Bio-identical hormone replacement therapy (BHRT) is the use of prescription hormones to correct hormonal imbalances that are the cause of the symptoms of perimenopause, menopause, PMS, PMDD, and PCOS. BHRT hormones most commonly used are estrogen (estriol and estradiol), progesterone, and testosterone. These hormones are chemically identical to the hormones that are naturally occurring in the human body. This means that the body cannot distinguish between the prescription hormones and the hormones that your body naturally produces on its own. The goal of BHRT is to correct the hormonal imbalance that is causing the symptoms of your condition. Most BHRT hormones are dispensed by compounding pharmacies and are tailored to your specific needs based on symptoms, lab values, and age. While some hormones can be administered through patches or oral capsules, most BHRT hormones come in the form of topical creams that are applied daily.
There are several conditions treated with BHRT. Most commonly, these are perimenopause, menopause, premenstrual tension syndrome (PMS), premenstrual dysphoric disorder (PMDD), and polycystic ovarian syndrome (PCOS). The most common symptoms of perimenopause and menopause are:
The symptoms of PMS, PMDD, and PCOS are usually caused by progesterone deficiency and/or estrogen dominance. These symptoms include:
Conventional HRT uses “unnatural”, conjugated estrogens, often derived from equine sources. These hormones are most often taken orally, and are usually taken without consideration of balancing progesterone levels relative to estrogen levels. All of these factors pose additional, unnecessary health risks for the individual. These risks include increased incidence of cardiovascular disease (CVD), stroke, dementia, and certain forms of cancer. When you use bio-identical hormones, balance estrogen and progesterone levels according to age and symptoms, and use topical applications when necessary, paired with proper follow-up and testing, not only do you not have an increased risk of these conditions, but studies have shown that BHRT actually REDUCES your risk of CVD, dementia, certain forms of cancer, diabetes, and osteoporosis. This study highlights some of these differences between conventional HRT and BHRT. Furthermore, the side effects of BHRT are minimal and usually only occur if the dose is too high. If at an appropriate dose, which is easy to achieve with proper follow-up and testing, there are usually no unwanted side effects. Once stable on an appropriate dose, follow up testing is only required twice per year. This study outlines some of the many health benefits of BHRT.
This is a common question of patients considering BHRT. No, you do not have to remain on BHRT forever once you initiate treatment. Treatment duration is highly dependent on symptoms, age, and desired results. While many patients elect to remain on BHRT for preventative medicine and the long term health benefits, treatment duration can range from months to several years. When treating symptoms of perimenopause or menopause, treatment is only necessary until the body has adjusted to the lower hormone levels in post-menopause. When treating conditions like PCOS, PMS, or PMDD in younger patients, treatment may be longer term. However, treatment in these conditions is not always continuous. Treatment plans are always highly individualized based on lab values, symptoms, medical history, and age. As well, there are several modalities of Naturopathic Medicine, including herbs and supplements, that can sometimes be used instead of BHRT to help balance hormone levels in certain conditions. Check out my bio for a comprehensive list of modalities I utilize in my practice. If you have further questions and are considering treatment, consider scheduling a free 15-minute consult.
Dr. David McHenry is a Naturopathic Doctor at the NH Health & Wellness Center whose practice focuses on hormone health, autoimmune disease, mental health, and gastrointestinal disorders. To schedule an appointment with him, call (603) 402-9134 or email at info@nhhealthwellness.com.
