Hormone Terminology
Many descriptions have been used to explain hormones and hormone therapies. They are often confusing and misleading. Here are the most important terms.
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Hormone Replacement Therapy (HRT)
This refers to treatment using the patented hormones manufactured and sold by pharmaceutical companies. These have been the standard hormones that most medical doctors prescribe in their practices. Examples are Prempro, Provera and Premphase. The molecular structure of these hormones is purposely altered to be different from the hormones that your body makes naturally. This makes them patentable and profitable for pharmaceutical companies. Unfortunately, these small changes to hormone structure can result in significant changes in hormone function, resulting in unwanted and unexpected side effects. Critics of HRT have termed them hormone-flavoured drugs or pseudohormones, and there are many studies that have shown HRT causes harm. The most prominent study, the Women’s Health Initiative (WHI), was abruptly halted in 2002 because morbidity and mortality (illness and death) were significantly increased by taking HRT.
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Bioidentical Hormone Replacement Therapy (BHRT)
This refers to treatment using bioidentical hormones. Individual prescriptions specific to each patient’s requirements are compounded by pharmacists into creams, gels, suppositories and oral lozenges. Treatment is unique to each patient. While BHRT has been around for decades, it has only been in the last 10 years that it has become very popular. Only a small percentage of doctors prescribe BHRT and they take additional medical education and training.
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Natural Hormones
We all like to think that natural is best. Natural hormones are the best hormones, but they are only made in your body. You cannot squeeze a natural hormone out of a wild yam or a soybean. Pharmaceutical companies cannot make a natural hormone; they can only make synthetic hormones. All hormones, including BHRT hormones are synthetic. The reason why proponents of BHRT incorrectly refer to them as natural is because their molecular structure is identical to the natural hormones your body makes. This means that when you take them, your body reacts to them just as if they were your own hormones. This is why BHRT is superior to HRT.
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Synthetic Hormones
Synthetic is the term often used to describe the hormones that are used in conventional HRT. Premarin and Provera are the hormones most commonly referred to as being synthetic. The term is used to convey a sense that they are inferior to natural hormones. While it is true that HRT hormones are inferior, it has nothing to do with the fact that they are synthetic. Since natural hormones cannot be manufactured, all hormones are synthetic, including BHRT hormones. They are all made from a substance called diosgenin that is extracted from soybeans and wild yams and then modified in the laboratory to create hormones.
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Bioidentical Hormones
Bioidentical hormones have the identical molecular structure to the hormones that your body makes. A more appropriate term might be ‘human-identical’ hormones. Bioidentical hormones are the hormones used in BHRT. These hormones are often mistakenly referred to as natural hormones. In reality, they are synthetic and made by pharmaceutical companies. They are, however, exact replicas of your natural hormones. Your body recognizes them as perfect hormones and metabolizes them as if you had made them. Bioidentical hormones have been manufactured for over 75 years and there is not one study that shows that they cause harm. Since they are exact replicas of your natural hormones, they cannot be patented, thus making them unprofitable for pharmaceutical companies.
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Progestins
Progestins are progesterone-like patented drugs that mimic the hormone progesterone. They are a standard component of HRT, for example, Provera (medroxyprogesterone acetate), has been mistakenly referred to as progesterone for so long that even physicians have used Provera interchangeably with progesterone. Progestins are not progesterone. Like progesterone, progestins help prevent the buildup of the uterine lining of women taking estrogen. That is where the similarity ends, as progestins cause a multitude of side effects including increased risk of birth defects and breast cancer.
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Progesterone
Progesterone is an anti-estrogenic steroid hormone secreted by the ovaries and adrenal glands. Natural progesterone, progesterone and bioidentical progesterone all refer to progesterone that is produced by your body and commonly used in BHRT. Bioidentical progesterone has the same molecular structure as the progesterone your body makes. Usually administered by cream or gel and sometimes by oral prescription, progesterone is a perfect fit for all of the progesterone receptor sites in your body. Unlike progestins, progesterone decreases the risk of breast cancer.
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Premarin
This is one of the common estrogens used in HRT. Premarin is a unique set of horse estrogens derived from pregnant mare’s urine. Many people think Premarin is a natural hormone because it is composed of estrogens derived from horse urine. While horse urine does occur in nature, it’s not natural to the human body. It’s bioidentical for horses, but it’s not bioidentical for humans. The Women’s Health Initiative study found that Premarin was responsible for increased risk of cancer and cardiovascular disease.
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Hormone Function
Understanding the role of hormones and how they function is critical to understanding the importance of Bioidentical Hormone Replacement Therapy (BHRT). Hormones are the chemical messengers that control all your body functions. They are formed in one organ or part of the body and are carried in your bloodstream to other organs and tissues. There are specific receptor sites in the tissues for each hormone. It’s like having a specific parking spot for your car that no one else can use and that only fits your car. The hormones attach to these receptor sites like keys fitting into locks. Once attached to the receptor site, your cells respond by carrying out their programmed hormonal functions. Hormones, therefore, must fit exactly like a key into a lock for optimal function. The hormones that your body makes are obviously a perfect fit.
The Key That Fits
If your levels of hormones fluctuate and you have too much or too little of a specific hormone, this creates hormonal imbalance and the dreaded symptoms that arise. Taking hormones is often needed to correct these imbalances. The hormones used in standard Hormone Replacement Therapy (HRT) do not have the same molecular structure as the hormones that your body makes. As a result, they do not fit exactly at the hormone receptor sites in your tissues. This causes many unpredictable and harmful side effects and health risks. BHRT hormones have the exact molecular structure of the hormones your body makes. They are perfect keys that fit at the receptor sites and function just like your natural hormones.
Bioidentical Hormone Replacement Therapy (BHRT)
What is BHRT?
BHRT refers to custom-compounded bioidentical hormones specifically made to meet your individual requirements. Based upon your hormone test results, history and symptoms, Dr. De Monte prescribes bioidentical hormones that are tailored to your specific needs. The striking characteristic of BHRT is that the hormones are identical to the hormones that your body makes naturally. Bioidentical really means ‘human-identical’. Your body recognizes them as perfect hormones and uses them just as if you had made them.
Do You Need BHRT?
Over time, aging and exposure to environmental toxins, there is a natural decline in your hormones. Genetics, diet and physical activity all have a role in how well your body responds to hormone loss, but none of the symptoms should be dismissed as expected life events. Hormone imbalances can cause a variety of symptoms, many of which are confused with the signs of aging. You may feel tired all the time or have difficulty sleeping. You may experience hot flashes or night sweats, or reduced sex drive. Your digestion may even suffer. This can have a very detrimental effect on your life. While responses will vary from person to person, you don’t have to endure uncomfortable symptoms and adverse conditions. BHRT restores hormone balance allowing you to experience renewed energy and optimal health.
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Common Symptoms of Hormone Imbalance
- Bloating
- Breast tenderness
- Depression
- Fatigue
- Hair loss
- Hot flashes and night sweats
- Insomnia
- Low sex drive
- Memory loss
- Mood swings
- Vaginal dryness
- Weight gain
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Benefits of BHRT
- Reduced hot flashes, night sweats and vaginal dryness
- More energy, less fatigue
- Improved cholesterol levels
- Reduced risk of endometrial and breast cancer
- Reduced risk of depression
- Improved sleep
- Better mood, concentration and memory
- Improved sex drive
- Better sleep
- Reduced risk of Alzheimer's
- Increased bone density
- Improved maintenance of muscle mass and strength
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Is BHRT Safe?
In 2002, The Women's Health Initiative (WHI) studies reported that women who used conventional Hormone Replacement Therapy (HRT) hormones, Provera and Premarin, were faced with a higher risk of developing, blood clots, breast cancer, stroke and heart disease. The resulting fallout was that women and doctors stopped hormone therapy. This landmark study did not include BHRT, only HRT. HRT hormones are not identical to the molecular structure of the hormones produced within your body. Your body recognizes that HRT hormones are foreign toxins and cannot metabolize their chemical make-up. This often leads to unwanted side effects ranging from non-life threatening to more serious conditions.
Soon after the WHI findings were released to the public, many women began to explore other options and BHRT was the logical alternative. Available for over 75 years, there are hundreds of studies that report BHRT is safer and more effective than HRT. There is not one study that shows that BHRT causes harm. With any hormone therapy, however, there is always the risk of side effects. Hormone imbalance, too much or too little hormone, is responsible for the symptoms that you experience even before you begin therapy. Consequently too much of one particular hormone can result in unwanted side effects. With proper testing, your hormone levels and imbalances are established. BHRT is given at the smallest dose to eliminate symptoms and optimize your health. Since bioidentical hormones have the exact same molecular structure to the hormones your body produces, they are metabolized in the same manner as your natural hormones, thereby minimizing side effects.
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How is BHRT Administered?
Unlike HRT which is essentially one-size-fits-all, BHRT is unique for each person and includes a variety of delivery systems. The hormones prescribed are usually compounded by a pharmacist into cream, gels and suppositories or sublingual oral preparations. Topical creams or gels are often applied to the inner thighs or inner arms where they are absorbed through the skin into the blood stream. Sometimes they are applied to the vaginal area. Some hormones are put into suppositories that are inserted into the vagina and absorbed through the vaginal wall. Most hormone pills are gelatine capsules that are usually taken with food, while some are in lozenges that are easily dissolved under the tongue (sublingual). The delivery method is determined by what works best for each patient, patient preference, cost and convenience. Each treatment plan and method is individualized specific to your hormone needs.
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Why BHRT is Best
With respect to hormone therapies, the only significant factor is whether the molecular structure of the replacement hormone exactly matches that of the natural hormone it is replacing. The only hormones that exactly match are the bioidentical hormones used in BHRT. Here’s a simple analogy. You have a Ford car that needs a new engine. Would you put a Chevrolet engine in your Ford car? You might be able to and it sort of might work, but why would you when there is a readily available Ford engine that is a perfect fit for your Ford car?
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Testing
Identifying and monitoring your hormone levels is an important component of Bioidentical Hormone Replacement Therapy (BHRT). The best method to accomplish this is a hot topic among experts. There is little consensus and much discussion with opinions on testing varying widely.
Premenopause
Most women don’t realize that the balance of hormones begins to shift in their thirties. If you are still having regular periods and are in your mid thirties to early forties, you are premenopausal. Typically during this phase of life, symptoms of hormone imbalance are commonly misdiagnosed and mistreated.
When hormone levels first start to change in premenopause, many women have a troubling time simply because they do not know what is going on. Strange symptoms start cropping up unexpectedly and many declare that they can’t possibly be menopausal because they are too young. Biology, however, has a different schedule.
During premenopause progesterone levels start to drop much more quickly than estrogen. While your estrogen levels remain stable or sometimes increase, it is the decrease in progesterone relative to estrogen that creates a significant hormone imbalance. High estrogen levels relative to low progesterone levels are defined as estrogen dominance. Almost all women from their mid-thirties on are estrogen dominant.
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Symptoms
Common symptoms of premenopause include the following:
- Worsened PMS
- Irregular periods
- Breast tenderness
- Migraine headaches
- Reduced sex drive
- Weight gain
- Fibrocystic breasts
- Depression
- Mood swings
- Foggy thinking
Though not as common, some women experience menopause-like symptoms such as hot flashes, insomnia and night sweats. Also during this time, the production of DHEA slowly decreases and if left unchecked can contribute to cancer, heart disease and osteoporosis.
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Treatment
Dr. De Monte first works with you to improve your diet, reduce stress and increase your activity. Botanical medicines are often beneficial at alleviating symptoms. If these measures do not provide relief, Dr. De Monte tests your hormone levels to determine what changes are beginning to occur and then creates an individually customized treatment using Bioidentical Hormone Replacement Therapy (BHRT). This can take away the mystery and provide you with immediate relief from the symptoms caused by hormonal imbalances.
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Perimenopause
Even though perimenopause literally means “around” menopause, it is often used to include premenopause. It usually starts in your mid-forties and is a transitional stage that typically lasts 2 to 8 years up to menopause. You often experience erratic changes in your menstrual cycle. Cycles can be shorter, less than 21 days or more commonly, they are longer, more than 45 days. Since menopause does not officially happen until you have not had a period for twelve consecutive months, pregnancy is still possible even if ovulation is irregular.
During this part of your life cycle, the balance between estrogen, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) begins to shift. Progesterone and/or estrogen begin to cycle at lower levels. Menses still happens, even though FSH and/or LH levels go up a bit trying to compensate for lower levels of progesterone and estrogen.
Even though estrogen levels can start to drop at this time, they are always higher than rapidly declining progesterone levels. This imbalance is referred to as estrogen dominance and almost all women starting in their mid-thirties experience it. During perimenopause testosterone levels also begin to decrease creating additional challenges.
Since perimenopause is the transitional stage between normal menstrual periods to menopause, women often experience a combination of PMS symptoms and common menopause symptoms.
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Symptoms
- Hot flashes
- Loss of sex drive
- Weight gain
- Irregular periods
- Heavy bleeding
- Insomnia
- Breast swelling
- Worsened PMS
- Headaches
- Hair loss
- Vaginal changes
- Mood swings
- Foggy thinking
- Memory loss (brain fog)
Hot flashes, low libido, trouble sleeping and weight gain are the most common perimenopausal symptoms. Weight gain, one of the most noticeable symptoms, is one of the first signs of hormone imbalance. These signs of early menopause and related conditions are influenced by stress, poor nutrition and inactivity.
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Treatment
During perimenopause your hormone levels are constantly fluctuating. This does not mean, however, that you have to live with undesirable symptoms. Dr. De Monte measures your hormone levels and creates an individual treatment plan of Bioidentical Hormone Replacement Therapy (BHRT) that can provide relief from the symptoms of perimenopause. Treatment also includes assessment of thyroid and adrenal glands. Less than optimal function can exacerbate perimenopausal problems.
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Menopause
Menopause is the time in your life when your ovaries’ production of estrogen, progesterone, and testosterone declines. The most telling change is the dramatic decline in the production of progesterone. It officially starts when you’ve stopped menstruating for 12 months. The average age of onset is fifty-one, but the process often begins up to 10 years earlier.
Long before your menstruation stops, you will probably notice changes. Your periods will become shorter. Your mood can change and you can become more agitated, depressed and forgetful. You may notice a decrease in strength, and a loss of energy and sex drive. Your hormones are changing and there is no way to stop menopause. Menopause is a natural cycle of life and every woman will go through it. The difference is how you deal with this normal process. Bioidentical Hormone Replacement Therapy (BHRT) can help you manage.
It is important to note that while menopause is a natural life event, it can also be induced through radiation, chemotherapy and the surgical removal of the ovaries (hysterectomy). These can occur at any age and you will require BHRT immediately to balance your hormones.
Postmenopause
Postmenopause follows menopause and usually starts 24 to 36 months after your last period. A woman is also considered postmenopausal after the removal of the ovaries because menstrual bleeding stops.
Postmenopausal women continue to have hormonal imbalances, because hormones are still circulating throughout their bodies. With the cessation of ovulation, progesterone production is reduced to almost zero. Estrogen continues to be produced in smaller amounts by your adrenal glands, fat cells and ovaries. For some women this can create estrogen dominance, a condition in which estrogen levels are high relative to low progesterone levels.
Many postmenopausal women begin to see relief from menopausal symptoms at this time. The most marked difference between menopause and postmenopause is the reduction in symptoms, for example, hot flashes are less frequent and not as powerful. Many symptoms, however, can continue.