Bioidentical Hormone Replacement Therapy (BHRT) for Perimenopausal and Menopausal Women: A Holistic Approach to Longevity
You wake up dripping in sweat at two in the morning. The sudden hot flash and your insomnia keep you from falling back to sleep...again and again.
Or maybe you have less energy, brain fog, and low libido.
Sound familiar?
If you’re experiencing symptoms of menopausal or perimenopausal hormone imbalances, you’ve likely been putting up with this for months now.
Navigating the hormonal shifts of perimenopause and menopause can feel daunting and hopeless.
While these transitions are natural, they often come with challenging symptoms like hot flashes, mood swings, sleep disturbances, a decline in energy levels, brain fog and a general feeling of aging.
As women seek solutions to manage these changes while maintaining an active and healthy lifestyle, bioidentical hormone replacement therapy (BHRT) is emerging as a promising option.
Unlike traditional hormone replacement therapies, BHRT offers a more natural, personalized approach that aligns with holistic health principles.
In this blog, I delve deep into the benefits of BHRT, its role in optimizing longevity, best delivery options, and how it complements a holistic lifestyle.
Understanding Perimenopause and Menopause
Perimenopause is the transitional period leading up to menopause, typically beginning in a woman’s 40s, though it can start earlier for some.
This phase can last anywhere from a few months to several years and is marked by fluctuations in hormone levels, particularly estrogen, progesterone, DHEA, and testosterone.
These hormonal shifts can lead to a variety of symptoms, including:
Irregular menstrual cycles
Hot flashes and night sweats
Mood swings and irritability
Sleep disturbances
Decreased libido
Vaginal dryness
Weight gain, particularly around the abdomen
Menopause is officially recognized when a woman has gone 12 consecutive months without a menstrual period, signifying the end of her reproductive years.
The average age for menopause is 51, but it can occur earlier or later depending on various factors, including genetics and overall health.
While menopause is a natural biological process, the symptoms associated with it can significantly impact a woman’s quality of life.
Traditional hormone replacement therapy (HRT) has been used for decades to alleviate these symptoms, but concerns about its safety have led many women to seek alternative solutions, such as BHRT.
The Evolution of Hormone Replacement Therapy
Hormone replacement therapy has long been a standard treatment for managing the symptoms of menopause.
However, its use became controversial after the publication of the Women’s Health Initiative (WHI) study in 2002, which linked synthetic hormone therapy to an increased risk of breast cancer, heart disease, stroke, and blood clots.
The WHI study was a highly flawed, large-scale, randomized controlled trial that aimed to evaluate the risks and benefits of HRT in postmenopausal women. The findings led to a significant decline in the use of HRT, as many women and healthcare providers became concerned about its safety.
However, it’s essential to understand the limitations of the WHI study.
The study primarily involved older women (average age of 62) who were about a decade past menopause and it used synthetic hormones, specifically conjugated equine estrogens (derived from the urine of pregnant mares) and medroxyprogesterone acetate.
These synthetic hormones were administered orally which showed an increase in the risk of venous thromboembolism (blood clots) by a factor of two (1).
Several studies show that transdermal application does not confer the same thromboembolic risk (3).
The hormones used in the WHI were:
-not identical to the hormones naturally produced by the human body
-administered orally
-administered to women who had over 10 years of diminished hormone levels
This may explain the adverse outcomes observed in the study.
Furthermore, other issues with the study were poor study design and flawed data analysis that led to the big hormone replacement scare in the early 2000s.
Today, we understand that HRT, specifically bioidentical hormones, are a savior to many menopausal women with benefits that reach far beyond symptomatic relief of their menopausal symptoms.
Bioidentical hormones are chemically identical to the hormones naturally produced by the human body. They are typically derived from plant sources, such as soy or yams, and are designed to mimic the body’s natural hormone levels.
Because of their identical structure, bioidentical hormones are believed to be metabolized in the body more efficiently and with minimal side effects compared to synthetic hormones.
What are the Preferred Forms and Delivery Methods of BHRT?
Hormones therapies come in various forms like pills, injections, patches, and creams, hormone pellets.
Some methods are better options than others considering bioavailability, ease of delivery method, and ability to titrate up to optimal levels and adjust dosing.
For example, pellets, which get placed under this skin with a small surgical procedure, have become increasingly popular because of their ease of use since they last for 3 months and release hormones on a recurring basis. This, however, can come with problems.
Problems With Various Delivery Methods of BHRT
While the automatic hormone release of pellets might appeal to you since you won’t have to remember to administer daily, but because the dose can’t be adjusted, pellets can lead to undesired effects such as mood swings, anxiety, hair pattern change, acne, and weight gain.
And you’re stuck with these symptoms for 3 months until the pellets wear off.
With patches, there is a similar issue with dosing although termination is easy by simply removing the patch (1).
Also, note that compounded bioidentical hormone therapy (custom-made in a pharmacy) is minimally regulated, may easily be under or overdosed, and lacks safety and efficacy data (4).
Oral estrogen is associated with an increased risk of venous thromboembolism. (1)
Micronized creams are readily available over the counter without a prescription or doctor's visit which may be appealing for some.
I strongly advise against tampering with your hormones without proper assessment and oversight by a hormone literate professional.
Another consideration with creams is the hormone is not properly dissolved in the cream and are not as efficiently or effectively reaching the bloodstream, rendering them less bioavailable.
Therefore, micronized creams require much larger dosing with much less effect.
So what is the best option?
Safer and Effective Delivery Methods of BHRT
Our preferred method of application is transdermal and oral advanced lipid nanotechnology liposomes or emulsions. Here are several reasons why.
Liposomes and emulsions are water or fat soluble molecules, respectively, encased in a lipid membrane (optimally smaller than 100nm) that provide enhanced absorption, bypassing digestive constraints and first pass metabolism in the liver (i.e. breakdown prior to being effective).
The smaller the particle the better the absorption. Studies show a 34-fold increase in absorption with 64nm compared to 234nm particles. Most conventional oral or transdermal liposomal products contain larger liposomes (>100nm) which greatly compromises their absorption.
The small stable particles are absorbed much quicker and have a more sustained effect thus requiring a much smaller dosing. The benefits of this nanotechnology is that these tiny particles actually reach the capillaries to enter the bloodstream, thus optimizing efficacy.
Being able to titrate hormone therapies to their effective dose over several months and continuously adjust as needed is an important aspect of personalizing BHRT.
Whether oral or transdermal, dosing is easy to adjust through these delivery systems (5).
What Hormones are used in transdermal BHRT?
Dehydroepiandrostenedione (DHEA)
DHEA is often considered the “everything” hormone due to its widespread benefits in the body. It is an androgen and is produced in the adrenal gland from pregnenolone. DHEA is a precursor for the synthesis of estrogen and testosterone in the body.
It plays a role in:
Lean body mass
Bone integrity
Stress resilience
Energy and vitality
Fertility
Libido
Immune function
Blood sugar regulation
Cognition and brain health
HPA axis modulation (6)
DHEA depletes as we age and with stress and excessive exercise.
DHEA is one of the first hormones to decline in perimenopause, along with progesterone.
As DHEA naturally declines with age, women can notice changes in menstrual health, bone density, fat metabolism, and sexual function.
Lower levels of DHEA at any age in men and women alike can also present with symptoms such as fatigue, depression, low libido, and weight gain.
Pregnenolone
The “mother hormone”, pregnenolone is a powerful neurosteroid and a precursor to other hormones like allopregnanolone, DHEA, and progesterone.
As the precursor to DHEA, it shares many of the same roles as DHEA. What distinguishes it is its neuroprotective effect.
Its neurosteroid benefits include memory, especially short-term, word recall, processing speed, and plays an important role in stress resilience (7).
It has been shown to help in addiction treatments and acts as a powerful modulator of neuroinflammatory diseases, including Alzheimer's disease (AD) and multiple sclerosis (MS), and in neuropsychiatric disorders such as schizophrenia, depression, and autism (8).
Distinctive signs and symptoms of low pregnenolone include:
Poor memory and concentration
Sleep disturbances
Joint pain
Increased cholesterol
Estradiol
Estrogen is the “ultimate female hormone” and is responsible for the development of secondary sex characteristics during puberty.
Estradiol (E2) is the primary form of estrogen in your body during your reproductive years. It’s the most potent form of estrogen.
Estrogens main functions are:
Thickens uterine lining
Female body composition (breast, hip development)
Bone density and muscle mass
Brain volume
Cognition and memory
Mood
Libido
Urinary and bladder function (9)
As decline happens in menopause, estradiol does so in a saw tooth fashion with highs and lows, while DHEA, testosterone and progesterone all decline steadily.
This decline can lead to the symptoms experienced in menopause like vaginal dryness, mood changes, night sweats and hot flashes.
Estrogen affects serotonin synthesis, explaining why fluctuating changes in estradiol leads to a higher risk for depressive symptoms in menopause.
Sadly, these women are commonly prescribed antidepressants like SSRIs instead of being treated for their hormone imbalances.
Supplementing with estradiol can ease low estrogen symptoms such as:
Hot flashes
Night sweats
Brain fog/cognitive decline
Depression
Vaginal dryness
Decreased bone density
Low libido
Increased cholesterol
Insulin resistance
Sleep disruption
Loss of skin elasticity/thinning skin
Estriol
Estriol is a weaker estrogen that is present in higher quantities during pregnancy.
Its use in BHRT can:
Ease hot flashes and night sweats
Strengthen bones and prevent osteoporosis
Remedy insomnia to help you sleep better
Improve incontinence
Relieve vaginal atrophy and vaginal dryness
Lower the risk of urinary tract infections (UTIs)
Protect the uterus and breast from cancer
Promising therapy for triple negative breast cancer (10)
Other effects include:
Improve cognitive function
Relieve menstrual migraines (hormonal headaches)
Smooth wrinkles
Treat postpartum depression
Treat neuroinflammation disorders like multiple sclerosis (MS) (11)
Progesterone
Progesterone is best known for its role in preparing the endometrium for pregnancy and maintaining pregnancy. Its functions, however, reach far beyond its role in pregnancy.
Benefits of progesterone include:
Balancing estrogen
Anti-anxiolytic
Promoting sleep
Neuroprotective/neuroregenerative
Diuretic
Promotes bile flow
Bone integrity
Contributes to thyroid function
Cancer protective/antiproliferative for breast and endometrial tissue
It is interesting to note how far reaching progesterone is as a neurosteroid. Studies have demonstrated its role in stroke, mental illnesses like bipolar disorder and schizophrenia, neurodegenerative diseases such as Alzheimer’s disease, strokes, and even traumatic brain injury (12,13,14).
The Benefits of Bioidentical Hormone Replacement Therapy
BHRT offers a range of benefits for women experiencing perimenopause and menopause, making it an attractive alternative to traditional HRT. Some of the key advantages of BHRT include:
Symptom Relief
One of the primary reasons women seek BHRT is to alleviate the common symptoms of perimenopause and menopause.
These symptoms can be debilitating, affecting a woman’s quality of life, productivity, and overall well-being. BHRT can help balance hormone levels, reducing or eliminating symptoms such as:
Hot flashes and night sweats: Estrogen plays a crucial role in regulating the body’s temperature. BHRT can help stabilize estrogen levels, reducing the frequency and severity of hot flashes and night sweats.
Mood swings and irritability: Hormonal fluctuations can significantly impact mood, leading to irritability, anxiety, and depression. BHRT can help stabilize mood by balancing estrogen and progesterone levels.
Sleep disturbances: Many women experience insomnia or disrupted sleep during perimenopause and menopause. BHRT can improve sleep quality by regulating hormones that affect sleep patterns, such as progesterone.
Vaginal changes: Reduced estrogen levels can lead to thinning of the vaginal walls (atrophy) and decreased lubrication, causing discomfort during intercourse. BHRT can help restore vaginal health by replenishing estrogen levels.
Genitourinary syndrome of menopause (GSM): GSM symptoms of urgency, frequency, dysuria, and recurrent urinary tract infections can occur as estrogen declines. BHRT can help mitigate these uncomfortable and potentially embarrassing symptoms.
Decreased libido: Hormonal imbalances can lead to a decline in sexual desire. BHRT can help improve libido by balancing hormones that affect sexual function.
The appeal of BHRT extends beyond symptom management.
Hormonal Balance and Longevity
Many women are turning to BHRT as part of a broader strategy to optimize longevity and maintain a high quality of life as they age.
As we age, the decline in hormone levels can lead to various age-related conditions, including cardiovascular disease, osteoporosis, cognitive decline, and metabolic disorders.
Hormonal balance is a key factor in healthy aging.
By restoring hormone levels to a more youthful state, BHRT may help reduce the risk of age-related diseases, enhance vitality, and support overall well-being.
Bone Health
Osteoporosis is a common concern for postmenopausal women, as the decline in estrogen levels can lead to a loss of bone density.
Osteoporosis can lead to fractures which significantly impact quality of life and mobility in older aged women.
Estrogen is crucial for maintaining bone health, as it helps regulate the balance between bone resorption (breakdown) and bone deposition (formation).
By supporting bone density and proper bone remodeling through BHRT, women can reduce the risk of fractures and maintain an active, independent lifestyle as they age.
Cardiovascular Health
Heart disease is one of the leading causes of death for women, particularly after menopause.
The decline in estrogen levels during menopause is associated with an increased risk of cardiovascular disease.
Estrogen has protective effects on the cardiovascular system, including improving lipid profiles, reducing inflammation, and promoting healthy blood vessels, reducing the risk of atherosclerosis (hardening of the arteries).
The WHI study raised concerns about the potential risks of HRT for heart health. However, it’s important to note that BHRT is different from the synthetic hormones used in the WHI study.
Emerging research suggests that BHRT may have protective effects on the heart when administered correctly.
Cognitive (Brain) Health
Cognitive decline is a common concern as we age, and hormonal changes during menopause can impact brain function.
Many women experience mood swings, anxiety, depression, and cognitive changes during this time.
BHRT can support mental well-being by stabilizing hormone levels, improving mood, and enhancing cognitive function.
Estrogen and pregnenolone have been shown to have neuroprotective and neural anti-inflammatory effects, supporting brain health and reducing the risk of neurodegenerative diseases such as Alzheimer’s and neuroinflammatory diseases like MS.
Metabolic Health
One of the critical aspects of longevity is maintaining a healthy metabolism.
Hormones like estrogen, progesterone, and testosterone play essential roles in regulating metabolism, body composition, and energy levels.
During menopause, the decline in these hormones can lead to a loss of muscle mass, lower energy, increased adipose (fat) tissue which all contribute to the weight gain many menopausal women experience.
Abdominal fat increases, which also means visceral fat accumulation, leading to and increased risk of metabolic disorders such as insulin resistance and type 2 diabetes.
BHRT can help support metabolic health by balancing hormone levels, promoting a healthy body weight, and reducing the risk of metabolic syndrome.
Skin Rejuvenation
Estrogen can promote youthful skin in several ways. It prevents the decrease of collagen and elastin thus maintains skin thickness and integrity.
Estrogen maintains skin moisture by increasing hyaluronic acid and other molecules. Overall, with estrogen therapy your skin can look more youthful and reduce fine lines and wrinkles (15).
Check out this blog, for more skin rejuvenation solutions.
Hormone Cancer Prevention
Progesterone has been shown to be protective and preventative of breast cancer and various cancers, uterine and colon cancers and may also be useful in treating other cancers such as ovarian, melanoma, mesothelioma, and even prostate cancer in men (16).
Furthermore, an updated analysis of WHI demonstrated that estrogen-alone hormone therapy does not increase the risk of breast cancer in postmenopausal women (17).
Estriol, coined the “weaker” of the three endogenous estrogens, has significant therapeutic effects when it comes to prevention of breast and uterine cancers (18).
Personalizing Identifying Hormone Imbalances Beyond Symptoms: Lab Testing: A Deeper Insight
When it comes to hormone health, symptoms alone don’t always tell the full story.
While signs like fatigue, brain fog, mood swings, weight gain, and hot flashes may suggest a hormonal imbalance, they are just the surface of a much deeper and complex system.
For a truly personalized and effective approach to BHRT, it's essential to go beyond symptoms and delve into precise diagnostic tools and testing methods that reveal the underlying causes of hormone dysregulation.
Lab tests provide a critical window into your hormonal landscape, helping to identify not only the specific hormones that may be out of balance but also the factors contributing to these imbalances.
By leveraging comprehensive testing, we can craft a more targeted and individualized treatment plan.
Below are some important foundational functional medicine tests, beyond basic blood work, that should be run for a comprehensive approach before BHRT.
DUTCH Test (Dried Urine Test for Comprehensive Hormones)
The DUTCH test is a highly advanced and comprehensive method for evaluating hormone levels and their metabolites.
Unlike traditional blood tests, the DUTCH test measures hormones in urine, providing a more accurate reflection of hormone production over a 24-hour period for postmenopausal women and full cycle for perimenopausal women.
This includes key markers such as cortisol, all 3 estrogens, progesterone, testosterone, and their metabolites, offering a detailed picture of how your body is producing, metabolizing, and secreting hormones.
For women who are looking for hormone-based cancer prevention or post cancer care, DUTCH provides data on key hormone-based cancer causing pathways.
Additionally, it provides insights into adrenal function, which is crucial in understanding the impact of chronic stress on hormone health.
Micronutrient Testing: The Foundation of Hormonal Health
Micronutrient deficiencies often play a significant role in hormone imbalances.
Certain vitamins and minerals are essential for hormone production, regulation, and receptor function.
By identifying and correcting these deficiencies, we can improve the effectiveness of BHRT and support overall health outcomes.
Toxins: The Hidden Disruptor
Testing for and addressing toxicity is a crucial aspect of personalized BHRT.
Toxins in the environment can interfere with hormone function by mimicking hormones, blocking their effects, or altering their production and metabolism.
In the toxic world we live in today, this is one of the biggest drivers of hormone imbalances.
Heavy metals found in soil, water, large fish, vaccines, and dental amalgams and endocrine-disrupting chemicals (EDCs) found in everyday products like plastics, pesticides, and personal care products, can accumulate in the body over time, leading to hormonal imbalances that can lead to more serious health issues like infertility and cancer.
Estrogen metabolism requires properly functioning detoxification pathways. Hormone imbalances can arise from improper estrogen detoxification. This can be due to impaired genetics and epigenetics, nutrient deficiencies, toxic overload, poor gut health, oxidative stress, and inflammation.
A personalized detoxification protocol, integrated with detox strategies such as dietary adjustments, supplements, and environmental modifications can help reduce the toxic burden on your body, allowing your hormones to function more effectively and significantly enhance the outcomes of BHRT.
Working under the guidance of a qualified practitioner, such as Dr. Martina Sturm, certified in Quicksilver Scientific Detoxification can ensure your toxins are eliminated in a safe and effective manner without a detox crisis.
Choosing the Right Healthcare Provider
If you’re considering BHRT, it’s essential to work with a healthcare provider who specializes in hormone health and understands the nuances of bioidentical hormone therapy.
A hormone literate practitioner, like Dr. Martina Sturm, who is a certified Quicksilver Scientific Practitioner in Menopause Hormone Literacy + Quicksilver Hormone Replenishing System, can help create a personalized treatment plan tailored to your individual needs.
When choosing a healthcare provider for BHRT, consider the following factors:
Experience and Expertise: Look for a provider with specialized training in hormone health and BHRT. They should have a thorough understanding of the different types of hormones, their effects on the body, and how to customize treatment for each patient.
Personalized Approach: BHRT should not be a one-size-fits-all treatment. Your provider should take the time to understand your unique symptoms, health history, and goals to create a personalized treatment plan.
Monitoring and Adjustments: Hormone levels can fluctuate over time, so it’s essential to work with a provider who will monitor your progress and make adjustments to your treatment as needed.
Is BHRT Right for Me?
Navigating the complex journey of perimenopause and menopause can be overwhelming, but you don’t have to do it alone.
Bioidentical Hormone Replacement Therapy (BHRT) offers a holistic, personalized approach to addressing hormonal imbalances, enhancing longevity, and improving your overall quality of life.
If you’re considering BHRT, it’s crucial to work with a knowledgeable healthcare provider who can guide you through the process and ensure that your treatment is safe, effective, and tailored to your individual needs.
By understanding your unique hormonal landscape through comprehensive testing and working with a hormone-literate professional, like Dr. Martina Sturm, you can regain control of your health, vitality, and well-being.
Are you ready to take the next step toward feeling like yourself again? Don’t let hormonal imbalances dictate your life.
Request a free 15-minute consultation with Dr. Martina Sturm at Denver Sports and Holistic Medicine, today.
With the right support, you can navigate this life stage with confidence, vitality, and grace!
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