Two-thirds of women experience night sweats and hot flashes as they go through menopause. These vasomotor symptoms can persist for many years after menopause, greatly reducing their quality of life.
Many women also deal with vaginal dryness, interfering with their enjoyment of sex, mood swings, and changes in their skin. Hormone deficiency in women increases the risk of Alzheimer's, diabetes, heart disease, colon cancer, and osteoporosis. It's only natural that millions of women ask their doctors about hormone replacement therapy.
It's always important that your doctor prescribes hormone replacement therapy on the basis of laboratory testing, not just on the basis of your symptoms. Your doctor should not attempt to raise your hormone levels without first confirming that they are low! Blood testing is more accurate than saliva testing, and hair analysis has no value to prescribing hormone therapy at all. But once you and your doctor have determined that hormone replacement therapy is best for you, you have a choice between bioidentical hormones and synthetic hormones.
Bioidentical hormones are chemically identical to the hormones the human body makes. Amazingly, the same chemicals that function as hormones in the human body sometimes also appear in other organisms, although sometimes with a totally different function.
The healing substances used inbioidentical hormone therapy are usually sourced from plants, such as soy or yams. It is also technically possible (but unnecessary) to manufacture small quantities of bioidentical hormones in the lab.
Dozens of self-help books and thousands of websites promote the use of bioidentical hormones for treating hormone deficiencies. These books and websites often claim that bioidentical hormones are safer than synthetic hormones (which we will describe in more detail in the next section). They often claim that synthetic hormones are "drug hormones" that don't really replace the hormones that the body needs.
There is an element of truth in the claims, but it's not as straightforward as some authors make it out to be. Both bioidentical and synthetic hormones can remedy the symptoms of hormone deficiency, although bioidentical hormones have a real advantage when it comes to dosing.
The major difference between bioidentical estrogen replacement and synthetic estrogen replacement is the inclusion of the female hormone estriol in the product. Bioidentical hormone replacement for women includes it. Synthetic hormone replacement for women doesn't.
What's special about estriol?
Estriol is a kinder, gentler form of estrogen.
Estriol is a relatively weak female hormone. In a woman's body before menopause, the ovaries make a relatively potent female hormone called estradiol.
After menopause, the ovaries stop making estradiol, but fat cells can make a weaker form of estrogen called estrone. A woman's body can convert estradione into the weaker hormone estrone and back again. It can also convert estrone into the still weaker hormone estriol, but once the product has been converted to estriol, it can't be transformed again.
Bioidentical hormone replacement is formulated to emphasize estriol over other forms of female hormone replacement because experiments with animals suggest it is less likely to stimulate the growth of hormone-sensitive breast cancer and hormone-sensitive uterine cancer.
We don't really know from human clinical trials that estriol is safer than other forms of hormone replacement—because the only way to find out would put some women at increased risk for cancer! But there is good reason to believe that bioidentical hormone estrogen replacement is safer for this reason.
In the United States, there aren't any compounding pharmacies that produce hormone replacement therapy that is just estriol. A 2.5 mg dose of the most common bioidentical estrogen replacement product Biest contains 0.5 mg of estriol and 2.0 mg of estradiol.
That's because products in the United States are usually formulated to address mood swings and hot flashes with estradiol, while estriol is primarily for treating vaginal dryness. In Europe, some products are formulated from pure estriol but are only used for dryness and sexual difficulties.
Synthetic hormones are functionally similar to the hormones the human body makes. They are made from non-organic sources.
These hormones must be activated by enzymes in the liver into an active form. But since liver enzymes process thousands of other products, the foods you eat and the drugs your doctor prescribes can affect how your body responds to hormone replacement therapy.
For instance, Premarin is metabolized by a liver enzyme called CYP3A. When you take St. John's wort, an antibiotic called rifampin, or a drug called phenobarbital for seizures or migraines, your liver makes more CYP3A. As a result, the synthetic estrogen breaks down before your body can respond to it.
Conversely, drinking grapefruit juice, eating apples, taking erythromycin, clarithromycin, ketoconazole, or itraconazole causes your liver to make less CYP3A. This makes estrogen build up in your body, possibly to excess.
Most women get the greatest benefit from a combination of bioidentical and synthetic hormone replacement, bioidentical estrogen with synthetic progesterone.
Estrogen replacement is always complemented by progesterone replacement. In theory, taking estrogen without progesterone could increase the risk of uterine cancer in menopausal women who have not had a hysterectomy. In practice, there have only been three cases of uterine cancer in women who received bioidentical estrogen replacement with bioidentical progesterone replacement, but prescribing progestin, the synthetic, solves the problem. The synthetic progesterone product is more completely absorbed.
There are bioidentical testosterone replacement products for both men and women, but there is a reason many men don't want either kind of hormone replacement. Testosterone replacement can lead to shrinkage of the testes. Most men opt for other kinds of treatment for low-T.
Both bioidentical and synthetic hormone replacement products come in gel form. Synthetic hormones are available as injections. Bioidentical estrogen replacement and Bioidentical testosterone replacement are also available as pellets placed under the skin.
There are significant drawbacks to getting hormones in the form of gels or injections. Bioidentical progesterone isn't well absorbed through the skin. Synthetic testosterone is unevenly absorbed from gels and gel patches. Synthetic hormones given by injection have a half-life that reduces concentrations between shots. You feel the benefits immediately after you get the injection, but for the rest of the month, problem symptoms start to come back.
The way to get around these problems is to get your hormone replacement in the form of pellets.
Pellets are injected under the skin with a device called atrocar. Your doctor can work with a compounding pharmacy to get exactly the dosage you need. The more hormones you need, the more pellets your doctor injects.
Pellets release hormones at a steady rate for up to six months. There are no shots to take, no pills to remember, and no messy gels. Hormone pellets are the easiest and most effective form of hormone replacement therapy for most men and women, although women may also need a synthetic progesterone cream.
Do you have questions? Trocar Supplies has answers! Call us at (937) 478-0469 orcontact us online.
