As we step into our late 40s, our hormone levels start to decline, and symptoms of aging increase.  This occurs in both men and women.   Women heavily rely on  Estrogen and Progesterone, which are essential for youth, energy, menstrual cycles, libido, mood, and so on.

menopause

For men, their secret hormone is Testosterone. This hormone is responsible for libido, muscle mass, exercise tolerance, and stamina.  In both men and women, hormonal imbalance reflects striking changes in their physical, emotional, and sexual health. An optimized and balanced hormone level is the key to a happy and healthy life.

One way to age gracefully is to balance our hormones by using bioidentical hormone replacement therapy at physiological doses.  BHRT helps reverse age-related decline in hormone levels, it is also referred to as Anti-Aging Hormone Therapy.

What are Hormones?

Hormones are special chemical agents secreted by glands in our bodies. Hormones control almost all bodily functions, from the brain to the digestive system and beyond, hence a variety of symptoms in case of an imbalance. Widely known premenstrual symptoms like mood swings, breast tenderness, bloating, etc., and the notorious menopausal symptoms such as hot flushes, vaginal dryness, and decreased libido are related to declining and imbalance of hormones.

balancing hormones

What are bioidentical hormones?

The Endocrine Society defines bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body” (Julia A. Files, 2011). These hormones are derived from yam, plants, and soy extracts. 

Why bioidentical hormone therapy over conventional hormone therapy?

In 2002, the Women’s Health Initiative (WHI) concluded that the risks of conventional HT outweighed the preventive benefits. Two prime risk factors studied were: an increase in cardiovascular consequences and a 26% rise in breast cancer risk. This conclusion was reached after a randomized trial was conducted over 10,000 women of ages between 50 to 79 years who were taking conjugated equine estrogens 0.625 mg with medroxyprogesterone acetate, 2.5 mg daily or placebo orally (Endocrine Society, 2019). This, along with celebrity advocacy and media endorsement, led to a 63% decrease in the prescription of conventional Premarin and Provera. With more women seeking alternatives, bioidentical hormone therapy seemed a safer way to compensate for the decline in hormonal levels. Bioidentical hormone replacement therapy is supported by claims of better efficacy and a safer side effect profile.  

Types and route of Bioidentical Hormones (BHT):

BHRT is a combination of estrogen, progesterone, and testosterone. Currently, two categories of BHRT are available. One is FDA-approved, pre-formulation by drug companies, strictly monitored and regulated. The other is Compounded BHRT (cBHT). Compounding is defined by the FDA as “the combining or altering of ingredients by a pharmacist, in response to a licensed practitioner’s prescription, to produce a drug tailored to an individual patient’s special medical needs.” Compounded BHT, in other words, is a custom-made BHT, varying from patient to patient; thus, it is not pre-formulated. 

The most common formulation prescribed by Dr. Lalezar is Bi-est cream which is 80% Estriol and 20% Estradiol.  This formulation is the safest since Estriol does not convert to estrone.  Estrone is a bad form of estrogen and can cause cancer.  Dr. Lalezar does not recommend oral estradiol because it is converted into estrone after passing through the liver. In the liver, it stimulates certain clotting factors, predisposing coagulation, and heart attacks. On the contrary, the liver is bypassed when Estradiol is given transdermally or vaginally, thus a lower risk of thromboembolism, also supported by a Case-control study (Canonico M, 2007 Feb 20;115(7):840-5.)  

Dr. Lalezar will also prescribe progesterone either in a cream or pill form.  Prometrium, which is a pharmaceutical formulary, is covered by your insurance.  It comes in doses of 100 and 200 mg.  Progesterone or Prometrium capsules are superior to creams for insomnia.  

What are the benefits of bioidentical hormone replacement therapy?

Older men and postmenopausal women have lower levels of testosterone and estrogen (17-beta estradiol (E2)), respectively. This anti-aging hormone therapy serves as a bridge to minimize the symptoms arising secondary to hormone depletion. Therefore, it helps to alleviate postmenopausal symptoms like:

  • reduces hot flashes, muscle pains, and body aches
  • reduces cardiovascular risk
  • improves osteoporosis
  • improves sleep
  • maintains libido and reduces vaginal dryness
  • helps with mood changes

Moreover, the doses can be customized. Since each body has a different level of hormone decline and a unique response to replenishment, bioidentical hormone replacement therapy can be customized and tailored to meet the exact demands of a particular patient.

How soon does anti-aging hormone therapy show its effects?

It usually takes anywhere between a few weeks to three months for BHRT to take effect. But if no improvement is seen even after four to six months of therapy, a different combination of HRT may be tried.

Should tests be performed to check the therapeutic effects of BHT?

There is no standard set value for the level of hormones in postmenopausal women, nor is regular testing required to check if the woman has an optimal level. However, levels can be tested on blood, urine, or saliva if required. Some entities have promoted the idea of saliva testing to measure hormonal levels during compounded bioidentical hormone therapy. Firstly, saliva is easier to collect and test, and secondly, it resembles the ultrafiltrate of blood. However, results are highly variable, depending upon salivary flow, patient age, diet, time of the day, etc., and thus unreliable.

Moreover, no scientific evidence suggests a relationship between salivary hormone levels and menopausal symptoms; therefore, the FDA has advised against saliva testing. (Julia A. Files, 2011). Even blood tests cannot accurately reflect the hormonal level (Bioidentical Hormone Therapy, n.d.). Having said that, it is advisable to clinically judge the response rather than extensive lab testing.

Adverse effects:

Although hormone replacement therapy helps with the symptoms of menopause and reduces the risk of osteoporosis, a few side effects bag along, too, if the dosage given to you is incorrect. Usually, these side effects improve or fade away with time. Common ones include:

  • weight gain (37.2%)
  • bloating (23%)
  • breast tenderness (19.2%) (Vigesaa KA, Downhour NP, Chui MA, Cappellini L, Musil JD, McCallian DJ., 2004).

Other side effects include:

  • Blurred vision
  • Fatigue
  • Acne
  • Headaches
  • Indigestion, etc

Conclusion:

It is imperative to mention that HRT alone cannot heal all the symptoms. HRT is to be backed up with balanced nutrition, a proper sleep cycle, and an exercise routine.

If you are dealing with hormone imbalance, gear up for a change by contacting The Health & Vitality Center for a step towards a happy and balanced life.

happy menopausal woman

Learn more about Menopause/Premenopause Treatments:

Dr. Shiva Lalezar will treat the underlying causes of your menopause/premenopause symptoms.  She employs an integrative approach, combining the best conventional therapies with the latest techniques and treatments in Functional Medicine for optimal results.

Call the Health & Vitality Center at 310-477-1166 or click here to schedule an appointment. We are one of the leading Functional Medicine centers in Los Angeles.

References

Harvard Women’s Health Watch. (2011, September). Harvard Health Publishing. Retrieved from Harvard Medical School: https://www.health.harvard.edu/womens-health/bioidentical-hormones-help-or-hype

American College of Obstetricians and Gynecologists. (2012). American College of Obstetricians and Gynecologists. Retrieved from Compounded bioidentical menopausal hormone therapy. Committee Opinion No. 532: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Compounded-Bioidentical-Menopausal-Hormone-Therapy?IsMobileSet=false

Bioidentical Hormone Therapy. (n.d.). Retrieved from North American Menopause Society: https://menopause.org/patient-education/menopause-topics/hormone-therapy

Canonico M, O. E.-B. (2007 Feb 20;115(7):840-5.). Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. DOI: 10.1161/CIRCULATIONAHA.106.642280.

Cleveland Clinic. (2014). Retrieved from https://my.clevelandclinic.org/health/articles/15660-bioidentical-hormones

Endocrine Society. (2019, October). Compounded Bioidentical Hormone Therapy. Retrieved from Endocrine.org: https://www.endocrine.org/advocacy/position-statements//compounded-bioidentical-hormone-therapy

Julia A. Files, M. M. ( 2011, July). Bioidentical Hormone Therapy. MayoClinic Proceedings, PMCID: PMC3127562. DOI:10.4065/mcp.2010.0714 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127562/#

Lynn Pattimakiel, M. N. (2011 December). 78(12):829-836. Cleveland Clinic Journal of Medicine. https://www.mdedge.com/ccjm/article/95466/womens-health/bioidentical-hormone-therapy-clarifying-misconceptions/page/0/2

Vigesaa KA, Downhour NP, Chui MA, Cappellini L, Musil JD, McCallian DJ. (2004). Efficacy and tolerability of compounded bioidentical hormone replacement therapy. Int J Pharm Compd. 2004 Jul-Aug;8(4):313-9. https://www.ncbi.nlm.nih.gov/pubmed/23924704

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