FREQUENTLY ASKED QUESTIONS - BIOIDENTICAL HORMONES
What are Bio-Identical Hormones?
Bio-identical (BHRT) hormones are derived from natural plant sources to produce molecules which are physiologically identical to hormones made in the human body. Bio-identical hormones are chemically processed from precursors found in yams or soy plants, yet they are identical to the hormones produced by the human body.
Hence the term “bio-identical plant-derived hormone.” These hormones are able to follow normal metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy. Synthetic hormones are chemically altered and are not identical in structure or activity to the naturally occurring hormones in the body.
No two women are alike, of course, and the value of bio-identical hormone replacement therapy is that it can be adapted to fit your individual body and hormone levels. In fact, hormones can be made in a variety of strengths and dosage forms including capsules, topical creams and gels, and sublingual troches or lozenges. With the help of Dr Morley and a compounding pharmacist, a woman can start and maintain a bio-identical hormone replacement regimen that closely mimics what her body has been doing naturally for years.
BHRT includes oestrogens (oestrone, oestradiol & oestriol , also known as E1, E2, and E3 ), progesterone, testosterone, DHEA, melatonin and pregnenolone (and many metabolites).
Benefits of BHRT include:
- Fewer side effects and better safety profile compared with traditional HRT
- Protection against heart disease
- Reduced risk of breast cancer , and
- Improved lipid profile.
Goals of Natural HRT
- Alleviate the symptoms caused by the natural decrease in production of hormones by the body.
- Give the protective benefits which were originally provided by naturally occurring hormones.
- Re-establish a hormonal balance.
The three types of hormones typically prescribed for natural hormone replacement therapy (HRT) are oestrogens, progesterone and androgens. The precise components of each woman’s therapy need to be determined after physical examination, medical history, and laboratory testing are considered. Close monitoring is essential to ensure that appropriate dosage adjustments are made.
There is no single hormone called estrogen. Oestrogen is actually a group name for many subtypes of “oestrogen”. The 3 main subtypes are known as Oestrone (E1), Oestradiol (E2), and Oestriol (E3). Each has unique functions and together they impact over 400 functions in the body.
Oestrone (E1), the primary estrogen produced after menopause, is made in the ovaries, adrenal glands and fat cells. High levels may increase the risk of breast and endometrial cancer and blood clots.
Oestradiol (E2) is the strongest form of estrogen and present in largest quantity in premenopausal women. High, unopposed levels of estradiol may increase the risk of breast, uterine, and prostate cancer. Ostradiol is often prescribed after menopause to maintain skeletal health and may reduce the risk of cardiovascular disease.
Oestriol (E3) is the most abundant but weakest form of estrogen. It is mainly secreted by the placenta during pregnancy. Oestriol is a protective oestrogen which does not stimulate the uterine lining, and does not increase the risk of breast cancer or blood clots. In fact, it is used in Europe to treat breast cancer.
Oestrogen (referring to the group of oestrogens together) keeps the uterus toned and flexible,increases HDL - the good cholesterol, preserves the elasticity and moisture of the skin, dilates blood vessels, prevents plaque formation in blood vessel walls, and slows down the rate of bone breakdown. In addition, oestrogen boosts the synthesis of neurotransmitters (brain chemicals) that affect sleep, mood, memory, libido, and cognitive factors such as learning and attention span. Oestrogen helps skin maintain a youthful plump appearance is by increasing the synthesis of collagen.
Oestrogen deficiency results in increased inflammation and degeneration of the body. This may be the mechanism behind the greater incidence of bone breakdown leading to osteoporosis, senility, heart disease, stroke, loss of muscle mass, and depression seen in estrogen deficient women. Oestrogen deficiency causes many of the symptoms associated with menopause including hot flashes, night sweats, vaginal thinning and dryness, urinary leakage and urinary tract infections, foggy thinking, palpitations, and thinning skin. Restoring declining estrogen levels with bioidentical estrogens may be helpful in relieving many of these symptoms. It may also help reduce the incidence of heart disease, osteoporosis, Alzheimer’s disease and memory disorders frequently seen in menopausal women.
Progesterone is one of the first hormones to decline in women starting around age 35. When levels start to fall, women may experience anxiety, panic attacks, lighter sleep, PMS, headaches, mood swings, fibroids, breast and ovarian cysts, heavier or irregular bleeding, and abdominal weight gain. Progesterone, with oestrogen, regulates the menstrual cycle. It is essential for creating and maintaining a pregnancy, and balancing other effects of estrogen. Progesterone is produced by the ovary, placenta, and adrenal glands in women and a small amount is produced by the adrenal glands in men.
Progesterone is responsible for regulating several bodily functions. It plays an important role in brain function and is often called the "feel good hormone" because of its mood-enhancing and anti-depressant effects. Optimum levels of progesterone promote feelings of calm and well-being, while low levels can cause anxiety, irritability, and anger.
Oestrogen is “pro-growth” (causing the cells in the uterus to multiply during a menstrual cycle), and progesterone is “anti-growth”. Progesterone balances the stimulating/pro-growth effects of oestrogen on breast and endometrial tissue and helps protect against endometrial and breast cancer. It also balances the following effects of excess estrogen: water retention, fat accumulation, and uterine bleeding. Progesterone is a diuretic and rids the body of excess salt and water.
It enhances the sensitivity of the body to insulin and therefore helps to maintain normal blood sugar levels. It also builds bone and benefits the cardiovascular system by blocking plaque formation in the blood vessels and lowering triglyceride levels. Progesterone increases libido, improves mood, promotes the breakdown of fat , increases energy and aids thyroid function. It plays an important role in reducing or helping prevent motor, cognitive, and sensory impairments in both men and women.
Low levels of progesterone can be caused by several mechanisms. Excessive stress lowers progesterone levels because progesterone will be converted to cortisol to fight the stress. In addition, poor food choices, inadequate sleep, and lack of exercise can lead to progesterone deficiency.
Supplementing with bioidentical progesterone:
- Promotes the breakdown of fat
- Maintains the lining of the uterus
- Facilitates sleep
- Helps maintain sex drive
- Stimulates formation of new bone, thus helping prevent or reverse osteoporosis
- Increases energy
- Protects against endometrial and breast cancer
- Protects against fibrocystic breasts
- Helps maintain normal blood sugar levels
- Balances side effects of excess estrogen - reduces fluid retention, bloating, headache, bleeding, and fibroids
- Rids the body of excess salt and water
- Decreases headache and bloating that accompany menstruation
- Acts as an antidepressant
- Protects against atherosclerosis by maintaining healthy hdl levels
- Facilitates thyroid hormone action
- Decreases the risk of blood clots
- Normalizes menstrual cycles
- Helps manage menopausal, perimenopausal and premenstrual symptoms
TESTOSTERONE FOR WOMEN
Testosterone is often called the “hormone of desire” because of its effect on enhancing female libido and sexual response. Production of testosterone in women decreases with age and by age 40, women produce about half as much testosterone as they did at age 20. Because testosterone is produced by the ovaries, adrenal glands and brain, deficiencies may result from damage to any of these areas. For example, surgical removal of the ovaries or adrenal glands, adrenal disease, pituitary disease, chemotherapy or use of high-dose steroids can all decrease testosterone levels. In addition, childbirth, endometriosis, substance abuse, antidepressants, and birth control pills can decrease testosterone.
Testosterone has many important functions besides its effect on sex drive. It is also important for building strong muscles and bones, maintaining stamina, and overall sense of well-being. It helps to combat wrinkles, sagging skin, muscular atrophy, and decreases body fat. It also combats cardiovascular disease by decreasing cholesterol and increasing HDL, and it helps prevent osteoporosis by increasing bone density and improving calcium retention. Testosterone is a memory enhancer and may protect against the development of Alzheimer's disease.
Symptoms of testosterone deficiency include: loss of sensitivity in the genitalia and nipples, vaginal dryness, lack of energy and motivation, lack of libido, loss of muscle tone, leaky bladder, weight gain and depression. A small amount of testosterone added to the Bioidentical hormone replacement regimen, may help revive a sagging sex life and make a noticeable difference in a woman’s overall quality of life.
Where do I go for help?
Dr Morley will assess your current hormone status by either a blood, saliva test, or a questionnaire. After determining the level of hormonal imbalance, he will prescribe natural hormones in various combinations and dosage forms, e.g., progesterone, biest and testosterone cream, biest & progesterone troches etc .
Where more than one hormone is deficient, they can be incorporated into one dosage form, e.g., DHEA & testosterone troche. In effect, he can prescribe a complete NHRT supplement tailored for the individual patient in a dosage form suitable for that patient.
Which dosage form do I use?
Dr Morley will prescribe the most appropriate dosage form for you. The types of dosage forms available include:
Hormones are compounded in a cream or gel to be applied to hormone sensitive areas on the skin for absorption via adipose tissue. The areas for application are tummy, inner part of the arms or legs. This allows the hormone to reach the target tissue (similar to hormone patches) avoiding rapid breakdown by the liver allowing a much lower strength to be used. It is a good idea to apply the cream on various areas of the skin, or rotate daily to avoid overload of the receptor sites. Please ensure that the hands are washed before and after application.
Troches are sublingual lozenges made to dissolve in the mouth and absorbed by the salivary mucus, avoiding first pass liver metabolism. Troches are probably the most favourable dosage form particularly if more than one hormone is deficient. Place it between your cheek and gum or under your tongue to allow for slow absorption via the saliva so that the active hormone will be absorbed straight into the blood stream. Avoid sucking the troche quickly as you would want maximum absorption into your body.
Some hormones are suitable to administer orally although most are better used via a topical cream or troche thus avoiding first pass liver metabolism.
What is compounding?
Compounding is the preparation of medicine by a pharmacist for an individual patient according to a doctor’s prescription. The practice predates the manufacture by mass production of drugs.
In every field of medicine, there are some patients who don’t respond to traditional methods of treatment.
Sometimes they need medicine at strengths that are not manufactured by drug companies. Sometimes they simply need a different method of ingesting a medication.