You may be wondering what exactly is bioidentical hormone therapy and how it differs from conventional hormone replacement?
Bioidentical hormone replacement therapy (BHRT) is the use of hormone therapy that is considered to be equivalent to the hormones that our body naturally produces (aka., bioidentical). Conventional hormone replacement therapy (HRT) on the flip side uses synthetic chemicals which are not considered bioidentical -- an exact mimicry of the hormones our body naturally makes.
Advocates of BHRT believe our body can more easily assimilate these exogenous “bioidentical” hormones and benefit a great deal more than with conventional HRT. They are also considered a safer alternative to synthetic hormones with the greatest known risks to be possibly linked to an increased risk for hormone-induced cancers and cardiovascular complications.
While it is important to be prudent with prescribing hormone replacement therapy in people with known risk for developing hormonal cancers such as those with a family history or genetic predisposition, it is equally important to note that the studies that showed increased cardiovascular risk generally only tested Estrogen in combination with Progestins (a synthetic version of progesterone), rather than Progesterone, and therefore only tell us about the risk of non-bioidentical hormone therapies (aka., synthetic chemicals). As a result, the cardiovascular risk of BHRT is not truly known. It's also important to note that cardiovascular risk is related to initiation of hormone replacement only at the onset of menopause. We know now the sooner treatment is initiated, the lesser the cardiovascular risk, and in fact, cardio-protective aspects of hormone replacement might be observed when starting HRT immediately following menopause. All in all, there are potential benefits to BHRT when compared to conventional HRT, as illustrated by both research and patient accounts.
Ultimately, however, hormone replacement might not even be the most ideal treatment for menopausal symptoms in all patients. Functional medicine approaches menopausal hormonal changes from a unique lens since it also looks at symptoms of hormonal imbalance linked to both the adrenals and thyroid glands which can mimic sex hormone imbalance symptoms such as:
As the ovaries stop producing sex hormones (estrogen, progesterone, and testosterone), the adrenal glands become responsible for the majority of hormonal production. While it is inevitable that the ovaries will stop producing hormones at some point in our life, it is not inevitable that a person will experience extreme symptoms as a result. The health of our adrenal glands is an important determinant of menopausal symptoms. In addition to sex hormones, the adrenal glands are also responsible for producing several other hormones in the body, including cortisol. Cortisol is a hormone that is produced in response to acute and chronic stress -- physical, emotional, and environmental. In addition, both cortisol and sex hormones are produced from the same substrate (chemical precursor): cholesterol. This means there are two rate limiting steps to producing appropriate post-menopausal hormones:
The overall health of our adrenal glands and thyroid plays key roles in menopause. For example, if a person has been under high levels of stress for a long period of time, it will naturally cause cholesterol circulating in the bloodstream to be increasingly used to produce the stress hormone cortisol and shift away from sex hormone production. This deficient in optimal sex hormone levels caused by a chronic demand for cortisol can cause menopausal symptoms. In this case, it is significantly more effective to figure out how to cut down drastically on the physical, emotional, and/or environmental insults which are causing the body to demand more cortisol production than to just presume hormonal replacement is the key solution.
It is also more important to address the health of the thyroid gland than to jump to presuming HRT is the answer to treating various symptoms since otherwise, it will cause the thyroid to be further neglected and worsen the overall long-term health prognosis for the patient.
As a result, a functional medicine provider will most often test adrenal health, thyroid function and sex hormone levels. Depending on the specific patient’s overall presentation, the practitioner may also recommend testing for elevated levels of inflammation, food intolerances, and environmental toxins, as these also impact hormone production and metabolism in the body.
It is easy to simply test sex hormones after menopause, and then supplement with hormones based on inevitable deficiencies. However, this approach is akin to placing a bandaid on the problem, rather than getting to the root cause. Sometimes it is the only option, after other testing and treatments have been tried; and sometimes, it does in fact improve health outcomes. But if your goal is achieving optimal wellbeing, looking at how your whole body functions is always the safest and most effective approach to permanently resolve your symptoms.
Jessica Kolahi PA-C and the SF Advanced Health Team Are Here to Support You on Optimizing your Health Journey
Our expert team of integrative functional medicine holistic practitioners work with patients suffering from acute and chronic health concerns they’ve been told can only be treated with invasive pharmaceutical drugs, surgery and other side effect-ridden solutions. If you are experiencing symptoms related to menopause, and would like to discuss how to optimize your health, reach out to Jessica Kolahi PA-C and start your journey to greater wellbeing.