How to Get Started with Bioidentical Hormones: a Step-by-step guide

If you choose to book in for a consultation for bioidentical hormones, you will be sent a questionnaire and consent form prior to the appointment.  You may be asked to arrange blood tests prior to your consultation.

Your first consultation lasts 45 minutes and your doctor will be there to listen to your concerns and find out how you are feeling. They will also discuss your goals and the importance of hormone balance. Your doctor may request a number of other examinations such as a pelvic ultrasound scan and mammogram. In your follow up, your doctor will explain the results of your tests and examinations. Together, you will review your options and decide on a treatment plan. For example you may wish to do things in stages: you may wish to try just oestrogen and progesterone first to see how you get on with them, and then at your follow up consider adding in another hormone such as testosterone if needed.

At the end of your appointment your doctor will explain how to order your prescription.

Your hormones will be posted out to you with the instructions of how to take them. Your doctor will issue you enough medication to last you until your next appointment so remember to look out for the number of repeat prescriptions you have been issued.

Starting your medication

Once you start your medication you should start feeling better soon. However, bear in mind that it can take up to 6 weeks to feel the full benefit, and changing things too soon can be unhelpful.

Please see the following table for possible side effects of the hormones that would require dose adjustment.

Progesterone Only

• Breast tenderness

• Spotting

• Missed periods

• Headaches and nausea (rare)

• All other premenstrual syndrome (PMS) symptoms

Discuss with your doctor – this might require stopping taking the medication and waiting until symptoms have cleared before restarting the medication,

or continuing taking the medication until symptoms have cleared.

Oestrogen and Progesterone

• Bloating and fluid retention

• Breast tenderness

• Spotting or an unexpected period

• All other premenstrual syndrome symptoms

Discuss with your doctor – this might require stopping taking the medication and waiting until symptoms have cleared before gradually restarting the medication at a lower dose.

Testosterone

• Facial spots

• Greasy skin

• Hair loss (extremely rare)

Discuss with your doctor – this might require stopping taking the medication and waiting until symptoms have cleared before restarting the medication at a lower dose . For hair loss, do not restart medication and inform your doctor.

DHEA

• Facial spots

• Feeling wired or agitated

• Hair loss (extremely rare)

Discuss with your doctor – this might require stopping taking the medication and waiting until symptoms have cleared before restarting the medication at a lower dose . For hair loss, do not restart medication and inform your doctor

For hair loss, do not restart medication and inform your doctor.

Hormone Replacement Therapy and Breast Cancer

Women thinking about starting hormone replacement therapy are often worried about breast cancer risk even if they know of the benefits of hormones on cardiovascular, bone and brain health. 

In fact, for the vast majority of women the benefits of hormones outweigh any risks. Its important to recognise that some lifestyle factors such as obesity and alcohol are greater risk factors for developing breast cancer the any type of hormone replacement therapy. Plus individual differences in genetics and the way we metabolise our oestrogen influence breast cancer risk.

A judicious personalised approach, the use of bioidentical hormones and consideration of extra testing may all help mitigate risk.

Firstly we always assess an individual’s risk factors for breast cancer.

Risk factors are as follows:

          Age: The vast majority (80%) of breast cancers occur in women aged 50 or older.

          Genetics: Genetics play a role in risk, for example, family history of breast cancer;  BRCA1 and BRCA2 gene mutations

          Reproductive history: Women who take the pill have a slightly increased risk of breast cancer

          Lifestyle factors: Smoking, alcohol consumption, and lack of physical activity can increase breast cancer risk. Obesity and alcohol are greater risk factors for developing breast cancer the any type of hormone replacement therapy.

According to the Lancet’s review of 58  studies from 1992-2018 of conventional hormone replacement therapy:

-If a woman aged 50 takes combined hormone replacement therapy and is followed up 20 years later, HRT increases breast cancer risk by 2%.

-For women with hysterectomies, oestrogen-only hormone replacement therapy increased breast cancer risk by 0.5% (this suggests that the synthetic progestin is the most problematic component).

The Lancet study did not look at the risk when using bioidentical hormones. According to the E3N cohort study, a study of 80,377 women after 8.1years found no increased risk of breast cancer with bioidentical oestrogen and progesterone. A review in Climacteric  states that bioidentical oestrogen plus progesterone does not increase breast cancer risk for up to 5 years of treatment and that there is limited evidence of slightly increased breast cancer risk after 5 years.

If you are concerned about breast cancer risk, we can carry out additional testing such as the following:

DUTCH test

We believe that the way oestrogen is metabolised affects breast cancer risk.

We all metabolise oestrogen and some of these metabolites are considered to be ‘good’ or protective (2-hydroxyestrone) and others ‘bad’ or toxic (4-hydroxyestrone, because it can bind to and damage DNA if overproduced or not adequately detoxed in the liver).

We can do a DUTCH test to understand how our body is metabolising and excreting oestrogen metabolites and there are diet and lifestyle modifications that we can make to improve our oestrogen metabolism.

Genomics testing:

Genomics tests analyse genes involved in the regulation, synthesis, signalling, transport and metabolism of oestrogen. It looks at how gene variants affect hormones balance and details the nutrients that can influence and improve their balance.

Lifestyle changes that can help are the following

• eat plenty of high fibre foods which promote gut motility
• avoid dairy and alcohol
• eat plenty of cruciferous vegetables
• take a supplement called  DIM that supports healthy oestrogen metabolism
• take a supplement called calcium d glucarate which can decrease the reabsorption of oestrogen in the gut
• incorporate ginger, garlic and curcumin into your diet for their inflammation reducing properties
• have plenty of green tea which contains catechins which are polyphenols important in detoxification.