Bio-identical Hormone Replacement Therapy

Menopause can be a challenging time for many of my female patients. Menopause is defined as having gone twelve consecutive months without a period and having a consistently elevated FSH, indicating low estrogen. If you don’t meet the criteria for menopause but you’re experiencing symptoms of menopause it is possible you are in perimenopause, the stage before menopause. During perimenopause progesterone levels start to decline and can cause changes in a woman’s menstrual cycle and menopausal symptoms including night sweats, hot flashes, mood changes, sleep problems, weight gain, poor focus etc.

Although a natural part of aging, menopausal symptoms can last for years and can have a detrimental impact on a woman’s quality of life. To help manage the symptoms of menopause, hormone replacement therapy (HRT) was introduced. Conventional hormone replacement therapy consisted of Premarin (pregnant mare’s urine), a synthetic estrogen, and Provera, a synthetic progesterone. HRT had a significant impact on menopausal symptoms but in 2002, as a result of a study done by the Women’s Health Initiative, patients were advised to discontinue their HRT due to an increased risk of adverse events. In response to this study and the risks associated with synthetic HRT, the popularity of bio-identical hormone therapy rose. Bio-identical hormones are derived from plants and are identical to our natural hormones, unlike synthetic ones. They can be prescribed topically, further reducing the risk of adverse events and are compounded in a pharmacy to ensure high quality. Based on the current research, bio-identical hormones are considered to be a safe and effective alternative to synthetic hormone replacement therapy[1].

In my practice, I have found bio-identical hormones to be an effective treatment for women experiencing menopausal symptoms that are not responding to other methods of treatment. While this article has focused on the use bio-identical hormones during menopause, I have also found bio-identical hormone replacement therapy to be beneficial for certain woman struggling with fertility or severe pre-menstrual syndrome symptoms. During a consultation we will go over hormone testing, the benefits you can expect and any risks associated with bio-identical hormones to see if they are right for you. If you are interested in bio-identical hormone therapy it is important that you consult a practitioner experienced in hormone prescription. Not all Ontario Naturopathic Doctors are able to prescribe hormones. However, I have completed the Ontario Prescribing and Therapeutics exam and the prescription of bio-identical hormones, desiccated thyroid and intramuscular injections of B12 and folate are within my scope of practice.

References:

1) Evidence Based Medicine: Holtorf, K. (2009). The bioidentical hormone debate. Are bioidentical hormones (estradiol, estriol and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgraduate Medicine, 121, 1-13.