern that they are menopausal.
NAMS does not recommend saliva testing to determine hormone levels and does not recommend custom-compounded products over well-tested, government-approved products for the majority of women.