Hormone Replacement Therapy (HRT) with bio-identical hormones
What are bio-identical hormones?
Bioidentical hormones are processed hormones designed to mimic the hormones made by your body’s glands. Taking bioidentical hormones can help people who experience symptoms of low or unbalanced hormones. This is often the case for people experiencing symptoms of perimenopause or menopause. Hormones are chemicals made by your endocrine glands. They are messengers that tell other parts of your body how and when to work.
Hormones affect many systems and functions in your body. Even the slightest imbalance can cause symptoms that interfere with your day. Healthcare providers may recommend hormone replacement therapy as a treatment for these symptoms. Bioidentical hormone therapy (BHRT) uses processed hormones that come from plants. Estrogen, progesterone and testosterone are the most commonly used bioidentical hormones.
Some prescription forms of bioidentical hormones are premade by drug companies. The U.S. Food and Drug Administration (FDA) has approved certain types of bioidentical hormones. Other forms of bioidentical hormones are custom-made by a pharmacist based on a healthcare provider's prescription. These are compounded (or mixed) bioidentical hormones. The compounded forms have not been tested and approved by the FDA. Though it is often advertised that products that are made from plants are "natural" choices, they are altered in a lab so are no longer natural when done with processing. Both the FDA-approved and compounded hormones come in various doses and forms (pills, creams, gels, sprays and vaginal inserts). Be sure to talk to your healthcare provider to find out which type of BHRT is right for you.
Conventional hormone therapy vs. bioidentical hormone therapy
Compounded bioidentical hormones are advertised as being a safer, more effective, natural and individualized alternative to conventional hormone therapy. However, these claims remain unsupported. Also, the lack of FDA oversight for compounded hormones generates additional risks regarding the purity and safety of compounded bioidentical hormones. Although custom hormone combinations often include blends of the same ingredients found in FDA-approved bioidentical hormones, some include additional hormones. These additional hormones have not had adequate testing and are not included in any FDA-approved products.
Who shouldn't take bio-identical hormones?
Using any type of hormone therapy is a decision made between you and your healthcare provider after carefully weighing the risks and benefits. Bioidentical hormones have been controversial, and many are not FDA-approved, but that doesn't mean your healthcare provider will rule them out as a treatment option. If you've had or are at high risk for the following conditions, hormone therapy may not be safe:
Previous history of Breast Cancer and currently on anti-estrogen therapy
History of deep vein thrombosis or pulmonary embolism
Previous history of reaction to hormone replacement therapy
Liver impairment or liver disease
Why are bio-identical hormones used?
The levels of certain hormones in your body go down with age. These hormones include estrogen, progesterone and testosterone. Some common effects of low hormones include:
Hot flashes
Fatigue
Lack of sex-drive
Lack of endurance
Memory loss
Poor or interrupted sleep
Replacing these lost or low hormones is the goal of bioidentical hormone therapy or conventional hormone therapy. Once hormone levels are increased, most people see their symptoms improve. However, there is not much evidence to support that bioidentical hormones are equal to conventional hormone therapy. Your healthcare provider can discuss your options for hormone replacement with you based on your symptoms and health history.
How common are bio-identical hormones?
One study suggests that approximately 1 to 2.5 million women in the U.S. over age 40 are using compounded bioidentical hormones.
How are bio-identical hormones given?
Bioidentical hormones come in many forms. These include:
Gels/creams that are applied topically
Oral forms
Patch forms
Pellets that are inserted under the skin
Your healthcare provider will decide which method is best for you. You may try more than one way before you find one that works well for you.
How does my healthcare provider select my dose?
People on hormone treatment are watched very closely by their healthcare providers. The goal is to relieve symptoms with the lowest dose possible for the shortest amount of time (typically less than 5 years). When starting hormone replacement therapy it is customary to check hormone levels and other blood tests to rule out diseases that may make starting therapy more risky. Dosing of the hormones is typically started in the low range and then adjusted according to symptom relief (hot flashes, energy, mood, sleep and memory).
The FDA recommends against using hormone levels to guide the dosing of hormone therapy in women, as normal levels fluctuate day to day. In particular, salivary hormone levels are known to fluctuate and have not been shown to be related to menopausal symptoms
How long does it take for bio-identical hormones to start
working?
The amount of time it takes for bioidentical hormones to work varies. Some people may feel mild relief within a few weeks. Most of the time, it takes about three months to feel the full effect of any type of hormone therapy.