Bioidentical Hormone Replacement Therapy (BHRT)

Recently there has been a lot of controversy in the news regarding bioidentical hormones, particularly with drug companies trying to discredit compounding pharmacies and influence the FDA to make obtaining bioidentical hormones more difficult. So, what are bioidentical hormones and why use them?

Bioidentical hormones are hormones derived from plants processed to look exactly like the hormones (estrogen, progesterone, testosterone, etc.) human bodies make on their own, thus “bioidentical.”

Most traditional hormone replacement therapies use synthetic versions of these molecules which have been altered in such a way that they can be patented.

Unfortunately the synthetic alterations often make it more difficult for the body to metabolize and detoxify these substances. Thus, they may be more likely to create unwanted or long term harmful side effects such as thyroid disturbances, insulin resistance and even cancer. It is important to understand that all hormones, even bioidentical ones need to be used judiciously, with attention to creating balance in the whole person. Not only do we need to evaluate estrogen levels but also thyroid and adrenal function, assess gastrointestinal function, and understand how all areas are influenced by nutrients, diet, stress levels, personal history, environmental toxicity and psycho-spiritual well-being.

Most of our clients come to see us because of hormonal imbalances: bad PMS, mood swings, difficulty sleeping, erratic periods or menopausal symptoms of hot flashes and night sweats. On top of that many are suffering from fatigue and mild depression.

The important thing to understand is that there is no one “pill” that is going to “fix” the problem. ALL organ systems in the body are related and influence one another–so it is really important to look at the “big picture”. Surprisingly enough, small changes in several different areas can make big differences in symptoms.

The first thing we do is assess and perform appropriate lab tests. The assessment will include a deep dive into:

• How much stress are you under? For how long? In what ways? What are your coping mechanisms and tools?
• What are you eating, drinking, or lacking in your diet which influences hormones?
• How is your bowel function? Irritable bowel symptoms (Gas, pain, bloating, constipation)?
• What toxic exposures have you had to antibiotics, medications, environmental factors?
• How well is your thyroid working? (i.e. Hair falling out, depression, dry skin, brittle nails, cold hands and feet?)

Hormonally, because of environmental and dietary factors, most women are estrogen dominant (lacking enough natural progesterone to balance excess estrogen); leading to heavy bleeding, erratic periods, PMS, endometriosis, fibroids, bad cramps, breast tenderness and even breast cancer.

Testing and monitoring hormone levels (we use saliva and urine tests), then treating imbalances with bio-identical progesterone or estrogen, can make a huge difference. It is also critical to test thyroid function both with blood testing and body temperature charting. There is a difference between the “normal” range of most laboratories and the “optimal” range, particularly for thyroid.

PMS symptoms tend to be particularly common for women in their thirties and forties; most often related to lack of self care, inadequate sleep and missing nutrients.

Menopausal symptoms can occur over ten years before your cycle stops. During this “peri-menopause,” it is normal to experience fluctuations of estrogen and progesterone, leading to all kinds of physical and emotional ups and downs.

There is a lot of confusion regarding hormone replacement and its risk and benefits, particularly regarding breast cancer. A common question we get is whether hormones, especially estrogen, cause breast cancer? The answer is yes and no.

Yes, long term exposure to excessive estrogen (synthetic or bio-identical) can affect the growth of cancer, yet it is an indirect effect. Important mediators of cancer include not only your genetics, but your exposure to internal and external toxins as well as your body’s capacity to detoxify and get rid of excess estrogens.

No, estrogen itself doesn’t cause the cancer, it acts more like a fertilizer which encourages growth.

Important factors creating the DNA damage which induces cancer include:

• Inflammation
• Mineral and nutrient deficiency
• Alcohol and sugar consumption
• Insulin resistance and diabetes
• Chronic stress
• Adrenal and thyroid dysfunction
• Recurrent antibiotics
• Environmental toxins
• Many drugs (including synthetic hormones)
• Smoking
• Obesity
• Detoxification ability

What about the Women’s Health Initiative studies?

Most of the studies showing increased breast cancer rates with hormone replacement were looking at the effects of synthetic estrogens and synthetic progestins (Premarin and Provera). These definitely conferred an increased risk.

However other studies have been done looking at the use of natural bio-identical progesterone which have shown a neutral to decreased risk of cancer. The analogy we use, adapted from Dr. Bethany Hays (True North Health Center in Maine) is that of a garden.

All of us have weeds (cancer cells) growing in our garden(our bodies) all the time. It is the job of the gardener (our immune system) to get rid of the weeds.

If your soil is toxic and depleted of nutrients, and your gardener is sick from too much stress, lack of sleep and poor nutrition, then the weeds will start to grow faster than the healthy seeds (healthy breast cells). Add too much fertilizer (synthetic estrogens or even bio-identical ones) and the weeds will flourish–thus cancer shows up.

The answer is to detoxify and create organic soil that encourages growth of healthy seeds and naturally suppresses weeds.

At the same time you have to support the immune system gardener through excellent nutrition, adequate sleep, and decreasing stress. If you are going to use a fertilizer, you want to use an organic one (bioidentical hormones) in small quantities!

In addition there are many nutrients and vitamins including indole-3-carbinol from cruciferous vegetables (Metagenics “Meta-13C”), lignans from flaxseeds, activiated folic acid (Metagenics “Fola Pro”), adequate iodine and selenium which specifically support breast health.

But there is no history of breast cancer in my family….

Most women who get breast cancer today don’t have a family history for it. It comes back to our poor diets combined with toxin exposure, xeno-hormones in our foods and excessive stress hormones that creates the damage to our genes which then triggers the cancer.

As healthcare providers interested in protecting breast health and preventing cancer we use an integrative, holistic functional medicine approach. If you’ve had breast cancer, you don’t want to just survive, you want to thrive! Careful use of bioidentical hormones, excellent nutrition and self-care are part of a complete program.