Posted: Tuesday 14 December 2010 06:58am
The Women’s Health Initiative study in the early 1990s had a tsunami effect through the world in raised concerns about the risks of Hormone Replacement Therapy (HRT), which had the effect of many women suffering unnecessarily through peri menopause and post menopause. One arm of the study demonstrated an increased risk of breast cancer from progestin, which the synthetic form of progesterone. Since then, there has increasing interest in and use of hormones which are identical to our own. Improved technology has created other biologically identical hormones for both men and women. these are the questions I am most often asked:
A significant number of medical experts and the ageing public realize that optimising hormone levels is necessary to preserve the aging body and the mind to physiological levels.
What are Bioidentical Hormones?
Bioidentical Hormones (prescribed as Bioidentical Hormone Replacement, BIHR) are identical in chemical structure to the hormones in our body. about 20 years ago, women were applying yam creams. some women would notice the benefits and some did not. this was due to variable absorption and more importantly, not all women could not convert the yam cream to the hormones that was needed by their body. it was assumed that the yam would be absorbed as progesterone and in the body it was converted to oestrogens.
Nowadays, the basic source is converted to the hormones outside the body and consequently when the hormone is absorbed either as a cream, troche or a capsule, the correct dose, ratios and more importantly, the deficient hormone is prescribed.
Bioidentical hormones are sourced from soy bean or wild yam, called diosgenin. the diosgenin is purified and modified to a chemical structure that is identical to our own hormones. the process also includes bringing the hormone to pharmaceutical grade and is micronised for improved absorption.
Unfortunately there is confusion between the term progesterone (what is in our body) and progestin (the synthetic form). these two names are used to mean the same when they are not.
Why would my doctor prescribe BIHR?
Our body’s chemistry is designed to connect with our own hormones, and not a hormone which has a structure that is foreign to the receptors and breakdown pathways. Therefore products that that do not have an exact fit are broken down less efficiently by the liver’s detoxification pathway.
Many factors affect this pathway. To name a few: fatty liver, external toxins, poor nutrients and our genetic profile. consequently is will be easier for our liver to breakdown hormone that easily fit into our receptors rather than a non-identical hormone.
Synthetic hormones also have additives that are foreign to our chemistry and stay in our body for longer periods of time, and may be responsible for side effects.
What hormones typically need to be replaced (in women) and at what age?
In my practice, young women up to the age of the peri menopause, present with premenstrual symptoms. In this age group, progesterone has been very helpful to control the fluid accumulation, the mood symptoms, the carbohydrate cravings and the central weight gain.
The peri menopause age group is more challenging as there can be oestrogen deficient symptoms as well as premenstrual symptoms. consequently oestrogen as well as progesterone may be needed. In addition the levels can fluctuate from month to month.
The menopause age group needs oestrogen and progesterone, even after a hysterectomy, as progesterone has benefits of its own. Additionally, testosterone may be prescribed.
DHEA is often prescribed for adrenal fatigue, a very common complication of modern society.it should be emphasised that the above is only prescribed in the presence of relevant signs, complaints and most importantly, deficient levels. it is also important that the hormones are in balance, as in our body, all the hormones work synchronously like a symphony orchestra.
What causes these hormones to decline?The pre- peri menopause age, often has low progesterone to oestrogen ratio, often called oestrogen dominance. this dominance is caused by the presence of synthetic hormones in our environment, called xenoestrogens; common sources are plastics, petroleum products, pesticides like DDT, synthetic hormones, fatty liver from causes mentioned above and overweight.
The most cause for deficiency is ageing; as our hormone glands age, they become less productive.
How do I know if I need BIHR?
Both, men and women have a choice of non BIHR and BIRH. Most people see a doctor if there are symptoms which they suspect is related to their hormones. In females the symptoms are:
* PMS, which includes mood and behaviour changes, fluid retention, breast tenderness, weight gain, headaches or migraines, increase menstrual flow and pain.
* Peri-menopause symptoms are as for PMS but may occur throughout the monthly cycle; feeling hot, sweats and loss of libido
* Menopause symptoms are night sweats, hot flushes, dry vagina, loss of libido, vaginal infections, urinary incontinence, depression, anxiety, irritability, muscle aches and pains, insomnia, facial hair growth, lower back pain, flatulence, indigestion, osteoporosis, hair loss, frequent urination, sore breast, snoring, palpitations, varicose veins, dizzy spells, panic attacks, skin feeling crawly, migraine headaches and memory lapses.
In males, there are symptoms related to the equivalent of menopause, called Andropause, which include loss of libido, erectile dysfunction, fatigue, inability to cope with stress, muscle weakness, weight gain, depression and loss of self esteem.
What benefits should I see if I am on BIHR?The benefits are an improvement to the above symptoms. the pre menstrual female will notice an improvement in most of her PMS symptoms. the peri menopausal woman will note an improvement of her moods, improvement in her PMS and better temperature tolerance. the post menopausal female will notice control of her hot flushes and night sweats, less aches and pains and less vaginal symptoms.
The male will notice an improvement in self esteem and libido.
How long do I need to stay on treatment?The Australian Menopause Society, states that for women between 50 to 59, the benefits of HRT outweigh the risk. however some women prefer to stay on treatment for many years as they have made the decision that the benefits outweigh the risks. the male can stay on the treatment for life.
The Anti-Ageing Colleges would recommend that BIRT is necessary for healthy ageing. Ultimately the decision is a personal one, but only if there is proper monitoring of hormone levels and possible side effects.
What is the difference between BIHR and HRT?The main difference is the BIRT are identical to our own hormones and the conventional HRT is mostly not identical to our hormones. Experts feel that the BIHR has less side effects. this is well demonstrated between the Bioidentical Progesterone and that non Bioidentical Progestins.
The progestin cause the unwanted side effects of weight gain, headaches and fluid retention to name a few. the progesterone causes weight loss, acts as a natural antidepressant, increases metabolic rate helps sleep and acts as a diuretic.
How is BIHR applied?
Cream, pills. Most of the world experts recommend a cream for oestrogen; this method avoids swallowing the hormone which then goes through the liver to be changed to a bad oestrogen. Swallowing the oestrogen can cause weight gain, increases triglycerides, increase depression, elevate liver enzymes and increase sex hormone binding protein and consequently reduce available testosterone.
Troches theoretically should be absorbed by the oral mucosa. however there is risk that some of the oestrogen will be swallowed. Therefore it is best to use a troche last thing at night so when there is no talking or swallowing.
Progesterone and DHEA can be swallowed as a capsule. like oestrogen, testosterone should be taken as a cream or troche.
Are there any side effects?Like all things medical and non medical there is a potential for side effects. We now know that our genes can affect the chemical pathways in the liver and the cellular and mitochondria response. the genes can change under the influence of the environment, diet and lifestyle. Therefore the risk can change with time.
Breast cancer and prostate cancer can occur even without taking hormone replacement. the risk increases with the wrong family history, smoking, obesity.
However there is encouraging news for BIHR. In a study of 80,377 women by Fournier in 2009, there was no increase in breast cancer in women taking oestrogen and progesterone compared to a 69 per cent increase in women taking oestrogen and progestin. Campagnoli stated in 2005 that synthetic progestins increase breast cancer risks.
In 2009, Holtorf wrote in Journal of Postgraduate medicine, “until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT”.
The Australian Menopause Society states in its website that there is no evidence for BIHT. it has a fact sheet on this treatment which interested parties should read for alternative view.
Blood clots and strokes can occur but is increased in individuals who smoke, have a sedentary lifestyle or have a family history. less serious side effects can occur but should be detected by elevated hormone levels.
What are the risks of BIHR?
The risks of BIHR are the same as HRT but there is encouraging evidence that with proper use and monitoring, the risks are small.
Apart from the possible risk mentioned above, there are local side effects if the cream is not applied correctly or the troches used incorrectly.
Creams should be rotated between the arms and only applied to non fatty region and where the skin is thin. Increased hair growth can occur if testosterone is applied to the daily to the same limb.
Excess progesterone can cause sweet cravings and weight gain and laxity of ligaments causing back ache and urinary incontinence, smooth muscles can relax to cause bloating, fullness and constipation.
Excess oestrogen can cause weight gain, sore breast, fluid retention, headaches, migraine, increase uterine bleeding and increase risk of breast cancer.
Excess testosterone may cause hirsutism, acne, greasy skin, aggressiveness, fatigue, depression and hair loss.
Excess DHEA can cause greasy skin and acne in a female (females are very sensitive to DHEA), fatigue, weight gain, facial hair, restless sleep, sugar cravings and insomnia.
The above is not a complete list of side effects, but are the most common. the individual should consult their own doctor for a comprehensive list.
Can any doctor prescribe BIHR?
All doctors can prescribe BIHR. it is my personal experience that my knowledge of BIHR was significantly improved by completing the Australasian Academy of Anti-Ageing Medicine (A5M) Fellowship. the course looked at all aspects of BIhr. it concentrated in detail, on appropriate testing and application of various preparations. it also prepared attendees for the various patient symptoms and management of side effects.
It is recommended that individuals consult practitioners experienced in BIHR or have completed the A5M Fellowship.
To find an anti-ageing doctor, visit a5m.net or call 03 9813 0439.
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