Production of estrogen, progesterone and testosterone can begin to fluctuate as many as ten years before menopause. This leads to irregular periods, decrease in fertility, as well as hot flashes, mood disorder, loss of energy and many other symptoms, some of which are:
- Hot flashes
- Night sweats
- Insomnia (due to night hot flashes)
- Lack of energy
- Mental haziness
- Mood swings
- Decreased libido
- Decreased ability to achieve orgasm
- Vaginal dryness
- Bone loss
- Elevation of cholesterol, decrease in good cholesterol (HDL) and increase in bad cholesterol (LDL)
- Deregulation of carbohydrate metabolism
- Frequent vaginal and urinary infections
- Weight gain
- Hair loss
- Skin dryness
- Deregulation of thyroid hormone
The degree of fluctuation in hormonal production and the severity of its symptoms varies greatly among women. It is important to evaluate each woman’s symptoms individually, considering her weight, lifestyle, and level of stress, as well as personal and family history. Her attitude towards the treatment, along with the lifestyle changes she is willing to take are also important factors that determine the treatment best suited to her specific needs.
There are many different preparations of HRT available today. Estrogen can be prescribed in different doses, and in different applications: pills, creams, and patches. Different estrogens are available on the market: conjugated estrogens, and conjugated equine estrogens (Premarin). Bioidentical estrogen or natural estrogen comes in different combinations of estradiol and estriol (Biest), and estradiol, estrone and estriol (Triest).
Natural progesterone or bioidentical progesterone is available in intravaginal cream preparations and pills. Progestins include: provera or medroxyprogesterone (used in combination with Premarin to make Prempro), norethindrone, and drospirenone. All progestins are not produced by human ovaries.
Testosterone is available in the form of methyl testosterone which can be taken as pills, and natural testosterone or bioidentical testosterone which can be administered transdermally.
Bioidentical hormone replacement therapy is considered to be the most natural way to replenish estrogen, progesterone and testosterone, as their levels decline during perimenopause. The bioidentical hormones have the same molecular structure as the hormones they are meant to replace, the estrogen, progesterone and testosterone produced by our bodies. However, these hormones are manufactured, and therefore are synthetic. The only natural hormones are the ones produced in the body.
Many preparations of bioidentical hormones are available through major pharmaceutical companies. Sometimes, the hormone therapy is prepared via pharmaceutical compounding, the mixing of drugs to better suit the patient’s needs. Estriol, for example, is available only through this method of preparation. Often a woman and her physician prefer working with a compounding pharmacy to better match the dosage and the combination of hormones to achieve optimum results.
Finally, as you choose to pursue this therapy, it is important to understand that bioidentical hormones have not been proven to have side effects different from other hormonal preparations.
Please contact our office for an assessment and consultation about the benefits and risks of bioidentical hormone replacement therapy.