Using bioidentical hormones for menopause: what you need to know

Did you know that menopause itself is a health risk? At the time of menopause the antioxidant effect of sex hormones is lost, and inflammation increases. What this translates to is the following changes:

higher level of bad cholesterol in the blood

 Increased risk of atherosclerosis

increased risk of metabolic syndrome and insulin

resistance

increase in inflammatory cytokines, inflammation,

which is at the heart of so many diseases

increased bone turnover and eventually, bone loss

worsened brain metabolic profile

Taking bioidentical hormones at the time of menopause has a number of health benefits:  

The Heart:

We know that at the time of menopause women lose the cardioprotective benefits of oestrogen – that’s one reason why if a woman goes though a very premature menopause she needs to take hormones until at least the average age of menopause to stave off this risk. Meta-analyses of trials have shown a significant reduction in heart disease and all cause mortality in women treated with oestrogen under the age of 60 or within 10 years of

menopause.For example a nationwide study in Finland looked at 489,105 women and found that the risk of coronary heart disease was significantly reduced by 18-54% in hormone therapy users; the risk of stroke was reduced by 18-39%, and the risk of all-cause mortality was also reduced in hormone therapy users by 12-38%.

The Bones:

Menopausal hormone therapy decreases the incidence of all fractures even in women not at high risk of fracture. It’s the only therapy available with proven efficacy of fracture reduction in patients with osteopenia. And unlike

osteoporosis drugs bisphosphonates, hormone therapy also keeps the discs between our vertebrae plump, helping preserve height.

Weight:

The hormonal changes that accompany menopause are associated with increases in total body fat and abdominal fat, even in slim women.

Oestrogen receptors in the brain control food intake, energy expenditure and body fat distribution. Oestrogen deficiency can increase hunger, slow fat metabolism and encourage central fat gain. As oestrogen levels fall, this turns on an enzyme called ALDH1A1 which causes us to store fat,

particularly visceral fat around the internal organs. This is the worst kind because it sends out metabolic signals to the rest of the body! Decreases in testosterone might also account for muscle loss and a 4-5% decrease in metabolic rate. Hormone replacement therapy shouldn’t cause weight

gain unless the doses of hormones are far too high for the individual  (too much oestrogen can cause bloating, fluid retention and weight gain). Non-bioidentical progestagens may also cause weight gain through fluid

retention whereas bioidentical progesterone may help weight

loss by acting as a diuretic. The point is that at the right dose many clinical studies have indicated that hormone replacement therapy prevents or reduces weight gain and body fat gain particularly abdominal fat gain which also improves insulin sensitivity and is associated with a lower rate of development of type 2 diabetes.

Brain:

The parts of the brain that process the learning of new information are rich with oestrogen receptors. Oestrogen increases production levels of neurotransmitters such as acetylcholine that influence memory, and it also stimulates the growth of dendritic spines that enable nerve cells to communicate. In addition, oestrogen helps regulate glucose, inflammation and antioxidants in the brain. Neuro-imaging

studies have shown that when oestrogen declines, there is

markedly less brain blood flow and activity. Oestrogen also promotes increased blood flow to the brain. Oestrogen replacement therapy has maximum benefit when started close to the menopause. 

Studies have found that among women who are over 65 years old, those that take oestrogen replacement therapy perform better on cognitive tests and show less cognitive deterioration over time.  Another study  found that women on oestrogen had better visual memory when compared to

those not on oestrogen. Women also had  higher scores on

verbal and fine motor skills tests and performed better in

speed and accuracy tests when oestrogen levels were at their

peak in their menstrual cycle. Systematic reviews of studies suggest a 34-44% reduction in the risk of Alzheimer associated with hormone therapy use at the time of menopause.

Research from Stanford university in 2014 found that bioidentical oestrogen but not the synthetic oestrogen, preserves key brain regions in

postmenopausal women at risk for dementia. If that

same bioidentical oestrogen was paired with a synthetic progestogen, all

benefit was obliterated!

Skin:

After menopause, skin thins and there is a loss of viscoelasticity. Skin surface texture, collagen content and elasticity all improve with oestrogen therapy.

Taking bioidentical hormones at the time of menopause can help symptom relief and disease prevention.

Low Testosterone and bioidentical hormones: exploring the connection

Its really common for menopausal women to suffer from the effects of low testosterone but all too often this is dismissed.. Testosterone levels may drop low for a number of reasons –  because of age, prolonged stress, chemotherapy, surgical removal of the ovaries to name a few – but frequently testosterone levels aren’t tested. Even if a woman does find out that she has low testosterone, its all too common not to be offered any treatment –  there is no licensed testosterone product for women in the UK! Yet this can have a huge effect on people’s marriages and quality of life. Many women may turn to bioidentical hormone clinics to access testosterone therapy at a dose tailored to their needs.

A lack of testosterone can cause many symptoms such as:

Muscle weakness

Depression

Brain fog

Bone loss

Fatigue.

Memory loss

body aches and joint aches

Loss of libido

Some of the benefits of testosterone therapy for women are:

Increased bone strength and density

Improved muscle tone

A healthier body composition with decreased body fat

Higher energy levels

Better emotional health

Restoration of the libido

Reduced insulin resistance

Certain lifestyle changes may help raise testosterone levels. For example, eating a high protein

anti-inflammatory diet, reducing weight, exercising regularly, improving sleep patterns, increasing intake of amino acids and reducing stress levels may help. 

Low levels of testosterone can also be associated with low levels of other hormones in the body –  for example, women with low testosterone also often have low levels of DHEA. Replacing DHEA or both DHEA and testosterone can be a powerful way to restore energy, mood and libido. Its important to find a medical practitioner who can consider all the hormones and their role in your health and who understands the importance of testosterone in women and can help you address low levels. 

The Safety and Regulation of Bioidentical Hormones

When it comes to taking hormones everyone is concerned about safety. Here are some of the key issues to consider:

1. Choose bioidentical over synthetic: research suggests that bioidentical oestrogen and progesterone are preferable to synthetic versions both in terms of cancer, effects on the heart and on the liver. 
2. Take what you need: too much of any hormone, bioidentical or synthetic, can cause side effects.

3) Discuss with your practitioner what works for you: if you are noticing side effects, its important to feed back to your practitioner. For example, if you have digestive disorders, oral progesterone may not be the best route to take progesterone. Depending on your sensitivity you might need to slightly adjust the dose of one or more hormones.

4) Have ongoing monitoring: regularly checking in, updating your medical history and reviewing whether you still need to take the same dose is an important part of the treatment plan.

When choosing which hormone to take, some bio-identical hormones are made by drug companies, are approved by the MHRA and are sold in standard doses. These are available on the NHS.

Other bio-identical hormone preparations are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient – for this reason they are unlicensed. People may choose to take compounded hormones because they require more precise dose and route regimes.

The main criticism about customised bioidentical hormones is that they are unlicensed. This is true because for a medication to be licensed it must be licensed at a specific dose and route for a specific disease. Bioidentical hormones are tailor made for individual patients in compounding pharmacies in specific rather than set dosages and by virtue of this will be unlicensed. This does not mean that they are not safe or effective however. Research shows that bioidentical hormones are safer than their synthetic counterparts. Research shows that compounded bioidentical hormone therapy is effective: for example a paper published in the Journal of Prescribing Practice showed a 52% increase in quality of life and significant reduction in  21 menopausal symptoms with bioidentical hormone therapy treatment, another showed that bioidentical progesterone cream significantly reduced vasomotor symptoms, and another that compounded bioidentical hormone therapy improves mood symptoms.

Moreover just because something is licensed this does not make it safer – for example the conjugated equine oestrogens are licensed despite a heightened risk of heart disease breast cancer and stroke. 

Although compounded bioidentical hormones are unlicensed, their production is still highly regulated by the General Pharmaceutical Council. In fact there are many circumstances in which compounded medicines are used. The General Pharmaceutical Council issues guidance on compounding and its practiced in many NHS hospitals to meet patients’ unmet needs. Compounding is a regulated activity and compounding pharmacies in the UK are tightly regulated by the General Pharmaceutical Council.

Pros of compounded hormones

• can be tailor made for the person’s needs
• can be made up free from additives or preservatives
• can include other hormones such as DHEA and testosterone that are not available in the standardised products

Cons of compounded hormones

• need to use a trusted UK pharmacy
• needs more monitoring
• expensive