Bioidentical Hormones: Miracles for Menopause?

December 9, 2011

BY KITT WALSH

At a recent doctor visit, I put the question this way: “Doc, there are two schools about taking hormones to treat the symptoms of menopause. One school of thought that says you are flirting with cancer and the other school that says without them you will turn into a wrinkled crone. Which side of the issue are you on?”

He came down on the side of avoiding “cronedom” by taking hormone replacement therapy. He thought the cancer risk was small (especially since I have no history of any kind of cancer in my family) and since I do have osteoporosis (thinning bones leading to breaks), I would be better off replacing the hormones. But he was against the Hormone Replacement Therapy most recommended by the medical profession—synthetic hormones– and wanted me to investigate bioidenticalhormones.

Here’s what I found out: Bioidentical hormones are a form of therapy for menopausal symptoms (like hot flashes and trouble sleeping) that match the type of hormones your body naturally produces. I also learned that not all doctors are versed in bioidenticals (I was recommended to a specialist in hormonal medicine.)

As we hit menopause, our bodies stop producing as many hormones as when we were younger (or as my doctor put it, “Our bodies think we are born, attract a mate, have babies and then it is time to get off the stage…”) Since we are living lots longer than the 40 or so years our bodies are programmed for, we have to think about how to best “stay on that stage” in a healthy way. Some women choose hormonal replacement.

To make that choice, though, you should first undergo some tests. Blood tests are what most doctors order (saliva testing, all the rage in some circles, doesn’t give a full enough picture, according to the AMA.) The blood screen to determine how low your “hormonal tank” is looking for:

–Your levels of Estrogen (estradiol, for ovary function),

–Follicle-stimulating hormone (FSH which tells where you are in the menopause timeline—pre, peri or post, and will help you decide whether you want to start any hormonal treatment,)

–Thyroid (TSH-if this is low, you want to talk to your doctor about taking other types of meds rather than hormones),

–Hemoglobin and hematocrit (a blood cell count), Electrolytes (including blood sugar and liver and kidney function tests) and

–Cholesterol (includes “good,” “bad,” and triglycerides).

If you have a family history of osteoporosis (or are small boned, light skinned or ever smoked) you should also ask to be tested for that diseases. Hormones may help arrest the thinning of the bones it causes. It is particularly important to get the blood sugar and liver tested, which can reassure you and your doctor that your symptoms are not caused by an abnormal change (like diabetes), rather than a normal one (like menopause).

Once you get the results back talk to your doctor about supplementing:

Estrogens: estradiol (“e2,” the main active estrogen, made normally during fertility by ovaries), estrone (“e1,” made normally after menopause by fat cells), estriol (“e3,” made normally during pregnancy by the placenta). Estrogens produce female-bodied characteristics in general.

Progesterone is made by ovaries and adrenal glands; mainly necessary for pregnancy, but also protects the uterus from too much estrogen. If you’ve still got a uterus and are taking Estrogen, your doctor will prescribe some type of progesterone.

Testosterone is made by adrenal glands and ovaries and produces male-bodied characteristics, including greater muscle mass, but also including a higher risk of acne, facial hair, lower voice and heart attacks. Testosterone is the main ingredient in your libido—so I was particularly interested in the outcome of that test—as was my lover.)

Once you have a idea of where you stand hormonally, you and your doctor can decide if you want to try hormone therapy—bio-identical or otherwise.

Bioidentical hormones are just natural versions of the same type of hormones your body already produces and can help in lots of ways. Your memory and brain function may improve (less fuzzy “where did I leave my glasses” moments.) You may sleep better, with less restless legs or tossing and turning. Body aches may be relieved as many headaches. Your mood swings may be less wild or you may feel less depressed or weepy. Your weight may stabilize and your skin may improve (as collagen is produced.) Your sex life may get a jump start (I had actually wet dreams after starting estrogen. I also got a period back after two years. I write that off to “win some, lose some”) and vaginal lubrication may improve.

But are bioidenticals safer than other hormone therapy?

Bioidentical preparations are medications that contain hormones that are an exact chemical match to those made naturally by humans, according to WebMD, and some are made by drug companies, are approved by the FDA, and are sold in standard doses. Others are custom-created—made just for you by a compounding pharmacy from your doctor’s prescription (thus the specialist part) and these aren’tapproved by the FDA as they aren’t standardized. (It’s a good idea to check if the pharmacy you choose is listed on the web site of the Pharmaceutical Compounding Accreditation Board (PCAB).

Now, before you dash out demanding bioidentical hormones, know a few things:

Hormone therapy has been linked to increased risk of breast cancer and though the research wasn’t done on bioidentical hormones, that doesn’t mean they don’t share the same (albeit small) risk. Talk to your doctor about the risk and stay on hormone therapy—of either type—for as short a time as possible.

About demanding testosterone for a sagging libido: A doctor may not even be willing to prescribe testosterone as it has side affects like growing more facial hair, lowering your voice and putting stress on your liver. Estrogen, as a bioidentical, is often prescribed as estradiol, a skin patch where the hormone is absorbed through the skin, thus bypassing the liver, to avoid just such stress.

Many insurance companies won’t pay for bioidentical hormone treatment or medications and they are not cheap. Here’s a comparative breakdown (with thanks to Dr.Leigh.org):

The costs of physician visits: $395 -$495 for the first visit and $275 for follow up visits. Follow-up visits usually occur at month three and then every six months thereafter. The lab costs range from $495-$595 for initial visits. Follow-up lab costs are generally less, ranging approximately $250. On average, the bioidentical hormones and supplements are approximately $100 a month. Therefore the first three years’ cost for using bioidenticals can run $8,140-$8,440 out of your pocket.

Non-bio-identical hormone therapy is usually half that much or less and is covered by insurance.

So there is much to consider, wallet-wise and otherwise, and you’ll want to do your own research before you commit to hormone replacement therapy of any kind, synthetic or bioidentical. I chose synthetic (actually, my insurance company chose for me) and, while many of the menopausal symptoms did ease, you should know … I still lose my glasses everyday.

Kitt Walsh owns a web content company, Behind Blogs, and freelances as a feature writer, editor and marketing consultant for magazines, newspapers, new media outlets and private clients around the world.