Hormone Therapy for Women
Restoring Hormone Balance
Bio-Identical Hormone Replacement Therapy (BHRT) is the replacement of deficient hormones with hormones that are chemically identical to those the body produces, but which have declined due to aging or hysterectomy.
Customized BHRT has improved the quality of life for many women who suffer from hormonal imbalance. The ideal process for achieving hormone balance includes an assessment of hormone levels (lab work) and an evaluation of signs and symptoms. Replacement of deficient hormones is begun with the most appropriate dose using the most appropriate dosage form for each woman. Monitoring using patient feedback and repeat lab work allows fine tuning of replacement therapy.
All steriod hormones are created from cholesterol in a hormonal cascade. The first in the cascade is pregnenolone, which is subsequently converted into other hormones including DHEA, progesterone, testosterone, and several forms of estrogen. These hormones are interrelated, yet each performs unique physiological functions. A sound hormone replacement strategy should focus on a woman's total hormone balance.
Progesterone is often prescribed to provide a balance for the estrogens, and help with sleep, anxiety and depression. Progesterone is also a precursor to our stress hormone, cortisol. Progesterone levels may decline during periods of extreme, chronic stress.
Androgens, which include DHEA and testosterone, are important for libido as well as the integrity of skin, bone, and muscle. These hormones may also decline as women enter menopause.
Bio-Identical or "Natural" VS Synthetic
Bio-Identical means that the hormones are an exact match to the hormones produced by the human body. They could also be called human-identical. These hormones get their start in nature, found in soy beans and wild yams, and can then be easily converted into the exact hormones that the body makes. The body can recognize these bio-identical hormones and use them just as they would if they were being produced by the ovaries, testes, or adrenal glands. Some of the side effects usually seen with bio-identical hormones are associated with incorrect dosing. By making slight variations in the dosing, or dosage form, these side effects disappear.
Synthetic hormones are not easily recognized by the body even though they may produce similar effects. Because they can be hundreds of times more potent than the hormones that our bodies make, they are linked to many side effects. The side effects that caused the Women's Health Initiative (WHI) study to be stopped have actually been suspected for several years.
Also, since Bio-Identical hormones can not be patented, drug companies will not spend the money necessary to bring them to market. They could not recover the cost of the studies nor the development of these new drugs, to make it profitable. Therefore, it is much more difficult for doctors and patients to get information on Bio-Identical hormones.
Estrogens are prescribed to relieve menopausal symptoms and treat postmenopausal problems such as vaginal dryness and tissue breakdown, painful intercourse, and various urinary disorders. Estrogens have been shown to decrease the risks of osteoporosis and colorectal cancer.
There are three main forms of estrogen including Estrone (E1), Estradiol (E2), and Estriol (E3). Each form of estrogen has it's own particular functions and effects.
Estradiol (E2) (the predominant form of estrogen in non-pregnant, reproductive women) primarily aids in the cyclic release of eggs from the ovaries. E2 has beneficial effects on the heart, bone, brain and colon. Reduction in the levels of E2 cause common menopausal symptoms such as hot flashes and night sweats.
Estrone (E1) is produced in the ovaries, adrenal glands and fat cells and is the predominant estrogen in postmenopausal women. Estrone is a stronger estrogen than Estriol, but weaker than Estradiol. Overweight women have high circulating estrone levels. Estrone can be broken down by the body into 3 known metabolites: 2-hydroxyestrone, 4-hydroxyestrone and 16-alpha-hydroxyestrone. The 2-hydroxyestrone is thought to be a protective estrogen, while the 4- and 16-alpha hydroxyestrones have been associated with increased development of cancer. The ratio between 2-hydroxyestrone and 16-alpha-hydroxyestrone (2:16 ratio) is sometimes determined to assess possible risk for estrogen dependent cancers. This ratio can be favorably effected by 3,3'-Diindolylmethane (DIM) and indole-3-carbinole (I3C) which are components of cruciferous vegetables.
Estriol (E3) is secreted in large quantities by the placenta during pregnancy. Estriol is a comparatively weak estrogen. Estriol can compete with E2 and E1 at estrogen binding sites. In this way Estriol may have some protective attributes in estrogen sensitive cancers.
Progesterone provides the balance for estrogens during the menstrual cycle in young women. Progesterone acts to prepare the uterus for implantation with a fertalized egg and to support the early stage of pregnancy. If pregnancy does not occur, progesterone levels drop and another cyle begins.
Progesterone has been used in BHRT to relieve menopausal symptoms such as insomnia, anxiety, depression, and heavy or irregular menstrual bleeding.
In some studies, Progesterone has been shown to have anti-proliferative effects on breast cancer cells. It is thought by many to have a protective effect.
Progesterone occurs very early in the hormone cascade which begins with cholesterol. This means that the body can convert it to other hormones that are also very critical. Our stress hormone cortisol is made from progesterone.
Testosterone is important for women also. It helps to maintain lean muscle mass, bone density, and libido. It is often also used in combination with estrogen to decrease incontinence and other vaginal symptoms. Low levels of testosterone has been associated with fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.
Side effects of too much testosterone include acne, oily skin, facial/body hair growth, scalp hair loss, irritability and increased aggressiveness. If you have diabetes your blood sugar may be affected.
DHEA (Dehydroepiandrosterone) is a hormone produced by the adrenal glands and is a steriod precursor of both androgens and estrogens. Concentrations of DHEA and its metabolite, DHEA Sulfate, peak at about age 20 and progressively decrease with adavancing age.
A few studies have demontrated low levels of DHEA in obesity, cardiovascular disease, non-insulin dependent diabetes, chronic fatigue syndrome and some types of cancer. There is speculation that low levels of DHEA might be partially responsible for age-related degenerative diseases and replacement therapy may be of value. A blood test can determine if a person is deficient.
Side effects of too much DHEA are thought to be due to its conversion to testosterone. Conversion to estrogen is also possible so women at high risk of estrogen dependent cancers should you caution and should be monitored carefully by their healthcare provider. Because DHEA is metabolized in the liver, patients with a history of liver disease should also be monitored closely. Some reports of rapid or irregular heart beats have been reported.
The conversion of cholesterol to pregnenolone is the first of many steps in the synthesis of some of the body's key hormones, including DHEA, Progesterone, the androgens, the estrogens and cortisol. Nicknamed the "mother hormone", pregnenolone is a vial building block in the hormone cascade. Pregnenolone is thought to play a role in memory and cognitive function.