Recognizing the Symptoms of Hormonal Imbalance
The other day during one of my hormone lectures, a woman asked me a really great question. She asked, “How do you know when you’d benefit from hormone replacement therapy?” This question provoked a lot of thought. Typically, women start feeling the effects of hormone imbalance as it relates to perimenopause and the vasomotor symptoms that accompany this time in a woman’s life. It starts with the typical hot flashes, night sweats, irritability, fatigue and brain fog—the turning point. She suffers through it because, as women, we are all told this is the “natural part of aging”. Then, time goes on. Not only is she still experiencing these symptoms, but new symptoms have also emerged- the vaginal dryness, the pain with intercourse, and weight changes. Again, she carries on because that’s what she was told to do.
Why Hormone Replacement Therapy Became Controversial
After discussing more of her symptoms and the duration of them, it was clear she could have benefitted from hormone replacement therapy several months ago. So, why wasn’t she offered this? The answer is complex. In 2002, the women’s health initiative halted hormone replacement therapy and said the risk was far greater than the reward. Women’s health literally changed overnight. It took 23 years for the black box warning on hormones to be lifted. Still, primary care providers are hesitant to acknowledge the effects of hormone deficiencies because they are clinging on to the risk profile out outdated hormone replacement.
Historically, oral estrogen and synthetic versions of hormones were given. Remember Premarin? Premarin was an oral estrogen synthesized from urine from pregnant mares (a female horse) used or vasomotor symptom relief. Strange, right? Then data came out to formally denounce its use because oral estrogen has been shown to increase the risk of blood clots and stroke. Then, for progesterone supplementation, synthetic progestins were used. Again, these formulations were not familiar to the body and increased breast cancer risk. I hope it’s starting to make sense now why hormone therapy was deemed unsafe.
What Makes Bio-Identical Hormone Therapy Different
Enter bio-identical hormones. Bio-identical hormones are synthesized from plants and are identical to the endogenous hormones your body makes. I know what you’re thinking—cool, Kait, but what does this mean for me? Let me tell you. By supplementing hormones that are identical to the ones your body already makes, it improves tolerability and decreases the likelihood of unwanted side effects that were common with the synthetic versions.
Let’s now talk about the safety profile of bio-identical hormone replacement therapy. First and foremost, we no longer provide estrogen supplementation by mouth. There is well documented data that the risk for blood clot and stroke remains. To mitigate this risk while also improving the symptoms associated with decreased estrogen levels, we often use transdermal creams applied to the skin. This formulation does not increase the risk for blood clot or stroke and is easily applied. As for progesterone supplementation, we do not use progestins in this space. Micronized progesterone, P4, is the bio-identical formulation that is often given as a sustained release pill. Giving P4 in a pill near bed time has the added benefit of GABA receptor modulation meaning it reduces anxiety, promotes restful sleep, decreases the excitability of the neurons, and acts as a protective mechanism for the brain. However, progesterone can also be provided as a topical cream and can even be compounded with topical estrogen formulations for ease of administration. The topical application of progesterone does not have the calming effects of the oral formulation. Testosterone deficiency is also commonly seen in the perimenopausal woman and is also able to be supplemented via transdermal creams. By restoring the hormonal balance in the body, there are many positive and protective effects on bone health, the skin, the brain and the gut.
If you’ve made it this far – we are almost done.
How Hormone Testing and Treatment Works
The first step in bioidentical hormone replacement therapy identification of the imbalance. My preference for initial hormone evaluation includes salivary and blood spot testing. Don’t worry, this doesn’t mean multiple different locations for lab draws. Instead, I have partnered with a company that will send the hormone testing kit to your door with instructions on how to provide salivary and blood samples. Then, once collected, you send the test back to the company and they notify me when the results are ready. Fortunately, this method allows testing of many things. We test cortisol (the stress hormone), sex hormones including Estrone (E1), Estradiol (E2), Estriol (E3), progesterone, DHEA, thyroid function including TSH, T3, T4, TPO antibodies, and we can even evaluate cardio metabolic markers and vitamin D all from the comfort of your home. Once the results of these tests come back, I review the results, send you a copy, and invite you back into the office to create an individualized approach to balancing your hormones in whatever way makes the most sense to you. From there, we take a structured approach to follow up, repeat labs, dose modifications, and ongoing support.
If any of this resonates with you, I invite you in for a consultation. My goal is to be able to create positive transitions from the cycling to perimenopause to menopausal stages of life. Women are no longer forced to suffer through hormonal imbalance.
Xoxo,
Kait
