What exactly is bioidentical hormone therapy? How does it differ from conventional hormone replacement? What can be done to treat menopausal symptoms from a functional medicine perspective?
Bioidentical hormone replacement therapy (BHRT) is the use of hormone therapy that is considered to be of equivalent chemical makeup to the hormones that our body naturally creates. Conventional hormone replacement therapy (HRT) is not generally "bioidentical." In this way, the chemical makeup of conventional HRT is similar, but not an exact mimicry of our body's endogenous hormones (the hormones our body makes).
Proponents of BHRT say that this means that our body can more easily assimilate these exogenous hormones (hormones from outside the body), and therefore, we can have greater benefit from the hormone replacement. Providers that offer BHRT also assert that BHRT is most likely safer than traditional HRT. The greatest known risks to pursuing exogenous hormone therapy include: increased hormonal cancer risk, and cardiovascular incidences. While it is important to be prudent with hormone replacement in people with high risk for developing hormonal cancers (those with family history or genetic predisposition), it's 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 nonbioidentical hormone therapies (1). 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 in relationship to onset of menopause. The sooner treatment is initiated, the lesser the cardiovascular risk, and in fact, cardio-protective aspects of hormone replacement might be observed when started immediately following menopause (2). 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...
Functional medicine approaches menopausal hormonal changes from a unique lens. Symptoms of hormonal imbalance in both the adrenal glands and the thyroid gland can result in symptoms that mimic sex hormone imbalance, including:
hot flashes
night sweats
fatigue
insomnia
weight gain
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 longterm stress (physical, emotional, and environmental stress). 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 amount of Cortisol our body is generating in response to stress, resulting in greater total amount of cholesterol being turned into cortisol rather than sex hormones
The overall health of our adrenal glands, and therefore their ability to perform optimally and produce all adrenal hormones
In addition, since thyroid function changes in relationship to circulating sex hormones, and also often changes with age, menopausal symptoms may therefore be supported best by treating the thyroid rather than sex hormone replacement therapy.
As a result, a functional medicine provider will most often test for:
adrenal health
thyroid function
and sex hormone levels
Depending on your overall presentation, your provider may also feel it is recommended to test for inflammation, dietary intolerances, and toxins, as these also impact all 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 overall (2). But if your goal is optimal wellbeing, taking a look at the whole body is the safest, and often most effective approach.
If you are experiencing symptoms related to menopause, and would like to discuss optimizing your physiology, schedule an appointment with Jessica Kolahi PA-C, to start your journey to greater wellbeing.
Hage FG, Oparil S. Ovarian hormones and vascular disease. Curr Opin Cardiol. 2013 Jul;28(4):411-6. doi: 10.1097/HCO.0b013e32836205e7. Review.
Hage FG, Oparil S. Ovarian hormones and vascular disease. Curr Opin Cardiol. 2013 Jul;28(4):411-6. doi: 10.1097/HCO.0b013e32836205e7. Review.