Meno Health. Clinical Evidence.

TWC #062: What is bioidentical hormone replacement therapy?

Dear MHI reader,

It’s difficult for you to function properly when your hormones are out of balance. A hormone imbalance can lead to weight gain or mood swings, for example, which can affect your daily life. Taking hormones can help you if your body is not producing a certain hormone in sufficient quantities or if your hormone levels are out of balance.

What are hormones?

Hormones are chemical messengers that perform important tasks in the body. They are produced by endocrine glands and organs and released into the blood to control and coordinate various bodily functions and processes. The most important hormones include sex hormones such as oestrogen and testosterone, thyroid hormones, stress hormones such as cortisol and adrenaline, growth hormones and insulin. Hormones bind to specific receptors in the target organs and trigger certain reactions there. Among other things, they regulate metabolism, growth and development, reproduction, mood and behavior as well as blood pressure and heart rate.

An imbalance in the hormone system can lead to various complaints and diseases. With increasing age, hormone production changes, which also leads to the menopause. Hormones therefore play a central role in the functioning of the entire organism and the maintenance of physical balance.

What are synthetic hormones?

Synthetic hormones are artificially produced hormones that are similar to natural hormones in their chemical structure, but are not identical to them. They are produced in laboratories by chemical processes and are not of natural origin. Although they are similar to natural hormones, there are subtle differences in their chemical structure that can lead to varying effects and side effects.
Synthetic hormones are often used in hormone replacement therapy (HRT) to treat symptoms of menopause. Examples include synthetic oestrogens and progestins. Due to differences in structure, synthetic hormones can have different side effects than bioidentical hormones, including an increased risk of thrombosis, stroke and possibly breast cancer. A well-known example of synthetic hormones are conjugated mare estrogens (CEE), which are derived from the urine of pregnant mares and contain a mixture of different steroids.
Synthetic hormones are often administered in the form of tablets, patches or injections.

What are bioidentical hormones?

Bioidentical hormones are artificially produced hormones that are used by the body like endogenous hormones. These hormones are structurally identical to the body’s own hormones and are also referred to as «nature-identical» or «body-identical». They are usually obtained from plant sources such as yams or soybeans and then chemically modified to achieve the exact structure of human hormones.

Commonly used bioidentical hormones are 17-beta-estradiol (an oestrogen) and progesterone. Their aim is to balance hormonal imbalances, especially in menopausal women. This therapy can alleviate symptoms such as hot flushes, vaginal dryness and other menopausal symptoms.

Compared to synthetic hormones, bioidentical hormones are said to have fewer side effects and are better tolerated. They can be administered in various ways, for example transdermally (through the skin), vaginally or sublingually (under the tongue). The dosage is often adjusted individually, based on hormone level measurements and the patient’s symptoms. Regular checks and adjustments to the therapy are recommended in order to achieve an optimal effect.

Effects of bioidentical hormone replacement therapy on your health

Replacing the hormones that your body no longer produces with medically prescribed bioidentical hormone replacement therapy (BHRT) can alleviate your symptoms and help you achieve a better quality of life.
BHRT can help with the following symptoms:
– Weight gain
Mood swings
Hot flushes
– Dryness in the vagina
– Night sweats
– Low energy levels
– Memory loss
– Difficulty sleeping
Decreased interest in sex

Hormone therapy can have many benefits, but it is also associated with risks. Not only with BHRT, but with any hormone therapy, the following risks exist:

– Increased risk of venous thromboembolism, especially in the first 1-2 years of therapy
– Increased risk of gallbladder disease
– Increased risk of stroke, especially after 3-4 years of therapy
– Increased risk of breast cancer, especially with prolonged use (over 5 years)

The risks can also be minimized. The following points are important:
– Timing: starting therapy before the age of 60 or within 10 years of the menopause can reduce some risks
– Form of application: Transdermal application (e.g. patches) appears to reduce the risk of thrombosis, strokes and gallbladder disease compared to oral administration
– Duration: Short-term treatment is recommended due to the risks of long-term therapy

As with most hormone therapies, there is an adjustment period when you first start BHRT. Side effects can occur in the first few weeks and disappear as your body gets used to the new hormone levels.

Some of these side effects may occur when you start BHRT:
– Weight gain
– tiredness
– bloating
– Increased facial hair
– spotting
– cramps
– Acne or changes to the facial skin
– Headaches
– Tenderness in the breasts

Breast tenderness, bloating and weight gain are the most commonly reported side effects of BHRT.

It is important that each woman and her doctor make an individual risk-benefit assessment based on her specific symptoms, health status and personal risk factors. A regular review of the therapy is also advisable.

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