Many women are conflicted abut the use of hormone therapy to combat the effects of menopause. Menopause is a natural condition that all women will experience in their lifetime. The term menopause describes a constellation of changes that generally occur in a woman’s fifties or sixties, with the symptoms of change often becoming noticeable in her forties. During this time, the ovaries stop producing eggs, menstrual cycles become less frequent and eventually stop, and estrogen and progesterone decline. The conflicting studies about the side effects of conventional hormone therapy have led many women to consider the use of bioidentical hormone therapy as an alternative.
Bioidentical hormone replacement therapy (BHRT) refers to the use of hormones that are identical, on a molecular level, with endogenous hormones in hormone replacement therapy. Specific hormones used in BHRT include estrone, estradiol, progesterone, testosterone, dehydroepiandrosterone and estriol (which is available in Europe but is not approved in Canada and the United States). The substances used in BHRT therapy are natural in the sense that they come from plant and animal sources rather than being artificially synthesized.
Bioidentical hormones were first used for menopausal symptom relief in the 1930s, after Canadian researcher James Collip developed a method to extract an orally active estrogen from the urine of pregnant women and marketed it as the active agent in a product called Emmenin. In the 1970s, research and reports indicating risks from synthetic estrogens began to appear. Investigation determined that the addition of a progestogen to estrogen treatment reduced the risks. As early as 1980, the British Medical Journal recommended oral bioidentical progesterone as an option when side effects from synthetic progestogens otherwise mandated discontinuing treatment. Starting in 1980, side effects caused by synthetic progestin use prompted more research into bioidentical progesterone. Physicians John R. Lee and Jonathan Wright were pioneers in the area of BHRT.[
BHRT therapy usually proceeds in the following steps:
- A woman’s hormones are measured via a saliva, blood or urine test, and “deficiencies” are identified.
- Her clinician prescribes a mix of hormones to correct any deficiencies and bring the hormones into balance.
- The prescription is filled at a compounding pharmacy using hormones derived from natural sources, usually soy or Mexican yams.
- Besides estrogen and progesterone, the prescription may include other hormones, such as testosterone, dehydroepiandrosterone (DHEA), and adrenal hormones extracted from animal glands.
- The woman’s hormone levels are retested periodically and her prescription revised as the clinician deems necessary.
Many women have found bioidentical hormone replacement therapy to be a safe and effective means to find relief from symptoms of menopause. There are individual and combination therapies available, along with a variety of delivery methods. If you are interested in this approach, you should consult a physicians specializing in BHRT. He or she will assess your needs through detailed lab testing to determine which hormones and delivery methods are right for you.