Bio-identical Hormone Replacement Program

 

Goals of therapy:

 

- patient specific

- relief of symptoms of fatigue, hot flashes, irritability, depression, low libido

- education and management of risks associated with bio-identical hormone replacement

- return of an improved quality of life with better mood, energy, and sleep

 

Risk / benefit discussion:

 

The Women’s Health Initiative was a ground-breaking study that dispelled myths that drug based hormone replacement reduced cardiovascular risk. In fact, use of synthetic estrogens such as conjugated equine estrogens and progestins such as medroxyprogesterone acetate increased risk of cardiovascular disease and cancer. 

 

There is a conception amongst the public that if we use bio-identical hormones, instead of horse urine estrogens or synthetic progesterones, the risk is less. While this may be the case, we do not know if it is. Therefore, we would prefer the patient to be educated on what the actual risk with synthetic hormone replacement is, and then assume that bio-identical hormone replacement gives the same risk.

 

It’s all about the balance:

 

Our program then goes one step further. If a patient is willing to accept the above risk, we then try to minimize any risk by testing comprehensively what the current hormone picture looks like, and then replacing the hormones to restore balance while we use nutritional means to help have healthy metabolism of those hormones.

 

Our preferred test that most comprehensively captures the current hormone picture is a 24 hour urine test for both sex and adrenal hormones, along with blood tests for thyroid hormones.

 

Sex hormones, estrogen, progesterone, and testosterone, fluctuate during the day. A 24 hour urine test allows us to capture all of those hormones in full day, allowing us to see what underlying imbalances are present.

 

For example:

 

Some females might have only low progesterone, and thus replacing estrogen would likely give added risk, while replacing low progesterone would improve quality of life while possibly reducing the risk of having too much estrogen and not enough progesterone.

 

The urine test also allows us to capture all three types of estrogen that are normally present in the body, estriol, estradiol, and estrone. Estriol has actually been shown to be associated with a lower risk of cancer, and thus if this is low, then we may have the compounding pharmacy use more estriol, or we may use liver support to help with estrogen metabolism.

 

While some physicians prefer using the urine test for thyroid hormone as well, we prefer the blood tests in combination with symptom assessment. This allows for better dosing and monitoring of thyroid hormone replacement.

 

Replacing hormones naturally:

 

Once we have our comprehensive assessment of a patient’s hormonal status, we can reliably decide on a treatment plan that replaces those hormones to restore balance.

 

We do not use the non-bioidentical hormones. We prefer to use what exact hormones that the body produces, identical in structure and function. We have compounding pharmacies make up a cream or pill that is specific for the patient’s test results. This might be a combination cream of different estrogens, or it might be simply bio-identical progesterone, or may be the thyroid hormones in pill form.

 

We follow up in 3 months to make sure the patient has an improving quality of life, and assess whether or not dosage modifications, up or down, can be made. At 3-6 months a repeat of the urine test (or blood test earlier, if thyroid replacement is done) is done to make sure our dosage is optimal for the patient.