Bio-identical Hormone Replacement (BHRT)

What does "natural" or "bio-identical" mean?

Natural or bio-identical hormones are the exact same molecular form of the hormones that humans naturally make.  They are made from a natural hormone in sweet potatoes or soybeans that is easily converted to natural human hormones.

Since natural substances, including hormones, cannot be patented, pharmaceutical companies lack financial incentive to fund research and development costs to develop and market natural products.  Unfortunately, pharmaceutical companies control the agenda and fund most scientific research at medical schools in this country.  Therefore the information presented to medical students regarding the treatment of almost all medical conditions is pharmaceutical based.

Although hot flushes are the most recognized symptom of menopause, there are many others that are common such as low libido, "brain fog", dry and thinning vaginal tissue, heart palpitations, weight gain from increased body fat (often abdominal), decreased muscle mass, poor memory, fatigue, and thinning hair.  Some women will have few and mild symptoms, while many women will have more severe and life altering symptoms.

For these women, personal and educated decisions must be made regarding the best treatment options for this transitional life event.  Hormone replacement therapy (HRT) is the solution for many women to stop or improve these symptoms and allow a return to a more satisfying lifestyle.

Hormone replacement Therapy is given little emphasis in medical school, but what is taught is the use of synthetic hormones or estrogens from other mammals such as horses (Premarin or generic conjugated equine estrogens) and the use of synthetic progesterone-like compounds.  These unnatural hormones are not recognized by the body as natural hormones are, so are not able to be converted by natural enzymes to other natural hormones as body needs determine.

As menopause approaches many hormone levels decline dramatically, including the estrogens estriol, estradiol, as well as progesterone, testosterone, pregnenelone, and DHEA.  A balanced approach to hormone replacement includes replacing all of these as needed on an individualized basis.

The many benefits of progesterone are discussd in John R. Lee, M.D.'s book, Natural Progesterone. Benefits include 1) a decrease in the rate of bone loss seen at menopause due to progesterone's stimulation of the cells that build new bone, 2) action as a mild diuretic as progesterone negates estrogen's effect of causing sodium and fluid retention when used alone, 3) a decrease in the risk of breast cancer by 20-30% as shown in a large ongoing study of menopausal women in France.

Estrogens that women normally produce are estriol 80%, estradiol 10% and estrone 10%.  Estriol is a very weak estrogen that has little or no stimulation of breast or uterine tissue which is a benefit.  Estradiol is the strongest estrogen and is the best for relieving symptoms such as hot flushes.  Estrone is a medium strength estrogen whose excess has been linked to an increased risk of breast cancer.  Because of this, estrone is not commonly used in hormone replacement.

DHEA is the most abundant hormone in the body and is a precursor to many other hormones, including the adrenal hormone cortisol.

Pregnenolone is also a precursor to many hormones and low levels of this have been linked with a decrease in memory.

Testosterone levels in women average about 10% that in men.  It has an important role in maintaining sexual desire and energy as well as strength and integrity of skin, muscle and bone.

The method of delivery of hormones is an important considerations.  When hormones are taken in pill form they are metabolized by the liver.  It is this metabolism that increases the risk of liver and gallbladder disease and the risk of forming blood clots.  When hormones are applied directly to the skin, absorption is good and liver metabolism is avoided, thereby decreasing the risk of unwanted side effects.  For the small percentage of women who find topical application inconvenient or ineffective, an oral form called a troche can be dissolved in the cheek or under the tongue. This method also avoids liver metabolism.