A question that comes up in my office on a regular basis is “are bio-identical hormones safe and how long should I use them for?”. Patients look to me for guidance in how to treat their menopausal symptoms.
I help patients weigh their needs for symptom relief, disease prevention and health improvement. Each of these needs have weight on helping a woman decide if bio-identical hormone therapy is the right path for her. Hormone decline is associated with increased breakdown of muscle, bone loss, brain function and memory decline, and increased inflammation. Many diseases — including cardiovascular disease and cancer - are associated with inflammation.
Before going over the safety of bio-identical hormones, I like to help patients associate their symptoms with hormone deficiencies. Hormones are gradually declining from the third decade onward. Women who present with hot flashes, night sweats, decreased sex drive, vaginal dryness, increased vaginal and bladder infections, decreased concentration and memory are suffering from Estrogen deficiency. Whereas women who present with insomnia, anxiety, breast tenderness, weight gain, headaches and emotional swings are suffering from Progesterone deficiency. And of course, there can be a mix of the above.
First steps I take are a detailed history and questionnaire. Purpose is to underline a woman’s family risk factors & gather baseline data of hormone levels and health. I then go over the large Women’s Health Initiative Trial from 2002. A couple of issues that came from this trial is the age of initiation of HRT, 10 years post menopause. In those 10 years there are many changes that happen to a woman’s arteries — increased atherosclerosis or hardening of arteries. So when you add in estrogen, thrombosis or blood clots become a risk. Another piece was the synthetic progesterone was shown to be the factor involved in increasing breast cancer.
On the contrary, earlier onset of hormone therapy, of any kind, does not increase heart disease risk. The use of bioidentical progesterone has been shown to improve cholesterol markers — increasing that good cholesterol, HDL. The use of bioidentical hormone therapy has not been shown to increase breast cancer risk.
Women who choose to use bio-identical hormones to ease symptoms and help prevent disease are given their prescription after the in-depth review. About 6-8 weeks after their starting dose, I have them do a 24 hour urine hormone panel. This is to assess hormone levels while on bioHRT and their metabolites. I adjust the prescription according to the lab results as well as symptoms. From here I monitor urine hormone levels at a year mark and encourage regular testing of cholesterol, blood sugar and periodic mammograms as any medication, including bio-identical hormone replacement needs to be monitored carefully .
Women can expect that their sleep improves first. I often see that it may take up to 3 months to resolve the dreaded hot flashes and getting back to feeling their normal again. I often recommend that women stay on bioidentical hormone therapy for longer than just to ease symptoms, due to the disease mitigation that they provide.
If you are curious about bio-identical hormone therapy and how they may help you, please contact me at Spokes Clinic in Summerland, BC.
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