Women’s Wellness

Bio-Identical Hormone Replacement for Women

As a woman moves through peri-menopause the natural hormonal depletion that occurs as a part of the aging process can bring on uncomfortable and sometimes unbearable side effects. Some symptoms women experience are;
  • Hot Flashes
  • Vaginal Dryness
  • Decreased Bone Strength
  • Acne
  • Irregular Menstruation
  • Diabetes
  • Sleep Disturbance
  • Mood Disturbance
  • Decreased Concentration and Memory
  • Decreased Libido
  • Decline in Healthy looking Skin
  • Thyroid Disease
  • Obesity
  • Depression/Anxiety
  • Fatigue
  • Increased Cholesterol
These are hormones that are derived from plants and are the exact molecular structure as those naturally occurring in the body. Most commonly, you will be prescribed bio-identical hormones to include estradiol (E2) and progesterone, however other bio-identical hormones including estriol (E3), estrone (E1), testosterone, DHEA, pregnenolone and cortisol may be utilized. The use of these hormones are specifically prescribed to each person and because they are bio- identical there is a lower risk of cancer and other hormone related risks.

As with any treatment there are risks and benefits that must be discussed and considered. Use of estrogen in women with current or history of estrogen sensitive cancers is currently not good practice.

For women who would like to take estrogen it is important that she also takes bio identical progesterone as this has been found to be protective against endometrial cancer. If you are considering taking hormone replacement, head over to the National Cancer Institute and take the risk assessment.

The Women’s Health Initiative (WHI) was a large study performed in 2002 looking into whether estrogen only, or estrogen and progesterone hormone therapy was protective for heart disease and strokes in pre-menopausal through post-menopausal women. This initiative showed that peri-menopausal women treated with synthetic hormones were at an increased risk for heart disease, stroke, blood clots, breast cancer, and dementia. However, women up to 79 years of age were permitted to join the study with the median age being 63.

These women were likely 12 years beyond menopause and this data likely contributed to the adverse findings. Additionally, it was found in the study that younger peri-menopausal women had a favorable benefit-to-risk ratio- meaning- the benefits gained by taking hormone replacement therapy to mitigate menopausal symptoms outweighed any risk associated with treatment. Furthermore, the estrogens that were used in the study were synthetic made from horse urine- not bio-identical hormones.

One of the main ramifications from the Women’s Health Initiative was many symptomatic women were denied hormone replacement therapy- likely unnecessarily. Luckily, studies have subsequently re-analyzed the WHI data and found that breast cancer rates actually decreased in estrogen only treatment groups.

Your symptoms and lab work will be the first steps in pursing treatment. We will use blood and/or saliva tests to look for deficiencies. These may include; Testosterone free and total with Sex Hormone Binding Globulin (SHBG), CMP, CBC, estradiol, FSH, TSH, LH, IGF-1, Hemoglobin A1c, lipid panel, and DHEA. Once we have some data back we will formulate a treatment plan that may include hormone replacement, supplements, and lifestyle modifications.
We will likely draw labs in six months then yearly if levels are stable. We will also need to check levels if there is a dose change. We will need to see you in the office every 6 months to ensure we are adequately managing your health.