Bioidentical Hormone Replacement Therapy (BHRT)
Balanced hormone function is critical for a balanced life. After all, hormones affect not only our reproductive function, but everything from our blood pressure to our moods, memory, brain function and physical appearance. Unfortunately, in today’s world, stress, pollution, poor diet, and other factors are all conspiring to throw our hormones out of balance. The result is that people are tired, overweight, moody, and have little libido and zest for life. While hormones are not necessarily the cure to everything, having hormones dialled in can be a big difference maker in the quality of your overall everyday life. Sometimes, Bio-Identical Hormone Replacement Therapy, or BHRT, can be a useful tool for replacing the hormones that have declined over time or, for a number of reasons, are lacking when they are supposed to be there in the first place.
What Are Hormones?
Hormones are simply chemical messengers. Hormones are created by one organ or gland and travel through the bloodstream to a target tissue in the body where it effects a change. Sometimes those changes can be gradual, such as the development of follicle through a woman’s 28-day cycle, or it can be quick, such as the near-immediate fight-or-flight response that raises our heart rate and blood pressure when we are scared. We have hormones for all purposes: for hunger and fullness, for blood sugar control, for growth and tissue repair, for stress response, for metabolism control, for sleep, and more.
What Can BHRT Help With?
By replacing hormones that may be lacking, bio-identical hormones can provide the following benefits:
- Decreased hot flashes
- Decreased anxiety
- Deeper, more restful sleep
- Improved body composition
- Higher libido and enhanced intimate life
- Reduced dryness
- Improved energy
- Preserved lean muscle
- Reduced stress levels
- Sharper memory and concentration
- Better hair, skin and nails
It is important to remember that you cannot out-supplement poor lifestyle practices. The benefits of hormones will only be fully realized with exercise, proper diet, and stress management.
Why Do Our Hormones Decline As We Age?
Apart from surgical reasons, women stop menstruating when they run out of eggs. Each female baby is born with a pre-determined amount of eggs, and when they run out as a woman ages, then sex hormone production drops. However, women can spend nearly one third of their lives in menopause, as life expectancies have increased due to medical and technological advances. Therefore, while menopause is a very natural state for most women, symptoms may need to be managed for a long time. Not everyone needs hormone replacement, but the people who have menopause symptoms that are difficult to bear may need to seek this therapy to manage their symptoms.
It is important to know that a formal diagnosis of menopause is made when a woman has not had her period for 12 months. Many women can even experience more frequent periods as their estrogen levels fluctuate before their periods decline and stop. During this time, patients are in a peri-menopausal state, which is often the most symptomatic time. We’ve also seen women go eleven months without a period only for it to return again, causing frustrated women to start the countdown over again. At this time in their lives, we’ve had many of our peri-menopausal patients ready to be through with their periods.
It is important to note that menopause can be a very empowering and freeing time for women. Some patients go into menopause fearful because they have heard of others’ negative experiences and near-horrific symptoms. However, this is not every woman’s experience. Some women say they feel clearer, freer, and get some of their best career work done while in menopause.
What Are Some Symptoms of Menopause?
Menopause symptoms can be very common, such as hot flashes and sleep issues, but some may also be surprising and unexpected. Every woman experiences menopause in a different way. Shifting hormones have many effects on the body and can influence levels of inflammation and water retention, for example. The following are some common and less common symptoms that can arise during menopause.
- Hot flashes/night sweats
- Mood disturbances, depression, anxiety
- Vaginal dryness
- Pain with intercourse
- Joint pain
- Dry eyes
- Thinner skin
- Weight gain, especially abdominal
- Decreased or increased libido
- Urinary tract infections
- Bladder leakage
- Poor memory and concentration
- Loss in muscle mass
- Heart palpitations
- Hair loss
- Burning Mouth Syndrome
- Body odor changes
- Breast changes, such as tenderness or shape change
- Changes in periods. Please remember that if you experience irregular bleeding or changes in bleeding, you should speak to your doctor about these signs just in case.
What Are the Benefits and Uses of BHRT?
Menopause is a clear indication for BHRT, but there are other reasons why a woman may want to use BHRT.
PCOS – Polycystic Ovarian Syndrome, or PCOS, is a condition that causes irregular periods and male hormone symptoms, such as scalp hair loss and facial hair growth. Despite its name, women with PCOS do not always have multiple cysts on their ovaries. Many women with PCOS experience trouble becoming pregnant. This condition has not been well understood by scientists and doctors in the past, but there also seems to be an increased risk for heart disease in these women. While some of the most common medical advice for women with PCOS is to lose weight, thin women can experience PCOS as well because this condition has a strong genetic component. BHRT can be helpful for some women with PCOS.
Fertility – It is no secret that infertility rates are climbing; the number of couples that experience trouble conceiving has doubled since the 1980s. There are many reasons why infertility rates are increasing, since hormones are profoundly affected by different factors in our environment. BHRT, in particular progesterone, can be helpful in cases of recurring miscarriage if the cause of the miscarriage is in part due to low progesterone levels.
Who Can Prescribe Bio-Identical Hormones?
Currently, practitioners licensed to prescribe BHRT are medical doctors, nurse practitioners and naturopathic doctors. However, none of these practitioners are taught to prescribe in their typical education. Our naturopathic doctors have undergone additional training to prescribe bio-identical hormones safely.
No matter who is treating you, it is important to have follow up imaging on a regular basis to ensure that things are going according to plan. Your practitioner will also do regular blood work to ensure that your blood hormone levels are within range.
How is BHRT Different From Conventional HRT?
Many people have heard that hormone replacement therapy is harmful, and doctors have stopped prescribing hormone replacement therapy in their offices. This change in practice was caused by the results of the Women’s Health Study that showed hormone replacement therapy to be connected to an increased risk of heart disease and breast cancer. Further examination of this study has revealed that the authors were shown to be biased against hormone replacement therapy, and so their examination of the effects of this treatment may not be accurate. In some cases, the increased risk of heart disease was only for a short period of time during the first few years of treatment. The most important thing to note is that the hormone replacement therapy is different from the bio-identical hormones that many practitioners use in their practices today.
First, conventional hormone replacement therapy products are synthetic hormones made from pregnant horse urine. These hormones are not recognized by the body as its natural hormones and have an increased risk of side effects. Bio-identical hormones are made from plants and are recognized as the body’s natural hormones. This form of hormone replacement is used more widely in other parts of the world and is not associated with the same risks as conventional HRT.
Please note: neither BHRT nor conventional HRT is an appropriate method of birth control.
Can BHRT Treat Thyroid?
Many people take thyroid medication and do not experience the relief of their symptoms that they expected. This difference is based on basic thyroid physiology. Thyroid medication is the T4 form of thyroid hormone, which must then be converted into T3, the active form of thyroid hormone. T3 then acts on receptors in cells all over the body, regulating metabolism. For some people, the T4→ T3 conversion is incomplete. For others, they don’t produce enough T4 or T3. In either case, these people may experience some or all of the following symptoms:
- Brain fog
- Weight gain
- Dry skin and hair
- Cold intolerance
- Muscle cramping or twitching
- Hair loss or eyebrow loss
These symptoms point to hypothyroidism, which can be either genetic or autoimmune. Autoimmune hypothyroidism is called Hashimoto’s thyroiditis, and is detected on lab testing by the presence of high levels of thyroid antibodies.
Unfortunately, most subtle thyroid dysfunction goes undetected because testing during your annual physical only detects one value: TSH. If your naturopathic doctor suspects there is a thyroid issue, he or she will order a detailed thyroid panel, which provides measures of the following laboratory values:
- TSH – the brain’s signal to the thyroid to push out thyroid hormone. When TSH is high, thyroid function is low
- T4 – the hormone secreted by the thyroid gland
- T3 – the converted, active form of thyroid hormone that acts on the cells of the body
- Thyroid antibodies – to tell whether the cause of the low thyroid function is due to an immune system issue
For some people, T4 medication prescribed by their doctor works well, and in other situations, symptoms fail to improve with this medication. When straight T4 medication does not work well enough, desiccated thyroid can be helpful.
The bio-identical form of thyroid medication is called desiccated thyroid. It is ground thyroid gland that is sourced from pork (although other sources can be found by a compounding pharmacist for kosher and halal purposes). Desiccated thyroid contains a specific mix of T3 and T4 hormones, which can help many people feel better, faster.
Like any thyroid medication, desiccated thyroid can have activity on the heart and can be harmful if overdosed. Your provider will start at a low dose and build up, testing blood regularly to determine if the dose you were prescribed is safe and effective.
What Are Reasons Not to Pursue BHRT?
To help evaluate whether or not you are a good candidate for BHRT, your practitioner will take a full and detailed history including reproductive and pelvic health details, and any other medical conditions such as heart conditions and clotting disorders, you have or may have had. Family history is also important in this case, as family history of gynecological cancers is a cause for extreme caution or avoidance of BHRT. Imaging and bloodwork is also required to safely begin and monitor a BHRT plan.
If you are curious about how BHRT can improve your life and whether you are a good candidate for this treatment, you can book a complimentary consult with our naturopathic doctor trained in BHRT therapy.