Bio-identical Hormone Replacement Therapy (BHRT)
Bioidentical hormone replacement therapy is one of the most under-utilized therapies by modern physicians. Restoring a woman’s hormones can balance their mood, reduce anxiety, improve sex drive, and improve confidence. Countless women start on an anti-depressant or anti-anxiety medication in their forties and fifties for what is most likely hormonal imbalance.
Mother Nature versus Bioidentical Hormone Replacement
A reasonable argument against bioidentical hormone replacement is that of Mother Nature. If Mother Nature wanted me to have hormones for the rest of my life, she would have provided me with hormones. While Mother Nature did in fact provide you with enough hormones to be fertile and live long enough for your offspring to become independent, Mother Nature did not expect that you would live much beyond age 50. Now, with modern medical advances, it is expected that we live into our 80’s and sometimes 100’s. It is reasonable to assume that your body did not intend to live half of its life without hormones. For women who choose to allow menopause to take place without hormone replacement, we honor their decision. However, it is never too late to start hormone replacement if a female changes her mind because of changes that she can perceive.
What are bioidentical hormones? How are bioidentical hormones different from synthetic hormones?
Bioidentical hormones are identical in shape and structure to the hormones produced by the ovaries. The only difference is that they are produced from plant matter (usually yams) and administered by a physician instead of the ovaries. Bioidentical hormones are drastically different from synthetic hormones. Synthetic hormones are usually derived from animals (horse urine is common), and they are not typically found in humans. Moreover, the most stimulating hormones are selected without concern for the balancing hormones, which are less stimulating.
Which hormones are replaced if I am post-menopausal?
For menopausal women, we replace all of your sexual hormones. We replace your estrogens, progesterone, and testosterone. Your Estrogens include three hormones: Estrone (E1), Estradiol (E2) and Estriol (E3). The combination of Estradiol and Estriol is called Biest. The first estrogen, Estrone (E1), is not replaced because your body continues to make it even after menopause.
Which hormones are replaced if I am pre-menopausal?
For premenopausal women, women who are having hormone disturbances but have not yet completed menopause, we prescribe the individual hormones that need replacement. Many women in their 30’s and 40’s are on Progesterone only hormone therapy since their ovaries are still making enough estrogens.
What are the symptoms of female hormone imbalance?
Female hormone imbalance is common. Younger women experience a different set of symptoms than women who have gone through menopause. Younger women typically experience estrogen dominant symptoms like acne, facial hair growth, weight gain, irritability, depression, low energy, and infertility. Post-menopausal women experience hot flashes, anxiety, weight gain, decreased sex drive, high cholesterol, and fatigue. Other symptoms of hormone imbalance include:
mood swings, insomnia, vaginal dryness, leaking urine, weak bones, and thin skin.
Why should I start bioidentical hormones?
If you are experiencing any of the symptoms listed above, you need to get your hormone levels evaluated. If your provider does not prescribe bioidentical hormones, then you should review them with a provider who does prescribe bioidentical hormones.
Bioidentical hormones help with mental clarity, feeling energetic, strengthening bones, and proper weight distribution. Your hormones direct where you store fat. Have you noticed that men store fat in their bellies and women store fat in their hips? Yet, by the time a woman hits 80 years old (without hormones), she has a potbelly. This elderly lady develops a potbelly because without estrogen and progesterone, the aging female body can only make testosterone, which directs fat into the belly.
One of the major benefits of bioidentical hormones is the cessation of hot flashes. Another excellent benefit is that estrogen maintains the vitality and vigor of your skin. It helps maintain a vibrant skin tone by allowing a healthy amount of subcutaneous fat. Without small amounts of fat beneath the skin, it becomes thin and transparent. Maintaining healthy amounts of subcutaneous fat allows for plump skin with a youthful texture. Women who age with BHRT look younger than women who age without BHRT.
Peri-menopause is classified as the time between normal hormone levels of youth and failing hormones in menopause. During perimenopause, women can become extremely frustrated since hormone levels can fluctuate wildly and unpredictably. By using bioidentical hormones, the hormone fluctuations can be blunted and improve hormonal stability which helps with mood swings and irritability as well as sexual interest.
Younger women can also have their hormone levels evaluated and replaced with bioidentical hormones if needed. Primarily, we are treating Estrogen Dominance or PolyCystic Ovarian Syndrome (PCOS) with progesterone cycling.
How do I get evaluated for hormone replacement?
Hormonal evaluation is easy to do and can be done by a simple blood draw. If you are not having periods or have had a hysterectomy, your hormones can be drawn at any time. If you are perimenopausal or still having periods, your hormone levels will be checked on day 19-21 of your cycle (Day 1 = First day of bleeding). Hormone blood levels are covered by most insurance plans, but you should call your insurance company if you are concerned about coverage.
Hormone testing from saliva is available at our office. It is not covered by insurance, so most people prefer blood testing. We prefer blood testing as it is predictable and affordable.
Which hormones levels are evaluated?
Different hormone levels are checked depending on the reason or medical problem being evaluated. For most women, we usually evaluate the balance of testosterone, estradiol, and progesterone. If you are in peri-menopause, or your hormones are more complex, then we frequently check all hormone levels, including estrogen, progesterone, total testosterone, free testosterone, DHEA, SHBG (Sex Hormone Binding Globulin), FSH, LH, Prolactin, and any other hormones needed.
Do I need progesterone even if I do not have a uterus? I had a hysterectomy, and my gynecologist told me that I did not need progesterone.
Your ovaries created progesterone your entire life until menopause. Why should it stop if your uterus gets removed? There are progesterone receptors located throughout the body. We want to stimulate them as progesterone serves as a balancing agent to estrogen. Progesterone should always be utilized when prescribing hormone replacement.
Progesterone has many positive effects, including balancing estrogen, improving sleep quality, strengthening bone, preventing mood swings, reducing bladder leakage, reducing bowel irritation, and many more benefits.
Why do women need testosterone?
Women need small amounts of testosterone just like men need estrogen. Testosterone provides bone strength, decreases body fat, increases muscle mass, maintains memory, improves self-confidence, and increases sexual desire.
How much do bioidentical hormones cost? What will my insurance cover?
Each pharmacy has different prices, so it is important to shop around for the price that suits you the best. Keep in mind that sometimes you will pay extra for high quality compounding, fast turnaround times, and excellent customer service. Since these hormones are compounded specifically for you, it is cheaper to buy a 90-day supply. A reasonable cost for a 90-day supply for all 3 hormones usually ranges $200 or less.
Note: Your insurance may or may not cover compounded medications. You can call your insurance company and ask if compounded medications are covered. Also, the pharmacy will be able to tell you if your insurance company will help cover your hormone prescriptions.
All of your hormone laboratory tests will be billed through your insurance plan.
Where can I get my bioidentical hormone prescriptions filled? What is a compounding pharmacy?
There are multiple compounding pharmacies in Austin, Texas. A quick Google search can identify many of them. You should find one that is close, friendly, and makes high quality compounds. If you need assistance, we can help suggest pharmacies that we have worked with in the past.
What are the different methods of bioidentical hormone replacement?
- Bioidentical Hormone Pellet Implants
Bioidentical hormone pellet implants are the preferred method of hormone delivery at Oubre Medical. The pellets create a sustained, steady hormone level that is dependable without risk of transference to others.
Bioidentical hormone pellets are inserted underneath the skin of your hip every 4-6 months. The pellets are slowly dissolved by your body thus creating a very constant and steady level of hormones. Progesterone cannot be implanted as a pellet, and it will need to be taken separately. Luckily, progesterone is the only hormone that can be taken orally as a capsule and is usually covered by insurance companies. Plus, progesterone capsules typically make you sleepy and help women get great quality sleep.
Refer to our Pricing Page for cost.
- Rapidly Dissolving Bioidentical Hormone Tablets (RDT, Trochi)
Rapidly dissolving tablets, or RDTs, are quickly becoming a preferred bioidentical hormone replacement method. The RDTs are simple and easy. They usually taste great, depending on the compounding pharmacy. There is minimal risk of transference unless oral contact with others occurs within minutes of administration. There is a potential risk of increased blood clotting if you swallow the tablets. They must be dissolved, not chewed or chased with water. The RDTs are difficult to assess hormone levels as immediately after administration, the levels are excessively high. Then, they drift downwards to a steady state 3-6 hours after dissolving. When getting labs drawn using RDTs, it is imperative to get blood work drawn 3-6 hours after dissolving your RDT. These tablets must be compounded by a compounding pharmacist.
- Topical Bioidentical Hormone
This method of bioidentical hormone replacement is the easiest to use. The topical hormone is applied to the skin daily. However, topical hormones are the most difficult to maintain adequate levels. Because every patient’s skin has different thickness, absorption, sweat, and oils, it can take months to achieve optimal levels. It also has the highest risk of transference to loved ones (spouse, children, parents).
The hormone creams must be compounded by a compounding pharmacy. They are affordable without insurance, and your physician can customize the prescription to fit your daily needs.
When do I stop taking bioidentical hormones?
You can continue bioidentical hormones for the remainder of your life. In fact, most women doing well on bioidentical hormone replacement do this as they realize the anti-aging benefits compared to other women their age.
Conversely, you can discontinue bioidentical hormone replacement at any age. You can expect that hot flashes and night sweats will return as you go through “hormone replacement menopause.”
What are the risks associated with bioidentical hormone replacement therapy?
As with all therapies, there are risks associated with bioidentical hormone replacement. If you are using testosterone in your BHRT cream, then you may notice dark hairs growing if you do not alternate sites of application. You may even notice acne spots if your testosterone levels get too high. Sometimes acne can be triggered by testosterone cream but not by other methods like Pellets or RDTs. If you are using high dose hormone creams, you can irritate the skin and cause tingling. Topical hormones can be spread to loved ones who touch the area of application. You can get localized infections at the site of insertion for the hormone pellets. Your period may restart although this rarely lasts more than 2 months. If you bleed for more than 3 months, therapy needs to be stopped, and you will need to be evaluated for post-menopausal bleeding. If you have a history of fibroids, they may awaken old symptoms as hormones can stimulate fibroid growth.
There is a controversial risk of blood clotting from all hormone replacement. If you are not swallowing hormones as capsules (except progesterone), then you should not have an elevated risk of blood clots.
There is also a controversial elevated risk of female cancers (breast, uterine) because hormones stimulate tissue growth and development. If you have a cancer that responds to estrogen or progesterone, hormone replacement can stimulate its growth. The risk of cancer is attributed to the Women’s Health Initiative where thousands of women received synthetic, estrogen-only hormone replacement, and they had more cancer. However, it is well known that oral hormones increase inflammation, which is a known contributor to cancer creation. Moreover, synthetic hormones are more stimulating than bioidentical hormones, and they lack the balancing hormones like estriol and progesterone.