What is BHRT?
Bioidentical Hormone Replacement Therapy is also called BHRT.
Bioidentical hormones are identical to the hormones produced in our bodies. In women, the main hormones replaced in this therapy are estradiol, progesterone, testosterone and thyroid. In men, mainly testosterone and thyroid.
What is Menopause?
Menopause is the time in a women’s life when the ovarian production of estrogen, progesterone and testosterone declines. The average age of menopause is 51, plus or minus several years. Medically it is defined as the time in which a woman ceases to menstruate for a period of 12 months. While this properly describes the event, the process can begin up to 10 years earlier, (called peri-menopause).
Long before a woman’s period has stopped, she has already noticed a change. Her periods become shorter in duration and she notices a loss of energy, a decrease in strength and a loss of libido. Her mood is altered and she may feel more anxious, depressed, apathetic and forgetful. These are all symptoms of menopause, the loss of estrogen, progesterone and testosterone.
The symptoms of menopause include:
* Hot flashes, flushes, night sweats
* Mood swings, sudden tears
* Trouble sleeping through the night
* Loss of libido
* Dry vaginal wall
* Crashing fatigue
* Anxiety, feeling ill at ease
* Difficulty concentrating, disorientation
* Aching muscles and joints
* Headaches and migraines
* Fluid retention
* Exacerbation of existing conditions
* Increase in allergies
* Weight gain
* Hair loss or thinning
* Increase in facial hair
In addition to decreased levels of estrogen, progesterone, and testosterone, many other hormones including thyroid hormone and human growth hormone taper off during menopause.
As hormones levels decrease, profound changes begin occurring with growth and metabolism that affect the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract, cardiovascular system, skin, brain, and energy levels.
Many women experience hot flashes, loss of libido, weight gain, insomnia, and emotional changes such as depression and anxiety. Some long-term risks of menopause include osteoporosis and cardiovascular disease.
Medical research has proven that the majority of women’s disorders, including menopause, PMS, migraines, and depression can be treated with bioidentical hormone replacement therapy.
For women the midst of menopause, BHRT - bioidentical estrogen, progesterone, thyroid and testosterone can bring a rebirth of energy, sexual desire, and the ability to have a healthy active life. Bioidentical hormones offer the same benefits of synthetic hormones, without many of the unwanted dangerous side effects.
Estrogen or Progesterone Deficiency
Follicle-Stimulating Hormone, or FSH, is commonly used by doctors to diagnose menopause. FSH is elevated when ovulation or egg production ceases. The hormone that is directly dependent upon ovulation is progesterone.
While estrogen can be produced from a variety of sources within the body and externally; progesterone is only produced after ovulation.
Estrogen and progesterone are produced together throughout the reproductive years and function best when they are produced in their normal balance.
Estrogen is produced prior to ovulation to replenish the inner lining of the uterus that was lost during the menstrual cycle. Progesterone causes the uterine lining and the breast to further develop to prepare for a possible pregnancy.
Estrogen and progesterone also effect other organs like the brain, the endocrine system , the immune system, etc. When these hormones are present in the normal levels they balance and counterbalance each others activity and do not cause any symptoms.
Progesterone and Menopause
During and after menopause ovulation ceases and so does the production of progesterone. Progesterone cannot be made from other hormones and it is not available in the environment in any significant amount. In order to maintain balance the body begins to make testosterone and other male hormones. This is why menopausal women begin to grow facial hair and develop male pattern baldness.
During menopause women may have normal or even elevated levels of estrogen while progesterone level is low or immeasurable. This imbalance of hormones, that are dependent upon one another for proper function , is more likely to be the cause of menopausal symptoms than estrogen deficiency.
Why is progesterone so important? Progesterone does more than just balance estrogen. Progesterone is vitally important to the normal functioning of several organ systems in the body. The functions of progesterone include using fat for energy, decreasing water retention, eliminating depression and anxiety, I improving mental function, increasing sex drive and increasing the effectiveness of other hormones like thyroid hormone, testosterone and estrogen.
A deficiency of progesterone can explain most of the symptoms of menopause. Hot flashes occur when the pituitary gland in the brain is attempting to force the the ovary to make its original amount of estrogen and initiate ovulation. When progesterone is available in the proper amounts the hot flashes decrease because the gland in the brain assumes ovulation is functioning normally since progesterone is around.
Mood swings can also be traced to progesterone deficiency or an estrogen excess. Progesterone has a calming sedative effect on the brain. It attaches to a receptor in the brain that decreases anxiety and elevates mood. This receptor in the brain is called the GABA receptor. The GABA receptor is the same receptor Prozac and other antidepressant and anti-anxiety drugs use to produce their effect on the brain.
Insomnia is another frequent complaint of women during menopause. The insomnia is probably due to the lack of the calming effects of progesterone. Replacing progesterone usually improves insomnia.
Many women complain of poor concentration and lapses in memory during menopause. Progesterone is involved with providing insulation to nerve cells. Myelin which surround nerve cells, acts like rubber around electrical wires. Myelin insulates nerve cells and improves conduction of nerve impulses. Decreased progesterone may interrupt the production of myelin and interfere with brain impulses.
Estrogen without the proper amount of progesterone can interfere with thyroid hormone function.Thyroid hormone is necessary to properly metabolize food and convert it into energy. If thyroid hormone is not functioning properly women experience weight gain, fatigue, food cravings and symptoms of low blood sugar.
What may be most disturbing to women is the loss of scalp hair and the growth of facial hair after menopause. Testosterone, the male hormone can be produced by the ovary and the adrenal gland after menopause. The body uses this hormone to balance estrogen in the absence of progesterone. This results in male pattern baldness and facial hair growth. Replacing progesterone usually reverses the process and initiates growth of scalp hair and stops facial hair growth.
What is Perimenopause?
Perimenopause is the period of time before, and for a year after, the final menstrual period during which ovarian hormonal patterns change. The average age at which irregular cycles develop is approximately age 47 but in many cases can start as early as 35 years old. Like menopause, this is a normal part of a women’s life cycle. Women can experience many of the same signs of menopause and can also find relief with Bioidentical hormone therapy. Perimenopause is that time in a woman's life which usually occurs between age 35 and menopause which begins around 48-52. Many changes occur in a woman’s body during perimenopause.
Because the menstrual cycle affects all aspects of a woman’s physical, mental and emotional functions; the perimenopausal period can create instability in a woman’s body.
During perimenopause, the menstrual cycle is erratic because ovulation, (egg release) is erratic. Ovulation is the timekeeper and helps to regulate the menstrual cycle. Women are more likely to have cycles in which they do not ovulate (anovulation). This disrupts the menstrual cycle and subsequently disrupts women physically and emotionally. The symptoms of abnormal menstrual cycles can be very frustrating to a perimenopausal woman. Between the ages of 18-35 the menstrual cycle is usually very predictable and manageable. This is because a woman is in her peak reproductive years and ovulation usually takes place without interruption.
As a woman ages the cells that are to mature into eggs have aged also. The body does not produce new eggs after birth. These aged eggs have more difficulty maturing to a developmental stage where they can ovulate properly. This causes a wide range of effects. Pregnancy is more difficult, birth defects are more frequent, menstrual cycles are irregular, fibroids appear and grow, risk of breast cancer increases, bone loss begins, weight increases and it becomes increasingly difficult to cope with the normal demands of life.
Perimenopause is often misdiagnosed and improperly treated. This causes women to suffer unnecessarily. Incorrect treatment can actually make the symptoms worse leading to surgery that could have been avoided or increase a woman’s risk to serious illnesses.
The balance of estrogen and progesterone is crucial to normal female body function. The amount of each hormone individually is not as important as their ratio to each other. A disturbance in the ratio of estrogen to progesterone results in many of the symptoms of perimenopause.
After ovulation the ratio of estrogen to progesterone should be 20:1 Progesterone should be 20 times as high as estrogen. An imbalance may involve either to much estrogen or to little progesterone.
The symptoms of excess estrogen and decreased progesterone are exactly the same:
- Breast tenderness
- Depression, fatigue, poor concentration
- Fibrocystic breast
- Decreased sex drive
- Fibroid growth
- Thinning hair
- Water retention and bloating
- Fat gain in hips and thighs
- Breast and uterine cancer
Estrogen levels are increased by annovulation, external estrogen found in animal fat, pesticides, and pollutants. Obesity leads to elevated estrogen levels because body fat produces estrogen. A low fiber, high fat, high sugar and carbohydrate diet increase estrogen levels.
Progesterone is decreased by the lack of ovulation which occurs more frequently during perimenopause and permanently after menopause. Recently several articles in conventional medical publications have shown that progesterone deficiency and estrogen excess define perimenopause. Urine measurements and salivary measurements show low progesterone levels accompanied by high estrogen levels. There is little doubt that this is the origin of this phenomenon.
The Misdiagnosis and Mistreatment of Perimenopause
Estrogen and progesterone affects many systems in the body. The symptoms of progesterone/estrogen imbalance are often misdiagnosed if a physician focuses on only a few symptoms in isolation.
The irregular bleeding of perimenopause is often treated with birth control pills. The synthetic progesterone (progestins) controls the bleeding but usually the other symptoms become worse because the synthetic progesterone binds to progesterone receptors and blocks the progesterone your body makes. Some doctors prescribe estrogen which almost always makes the symptoms worse. This can lead to a D&C or hysterectomy.
The increased breast tissue growth of perimenopause can lead to multiple biopsies and constant fear of breast cancer in women. This fear is not totally unfounded because women are more likely to die from breast cancer when it develops during perimenopause. Suggestions of lifestyle changes, which include exercising, dietary changes and the use of soy and natural progesterone supplementation are many times not offered even though these changes may prevent breast cancer.
Many doctors prescribe estrogen during this period to women at high risk for osteoporosis. Bone loss begins at age 35 when estrogen levels are normal or elevated. This usually causes symptoms of estrogen over load. Progesterone is responsible for new bone formation and estrogen helps prevent bone loss. The bone loss seen in perimenopausal women is due to a decline in new bone formation because of decreased levels of progesterone.
Progesterone/estrogen imbalance has a profound affect on the GABA receptors in the brain. Women are often misdiagnosed with depression, anxiety and other mood disorders. Millions of women have been placed on Prozac and other antidepressants unnecessarily. Many women have become addicted to valium and other anti-anxiety medications while masking hormonal imbalances, specifically excess estrogen and decreased progesterone.
Women are often diagnosed with low thyroid function if their main complaint is decreased energy, fatigue and sudden weight gain. These are all symptoms of low thyroid. However, in many cases, thyroid levels are usually found to be normal. These women are placed on thyroid medication. Estrogen blocks the action of thyroid hormone. Progesterone allows thyroid hormone to work more effectively. While the symptoms are similar to low thyroid levels the problem is excess estrogen.
Women who complain of bloating and weight gain prior to menses are often given diuretics to decrease water retention caused by low progesterone levels. The effect of a hormone aldosterone is to cause water retention. Progesterone decreases its effects when produced after ovulation. Without appropriate amounts of progesterone aldosterone causes water retention.
As you can see treating symptoms without an understanding of the cause can lead to more problems than solutions.
Exams and Tests for Women
To determine our hormonal needs, we will thoroughly evaluate your symptoms and order saliva testing and/or blood tests to determine what your unique hormonal needs are. After starting therapy we will reevaluate your hormone levels to ensure that they are maintained within optimum balance.
We may order the following tests, depending on your individual needs:
- Serum growth hormone levels