What is BHRT?
Bioidentical hormones used in Bioidentical Hormone Replacement Therapy for Women are non-synthetic, plant based hormones that are identical biologically and structurally to human hormones. The best analogy to differentiate them from synthetic hormones is to look at the hormones and the receptors they activate (hundreds of thousands in our bodies) as a lock and key. The hormone is the key and the receptors are the locks. Bioidentical hormones fit perfectly in the lock and unlock all the beneficial effects of the hormones. When dosed properly there are minimal to no side effects. Synthetic hormones, in contrast, fit in the lock but do not turn the lock and are associated with many untoward side effects.
What is Hormone Pellet Therapy?
Prestige Medical Rejuvenation Center uses the BioTE Pellet Therapy Method for testosterone and estradiol replacement. The pellets are just a little bit bigger than a grain of rice. Using a local anesthetic and a small incision (approximately 5mm) they are placed in the fatty tissue underneath the skin on the hip/buttock. This method is one of the most widely studied, effective and safest methods of natural bioidentical hormone replacement therapy available. We chose to use BioTE Medical as our supplier of testosterone and estradiol as the purity of the BioTE Medical pellets are unmatched in the industry. Pellet Therapy uses hormones derived from natural plant sources to replicate the body’s normal hormonal levels. Patients have found that bioidentical hormone replacement therapy with pellet implants is extremely effective as they consistently release small physiological doses of the hormones providing optimal levels. Unlike typical oral, transdermal, or injection forms of hormone replacement therapy (which produce “roller coaster” hormone levels, resulting in mood and energy fluctuations for the patient) BioTE Medical Hormone Pellet Therapy is the only method of hormone therapy that provides sustained hormone levels throughout the day lasting up to 4 to 6 months without the “roller coaster” effect.
Is Bioidentical Hormone Replacement Therapy for Women Safe?
Researched and developed since 1939 in the U.S. and Europe, there is a myriad of data to support the long term safety and efficacy of hormones delivered by pellet implants. Bioidentical hormone pellet therapy is being used safely in 5 continents and has been studied for 8 decades not only looking at safety and efficacy but also the prevention of disease states such as breast cancer, heart disease, osteoporosis, Alzheimer’s disease, diabetes and so much more.
What Are The Symptoms of Hormone Imbalance In Women?
- Night Sweats
- Decreased libido
- Hair falling out
- Sleep problems
- Hot flashes
- Difficulty achieving orgasm
- Gaining weight/belly fat
- Decreased mental clarity/focus
- Cold all the time
- Vaginal dryness
- Dry skin
- Breast tenderness
- Bone loss (osteoporosis)
The Menstrual Cycle
Before we can discuss the decline in hormones as a woman ages and hormone replacement therapy we must first review what happens during a woman’s menstrual cycle. The purpose of the menstrual cycle is to prepare the uterus for implantation of a fetus. This process is hormonally driven and replenishes itself on a monthly basis. The pituitary gland releases follicle stimulating hormone (FSH) and this stimulates the ovaries to produce estradiol (the primary type of estrogen). Estradiol in turn stimulates the cells in the lining of the uterus to proliferate leading to a thicker uterine wall. It is stimulated for the first half of the menstrual cycle. In response to the elevated level of estradiol there is an increase in the amount of Luteinizing Hormone (LH) which causes the release of an egg from an ovary. The follicle from which this egg is released becomes the corpus luteum and begins to produce progesterone. This counter balances the effects of estradiol on the uterine lining and readies it for implantation of a fertilized egg. If pregnancy occurs the placenta will take over the progesterone production. If no pregnancy occurs the production of progesterone from the corpus luteum stops after about two weeks and the lining of the uterus sheds with menses. The entire process then begins over again.
The age of menarche (first menses) varies among individuals as does the regularity of their menses. Typically there is some irregularity early on but for most women by the time they reach late teens her menstrual cycles become more regular.
As a woman approaches her mid-thirties there is a slight decline in her production of estradiol and progesterone. She continues to have regular cycles but her ability to become pregnant may be decreased. Over the next 5-10 years she may experience fluctuating cycles, cycles where she doesn’t ovulate, and symptoms related to hormonal imbalance: hot flashes, night sweats, fatigue, memory difficulties, vaginal dryness, breast tenderness and bloating to name a few. This time period of fluctuating cycles is commonly referred to as “perimenopause”. Within perimenopause great variance can be expected from having no bleeding to having heavy bleeding.
The term menopause is defined as having gone 12 months without a menstrual cycle. The lack of a period is secondary to the lack of estrogen stimulating the lining of the uterus. The lack of estrogen further accelerates the symptoms related to her hormonal imbalance.
The term estrogen is used to refer to three hormones called estrone, estradiol, and estriol. All three of these have estrogen like effects in the body. Estradiol is the most potent of the three followed by estrone and then the weakest one estriol. The drastic decrease of estrogen noted in menopause and the varying levels in perimenopause are responsible for much of the symptoms a woman experiences. Doctors have been prescribing estrogen for women to combat the symptoms of perimenopause and menopause for several decades. By doing such they have been able help relieve their symptoms and improve their quality of life. Estrogen replacement also lowers a woman’s risk of heart disease, stroke, Alzheimer’s disease and osteoporosis.
Estrogen Replacement Therapy
For decades women have been enjoying their improved symptoms due to estrogen replacement therapy. However, thousands of women stopped taking their hormones in 2002 when the Women’s Health Initiative Study was stopped due to an increase in strokes, heart disease and breast cancer in women that took the synthetic hormones Premarin and Provera together. This increased risk was not seen in the women that took Premarin alone. There have been later studies that have shown in increase in blood clots, heart disease and strokes with the use of Premarin. The media frenzy over Premarin and Provera alarmed the public and caused many women to throw away their prescriptions and go without hormone replacement therapy.
Fortunately, the literature has shown that the problem is in the synthetic hormones Premarin and Medroxy-progesterone (Provera) and NOT the bioidentical hormones estradiol and progesterone. The media misrepresented the data and grouped all hormone replacement therapies together whether it was synthetic or bioidentical. To this day, however, many women still fear estrogen replacement therapy due to the media hype in 2002. This is rather unfortunate as I believe women should have a stronger fear of the harmful effects of the loss of their own natural estrogen.
Do You Have To Take Hormones?
No and some women choose not to. Most women will experience hot flashes, vaginal dryness, memory problems, mood swings, decreased libido as well as bone loss (osteoporosis) as their bodies adjust to menopause. These symptoms can continue for several years until she becomes more acclimatized to the changes and she doesn’t feel quite as bad. At that point she is considered to be “post menopausal”. Although she may not feel as bad as before, her risk of cardiovascular disease, diabetes, osteoporosis and Alzheimer’s disease continue to rise due to the hormonal imbalance.
Benefits of Estrogen Replacement Therapy
The rapid loss of bone after menopause has been attributed to the decline in the production of estrogen. There is a significant morbidity and mortality secondary to osteoporotic fractures in women. Her risk of heart disease climbs exponentially with the loss of estrogen. Women that are on estrogen replacement can decrease their mortality risk from heart disease upwards of 70%. Additionally, estrogen has been shown to increase the good cholesterol (HDL) and decrease the bad cholesterol (LDL). The brain blood vessels are also protected by estrogen and women on estrogen replacement have a lower incidence of Alzheimer’s disease.
Types of Estrogen Replacement Therapy
For most women being treated by their primary care physicians the form of the estrogen they receive is the synthetic hormone Premarin which is derived from the urine from pregnant mares (hence the name PREgnant MARe urINe). This hormone preparation has several estrogens found only in horses. They are associated with many side effects since they are recognized as foreign to the female human body. Fortunately, the side effects seen with the synthetic estrogen are not seen with bioidentical forms estradiol, estrone, and estriol.
Bioidentical estradiol can be given in an oral pill, sublingual troche, transdermal cream or subcutaneous pellet/implant. At Prestige Medical Rejuvenation Center we prefer the subcutaneous pellets from BioTE Medical due to the purity of their product and due to the fact that the pellets negate the patient compliance component associated with the other methods.
Progesterone stands for pro-gestational or the hormone of pregnancy. It is required for the initiation and maintenance of pregnancy. It is credited as the “feel good” hormone in pregnancy and is a first line therapy for post-partum depression. It is produced in the ovaries and balances the effects of estrogen.
During menopause women lose progesterone as well as estrogen. Progesterone protects them from uterine cancer, breast cancer, osteoporosis and heart disease. Progesterone and estrogen work together to maintain normal hormonal balance. The lack of progesterone can cause similar symptoms and disease processes as a lack of estrogen. Progesterone also reduces total cholesterol and can increase the good cholesterol (HDL). It is a natural tranquilizer and can help with sleep. It is very helpful as a treatment of premenstrual symptoms. In addition, it stimulates osteoblast, which are the cells that grow new bone. Estrogen will only prevent bone loss.
Provera vs. Bioidentical Micronized Progesterone
For many physicians their first choice to replenish progesterone is the synthetic drug Provera. Its generic name medroxy-progesterone is very similar to the natural hormone progesterone and many physicians mistakenly think they are the same. But, they clearly are not. Provera is considered a progestin/synthetic progesterone and is also a teratogen that causes birth defects and is contraindicated in pregnancy. This is a far cry from progesterone that is required for pregnancy. There are no studies that show bioidentical progesterone as being harmful however multiple studies have found Provera to be harmful in many ways. The Women’s Health Initiative Study was stopped in 2002 due to increased incidence of heart disease, stroke and breast cancer from the use of Premarin and Provera. Breast cancer risk was found to be directly related to taking Provera.
The side effect profile of natural/bioidentical progesterone is much better and women tend to not experience the bloating, breast tenderness, bleeding and depression that can be associated with Provera. In the PEPI Trial Progesterone went head to head with Provera. The Provera arm of the study resulted in elevated cholesterol levels and increased heart disease risk. The Progesterone arm of the study showed the direct opposite.
Oral Progesterone vs. Cream
Progesterone is available in many forms: oral capsule, sublingual tablet/troche, or topical cream. There is some controversy as to which form is the best. Many like to prescribe the topical cream and use salivary testing. But, the studies have shown that although one may have good salivary levels with topical creams the blood levels do not correlate and are often suboptimal. The blood levels are the true indicator of the progesterone level and the ability to get optimal serum levels are only found with the sublingual form and the oral capsule.
Testosterone Replacement Therapy In Women
Testosterone is not just for men. Believe it or not women need their testosterone levels optimized to feel good too. Women produce testosterone in their ovaries and their adrenal glands. Female testosterone levels are approximately 10% of a male. Much of the symptoms women experience during perimenopause and menopause can be alleviated with testosterone alone. Testosterone replacement therapy in women contributes to an enhanced feeling of well-being, increased sex drive, increased energy, relief of night sweats and hot flashes, improved skin, decreased body fat, increased lean muscle mass, and decreased risk of osteoporosis through the production of new bone. Testosterone has also been shown to decrease the risk of Alzheimer’s disease.
Types of Testosterone Replacement Therapy In Women
- Improves our immune system function
- can help decrease body fat and cholesterol
- Increases insulin sensitivity decreasing the amount of insulin needed which helps decrease incidence of diabetes
- Has antioxidant functions
How Does One Get Started On Testosterone and Bioidentical Hormone Replacement Therapy?
The initial step is checking your hormone levels in your blood to see if you are indeed a good candidate. If you are a candidate and choose to go ahead with the hormone replacement therapy and pellet procedure your dose is individualized based on age, body weight, activity level as well as your baseline blood levels. Six weeks following the procedure we verify the dosing by rechecking your serum hormone levels. If your levels are not in the optimal range we will offer you a booster implant/pellet for no extra charge and will adjust your thyroid medications if need be. Call us at today at (402)334-5433 and GET OPTIMIZED!