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Menopause and Bioidentical Hormones

Right now, thousands of women are having their first menopause-related hot flash. If you’re one of them you’re not alone: about 40 million US women will go through the menopause transition over the next 20 years, and virtually every one will experience a symptom of shifting hormones.

That’s because in the years leading up to menopause, levels of the hormones estrogen and progesterone slowly decline. You’ll first notice irregular periods. Then, as hormone production drops further, you’ll stop menstruating altogether. Since you won’t be able to tell precisely when you stop ovulating (releasing eggs), continue using birth control until you’ve had no period for six months.

Symptoms of declining hormones—and not all woman have them–can include hot flashes and night sweats, vaginal dryness, mild depression, headaches, fatigue, brain fog, and urinary incontinence.

Virtually all menopause-related symptoms can be eliminated with bioidentical hormone replacement therapy (BioHRT). It’s important to mention, though, that there are alternative approaches that don’t involve hormones at all, including exercise, healthful diet, progesterone cream, and herbs like black cohosh.

What is BioHRT? BioHRT consists of hormones that are biologically identical to yours, manufactured from plant sources. How does BioHRT differ from the hormones in the “other” HRT, the one linked to an increase in breast cancer and heart disease risk?

I believe those increased risks have to do with the source of the hormones. Premarin, the most commonly prescribed non-BioHRT estrogen, is extracted from the urine of a pregnant horse, and I assure you it’s not the same as your estrogen.

Human estrogen consists of three molecules: estrone (10-20%), estradiol (10-20%), and estriol (60-80%).

Premarin is estrone (75%) and equilin (25%), the latter found only in horses. Although Premarin acts like a replacement, the estrone amount is three times that of a woman’s, making the match far from perfect. And equilin is a totally foreign molecule.

What does BioHRT do? BioHRT relieves menopause symptoms by replacing estrogen and progesterone. We don’t know if BioHRT is as effective at preventing osteoporosis as Premarin and similar hormones. It should work just as efficiently, but hasn’t been tested for this.

Where do I get BioHRT? Because human molecules (unlike horse molecules) can’t be patented and made into drugs, the pharmaceutical industry has little incentive to invest in BioHRT clinical studies. Without research, using BioHRT is based more on common sense than hard evidence, and as a result many conventional doctors don’t prescribe it. To locate a physician who does, go to one of these websites:

Women’s International Pharmacy
By clicking on “Resources” and then on “Request a Practitioner Referral,” you can request a list of physicians in your state who have asked to be listed on this referral service.

College Pharmacy
Click on “Find A Health Care Provider” to receive a list of local physicians who prescribe BioHRT.

These are compounding pharmacies that fill prescriptions for BioHRT and offer free physician-finder services. After they receive a telephone order or written prescription from your doctor or one of theirs, the BioHRT (eligible for insurance reimbursement) is mailed to you.

Your physician may recommend “Tri-Est” (all three estrogens) or “Bi-Est” (dropping the weakest, estrone) with progesterone. Some doctors suggest you cycle the hormones, taking them three weeks every month. Others recommend you take them daily. The amount of hormone per capsule can be adjusted based on your symptoms, and sometimes a small amount of the male hormone testosterone is added to enhance the estrogen’s effect. Testosterone will also boost a faltering sex drive if this is among your symptoms.

In case you’re wondering: your local chain pharmacy is more of a pill dispensary than a compounding pharmacy and doesn’t have the capacity to offer BioHRT, which requires that several substances be mixed and encapsulated.

Are there health risks? The “official” risks of BioHRT are the same as those for drugs like Premarin–gallstones, increased susceptibility to blood clots, and stimulation of existing estrogen-sensitive breast cancers. But physicians whose patients take BioHRT report they virtually never see these problems, probably because the hormone exposure is lower and the product matches exactly what’s already in your body.

I regard using BioHRT for three years or less as extremely safe. It’s also usually enough time to get you through the roughest menopause symptoms. Some women (Suzanne Somers comes to mind) choose to remain on BioHRT indefinitely.

If you’re currently using Premarin or a similar product, I suggest a switch to BioHRT. If you’ve been using HRT of any kind for a year or two, stop for a month or so to see if your menopause symptoms are still present.

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