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What is it and what is it used for?

Hormone replacement therapy (both bioidentical and non-bioidentical) is used to relieve the signs and symptoms of menopause and perimenopause. Some of the more common symptoms that hormone replacement therapy treats include: hot flashes, sleep disturbances, foggy thinking, painful intercourse, low libido, night sweats, vaginal dryness as well as preventing bone loss.

In order to understand and differentiate between bioidentical and non-bioidentical hormone replacement therapy one must understand what exactly is meant by the term, “bioidentical”.  In the case of hormone replacement therapy, bioidentical indicates that the chemical structure of the drugs used in BHRT compounds is identical to that of the hormones that exist naturally in the human body.  As a result they will act in exactly the same manner as the hormones made naturally by the body once they enter the bloodstream.  On the other hand the term “non-bioidentical” refers to the fact that the chemical structures of these drugs is not identical to that of the hormones that are produced naturally in the body. Typically these drugs are made similar to the natural hormones such that they will still bind to hormone receptors in the body, however, they are modified in such a way to either make them last longer or bind more tightly.

The hormones used in bioidentical hormone replacement therapy include 3 types of estrogen, progesterone, testosterone, dehydroepiandosterone and cortisol. The three different types of estrogen, from strongest to weakest, are: estradiol, estrone and estriol. Estrogen is responsible for female sexual characteristics and plays an important role in the menstrual cycle. In menopause, and often in perimenopause, estrogen levels may be low which results in symptoms such as hot flashes and night sweats. As a result, supplementing with a unique combination of the three different bioidentical estrogens can increase the levels of estrogen in the body and can reduce/eliminate these symptoms. Progesterone is required in the body to balance the effects of estrogens and prevent the uterine lining from getting too thick. Because of this bioidentical progesterone is commonly used to treat symptoms of estrogen excess that can sometimes occur during perimenopause when a woman’s hormones are “out of wack”. Estrogen is never used without progesterone unless a patient has had a full hysterectomy. The reason for this is that estrogen causes the uterus to grow. Without progesterone to balance/ inhibit the effects of estrogen on the uterus it would continue to grow eventually leading to uncontrolled growth that could possibly result in uterine cancer. Therefore, by ensuring that all patients with a uterus are given progesterone with the estrogen we prevent the formation of uterine cancer. Testosterone is another common form of hormone replacement therapy. Although many people think of testosterone as a male only hormone it is in fact also found in females and can sometimes be deficient in menopause. In the female body testosterone is responsible for many of the same effects it is responsible for in the male body, including: maintaining muscle and bone mass, improving one’s sense of well-being and improving sex drive. Testosterone levels are lower in females and therefore when supplementing with testosterone in females lower doses are used.

What are the advantages and disadvantages of hormone replacement therapy (including both bioidentical and nonbioidentical)?

The advantages of both types of hormone replacement therapy include:

  • Relieves symptoms of menopause
  • Possibly reduces the risk of heart disease
  • Improves lipid profile
  • Prevents osteoporosis
  • Prevents urogenital and vaginal atrophy

The possible disadvantage of both types of hormone replacement therapy is that it may increase the risk of breast cancer and heart attack. The women’s health initiative study which used nonbioidentical forms of hormone replacement therapy, (premarin- a form of estrogen and provera- a form of progesterone) found that using this form of hormone replacement therapy could increase the risk of breast cancer and heart attack. It must be noted however that the risk of breast cancer and heart attack from taking hormone replacement therapy was no greater than that of being overweight and smoking for example. Therefore, if there is a history of breast cancer and heart attack in your family you may want to avoid hormone replacement therapy but you should also look into losing weight and quitting smoking.

What’s the reason for all the hype over compounded BHRT?

There are several forms of BHRT available as prescription products such as prometrium for example, which is a bioidentical form of progesterone. However, these products only come in 1 or 2 different strengths and combinations. As a result the dosing and combinations of these available prescription products cannot be individualized to each unique person’s requirements. With a compound of BHRT there are limitless possibilities as to what doses and combinations of hormones we can make. The doses of each hormone can be titrated or changed according to the patients symptoms until the right balance of hormones for that patient is found. Another advantage of compounded BHRT is that it is typically given as a cream (several prescription products are also available as similar creams) that can be applied to the skin (often rubbed into the forearm at the wrist or near the elbow). Not only is this an easy way to “take” your drug but it also beneficial because it allows us to use smaller doses of the hormones. The reason for this is that when a hormone is taken as a pill and it is absorbed from the GI tract much of it is broken down by the liver before it ever reaches the body. Because of this we must give higher doses so that some of it will make it to the rest of the body. These higher doses can lead to more problems since they can increase the production of clotting factors in the liver before they are broken down. This in turn can then increase your risk for clotting and possibly stroke or heart attack. By giving the compounded BHRT topically you avoid this breakdown by the liver and therefore you can give smaller doses therefore reducing the likelihood of these clotting disorders.

What types of hormone testing are available and what one is better for me?

There are two types of hormone testing available: blood testing or saliva hormone testing. Blood testing measures the amount of hormones in the blood, and therefore is measuring the amount of hormone that “might” eventually get into tissues and produce its effects. On the other hand saliva testing measures the amount of hormone that has actually gotten into tissue and exerted its effects. This is because in order for the hormones to end up in the saliva they must first enter and pass through the tissue from the blood. As a result saliva hormone levels, if collected properly, tend to correlate better with the patients symptoms. An additional advantage to saliva testing is that the results come with an interpretation and suggestions regarding next steps from a hormone specialist hired by the lab performing the testing. Blood tests, on the other hand, only report numbers and give no explanation as to the meaning of those results. Both tests can be used by the pharmacist to individualize a hormone therapy for your symptoms and needs. However, saliva testing tends to produce better results because of the advantages mentioned above.

If you are experiencing any of the following signs and symptoms common with perimenopause and menopause please feel free to contact one of our pharmacists for help and guidance as to what path you should take.

Common symptoms of menopause and perimenopause include:

  • Hot flashes
  • Night sweats
  • Low libido
  • Painful intercourse
  • Vaginal dryness
  • Foggy thinking
  • Sleep disturbances
  • Mood changes

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