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{Bioidentical Hormone Replacement Therapy}



One of the most popular questions we receive from women is "Should I take hormone replacement therapy?".  Answering that question is ultimately a very personal decision based on your symptoms, family and personal history, as well as your desire for the positive benefits hormones can offer vs. the potential risks that they pose.


Several years ago, the Women's Health Initiative revealed that hormones may increase a woman's risk of breast cancer, strokes, and blood clots.  The study was done with Premarin and Provera, which are not natural to a woman's body.  There are no studies done with "natural" hormones because there is not a large drug company that makes them.  However, from other research studies we know that the way hormones are given can affect the risk.  For example, estrogen and testosterone given by mouth is processed by the liver and the metabolites are not favorable (increases in clotting factors, triglycerides, and cholesterol).  Estrogen and testosterone given transdermally (across the skin or implanted) does not increase clotting factors or triglycerides and should be given this way if at all possible.  Natural progesterone, on the other hand, has favorable benefits when given by mouth and is best for women having insomnia.  Hormones are very complicated and must be individualized!


When individualizing hormones, there are basic categories to consider:


Bioidentical Hormones

Natural or bioidentical hormones are hormones made from a natural substance and are biochemically identical to human hormones (called bioidentical hormone replacement therapy or BHRT).  There are two types:  commercially made products available at the pharmacy and hormones compounded by a specialized pharmacist.


Bioidentical hormones available from the pharmacy include estradiol patches, gels, and micronized progesterone capsules.  These hormones are only available in standard doses are not customizable, but are more often covered by insurance.  Testosterone is not commercially available for women unless compounded.


Compounded Bioidentical QuickFacts:

  • Customized for the individual and meet the unique needs of each woman

  • Offered in lower doses, special combinations and unique delivery methods (creams, gels, troches, and pellets)

  • Prescribed by a health care provider and made by a compounding pharmacy

  • Tolerated better by many women because they are identical to the hormones in the body and can be delivered in individual doses


Note:  Progesterone creams sold over the counter are also available in unique low doses.  Look for brands that contain USP progesterone and are paraben free.


Commonly Used Bioidentical Hormones

ESTROGEN:  two main types are used--Estriol and Estradiol.  Can be combined in BiEst or compounded separately.


ESTRIOL causes little or no stimulation to the uterine lining and is clinically effective for the treatment of symptoms caused by estrogen deficiency, such as vaginal dryness and atrophy, painful intercourse and urinary tract disorders (incontinence, frequent urinary tract infections).  Estriol is very safe used vaginally and can even be used in women who have had breast cancer (with their oncologist's permission).  Estriol is even used in Europe for the treatment of breast cancer.


ESTRADIOL relieves symptoms such as vaginal thinning and dryness, decreases hot flashes and night sweats, improves mood, energy level, sleep patterns, memory, cognitive function; and reduces bone loss and the risk of developing type 2 diabetes.  It also helps lower blood pressure.



Progesterone is a hormone commonly prescribed for women along with estrogen.  Progesterone minimizes the stimulating effects of estrogen on coronary arteries, breast, and most importantly on the lining of the uterus.  Given along with estrogen, it may improve bone mineral density.  Progesterone is the first hormone to decrease in perimenopause and supplementation can improve sleep, increase sex drive (libido), act as a diuretic, lower blood pressure and improve blood glucose control.


In the past, some women were told they did not need progesterone if they had a hysterectomy.  Progesterone can be beneficial for symptoms related to menopause, not relieved by estrogen alone, and may have other benefits for post-menopausal conditions when prescribed with estrogen.  The decision whether to take progesterone if you have had a hysterectomy can be made in consultation with your provider.


**Special Note:  "Progestins" are sometimes erroneously referred to as "progesterone".  A progestin is very different and is not a bioidentical hormone, but rather a synthetic hormone made to mimic the effects of progesterone.  In fact, in the most recent evaluation of the Women's Health Initiative, the only women who had an increased risk of breast cancer were the women who took the progestin "Provera".  The women who took Premarin (estrogen) only did not have an increased risk.  Progestins and progesterone are not the same thing and do not carry the same risks!  If at all possible, we recommend avoiding Provera for the much safer Prometrium or compounded progesterone.



Dehydroepiandrosterone (DHEA) is an adrenal hormone.  It is a precursor to all of our other hormones and can decline most often from aging or stress.  DHEA should only be taken when a level is low as determined by blood, saliva, or urine testing.  Most often low levels are recommended as a supplement for women--starting with 5-10 mg daily and increasing based on testing levels.  DHEA can improve bone mass, lower cholesterol and triglycerides, and improve a sense of well-being as well as increase alertness.



Testosterone is prescribed for women deficient in that hormone.  It can help improve sex drive (libido), build bone mass, improve mood, and the sense of well-being, as well as increase muscle mass and strength, and decrease body fat.  Testosterone must be compounded for women in a cream, gel, or pellet.



Non-bioidentical hormones and synthetic hormones are not biochemically equivalent to a woman's hormones.  They are manufactured by pharmaceutical companies to mimic the effects of female hormones.  Many women experience side effects because the chemical structure does not match that of biological hormones and may stimulate the receptors differently.  Some doctors and researchers feel that these differences may cause some of the increase in risks associated with hormones that may not be present with bioidentical hormones.


In summary, the decision whether to take hormones, and what type to take should be personalized.  We feel the safest way to supplement hormones is using bioidentical hormone replacement in a balanced manner.  Estrogen and testosterone are safest when given across the skin or implanted.  Progesterone is safe to take by mouth or across the skin, but it cannot be implanted.  Progesterone by mouth improves insomnia in women who are deficient.  Hormones can be individualized based on monitoring levels and symptoms.


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