Bioidentical Hormone Replacement and Women’s Health

As women we know how important hormonal balance is.  We have felt the effects of hormonal change since adolescence and are acutely aware how life events, diet, and sleep all seem to impact our menstrual cycles.  Many women have used the birth control pill to create stability in what can be a far too unpredictable monthly cycle.  Pregnancies can sometimes help and sometimes disrupt our delicate hormonal cascade. Perimenopause can start as early as our thirties, dramatically altering our mood and energy, followed by a long transition of up to 10 years to menopause.  It can seem as if we are slaves to our hormones with very little control.  
 
I think we are finally entering the age of enlightenment where hormonal health is concerned.  There is finally consensus on the many tools we have to help women who are suffering through hormonally related health issues.  Learning about how interconnected all hormones are in the body has opened the door to influencing them in by improving certain health parameters.  The following aspects of our health seem to be the most important. 
 
Adrenal Health: 
We have learned that under chronic stress the body steals the building blocks of hormones to make cortisol.  This leaves us with a possible deficit of progesterone, DHEA, Testosterone and Estrogens.  Although this is not the only cause of hormone depletions it is possibly the most important.  We constantly hear how important it is to reduce stress but it has become apparent that it is vital to good health.  The good news is that lifestyle interventions like yoga, meditation, exercise and a low stimulant diet have been shown to lower cortisol and increase levels of sex hormones.  Herbs and nutrients can also achieve this goal.  Possible therapies include DHEA, Theanine, Ashwagandha, Rhodiola, Magnesium, GABA amongst many.  
 
Sleep: 
 
None of us can survive without it.  Some us have learned how to cope with a lot less than we should have.  It seems that in many women sleep is one of the first things to go as hormones get disrupted.  The culprit can be low estradiol or low progesterone.  Regardless, our melatonin levels are low and this causes further degeneration in our health.  In some individuals giving melatonin can improve sleep which in turn improves our ability to cope with stress which then allows more production of our sex hormones.  There are no dangers to melatonin and thousands of studies have been done to prove this.  Melatonin not only improves sleep, it improves our immune function, promotes healing and decreases our risk of cancer.
 
Thyroid Health:
 
We know that a poorly functioning thyroid gland or an inability to use the thyroid hormone we make can cause us to feel fatigued and depressed, causes weight gain, cold intolerance, dry skin and hair loss.  What is less obvious is that it affects our adrenal glands and our pancreas.  When our thyroids are not doing their fair share then the adrenal glands have to pick up the slack, raising cortisol which results in lower sex hormones.  The pancreas also takes a blow producing more insulin which makes us constantly hungry and fatigued due to crashes in blood sugar.  Insulin is also pro-inflammatory which causes body pain and increases our risk of all inflammatory diseases of which most diseases are.  Managing thyroid disease is not as simple as previously thought.  A quick prescription of Synthroid does not always fix all of our problems.  A host of nutrients are important including iodine, tyrosine, and iron.  We also need to ensure that the adrenals are up for the increased metabolism that healing the thyroid brings.  A combination of nutrients, herbs, T3 and T4 is usually necessary for true healing.
 
Nutrition and Exercise: 
 
We can never underestimate the power of good nutrition and exercise.  This is not to say that many women who eat well and exercise regularly don’t have hormonal issues but they are certainly less likely to.  Magnesium and B vitamins are crucial but it is all about balance.  No nutrient should be overdone.  We need to evaluate our diets and determine what we are missing.  Exercise does so many things including lowering our cortisol levels and we now know how important that is.  Early man/woman when confronted with a stressor (ie. Bear) would have a surge of cortisol and run.  When safe her cortisol levels would drop back to normal and physiological balance restored.  Most of us just sit with ongoing stress and the subsequent increase in cortisol all day doing nothing to manage it.  If you feel stressed run or walk away from it until you no longer feel the anxiety associated with it.  
 
Bioidentical Hormone Replacement:
 
Bioidentical Hormone Replacement (BHRT) is a wonderful tool.  To be able to safely and directly replace that which the body is lacking is invaluable.  If all of the above health parameters have been addressed and hormonal balance still has not been achieved then it is time to provide these hormones directly.  The only way to know the levels of sex hormones in your body is to test for them.  Symptoms can guide you but testing provides concrete numbers to go by.  There are a number of options for testing. Salivary hormone analysis is excellent although blood/serum testing does provide valuable information if interpreted correctly.   Urine can also give us a glimpse of your hormonal status. Using saliva we get a clear and longer term picture of a person’s hormones and are also able to look at DHEA and cortisol levels over a 12 hour period.  The cost of testing is not insignificant ($150-300) but well worth it if you can afford it.  Naturopaths can order blood tests but so can your GP at no cost to you which does make it very convenient for some.  Once you have the results of testing you can go forth and restore hormones to a healthy level.  
 
Some women ask if there is a time limit on hormone replacement – 2 years, 10 years, 20 years etc. My answer to this is if you feel great while on hormones and upon retesting your levels are in a healthy range there is little reason to stop.  Alternatively if you do stop hormones and retest and your hormones are in the healthy range, and you feel well, then you no longer need to be on them.  There is also no rule as to when to start hormones.  Some women sail through menopause and are balanced until their 60s or 70s and need to start hormones then.  Some women need help in their 30s and 40s through perimenopause and continue through menopause.  I have some patients in their 80s still on BHRT and feeling wonderful.  
 
The benefits of hormone replacement are many and using BHRT seems to have reduced the risks dramatically.  We see improvement in bone density, cardiovascular disease risk, sleep, energy, mood, exercise tolerance, skin, hair and an overall feeling of youthfulness.  
 
With increased knowledge and experience we have come to realize that by improving certain health parameters we can improve our hormonal status. In addition we have learned that bioidentical hormones are a safe and highly effective means of restoring our sex hormones when lifestyle changes and supplements are not enough.  The path has been cleared to feeling like your true self.