Bio-Identicals & The Hormone Debate

(As featured in the Summer 2009 PMN Newsletter)

Thanks to the likes of Oprah, Dr. Phil, Dr. Oz and Suzanne Sommers, there has been a growing awareness among the public about hormone balance, bio-identical hormones and the risks and dangers of synthetic HRT (hormone replacement therapy). More information to educate the public is always good, but it also inevitably generates a lot of confusion. I hope this article will help to clarify when bio-identical hormones are appropriate as a better and safer alternative to synthetic HRT (Premarin, Prometrium, Progestins, Prempro, Medroxyprogesterone) and the biological significance of hormone therapy.

DO I REALLY NEED TO SUFFER?

First of all, most women should know by now that there is no need to suffer horribly through the transitional phase of their lives known as menopause. In fact, menopause should be a fairly easy transition in a healthy, hormonally-balanced female (or male - in which case, this transition is referred to as “andropause"). Hot flashes, night sweats, diminished sex drive, vaginal dryness, breast tenderness, mood swings (everything but the kitchen sink in this emotional saga), sleep disturbances, weight gain, fatigue and a general lack of motivation or zest for life are among the many symptoms a female can experience during this phase.

But no longer does a woman actually have to suffer! There is an answer for women and men everywhere that does not involve putting him/her at an increased risk of developing hormone-dependant cancers, blood clots, stroke or cardiovascular disease. Bio-identical hormones can be a useful intervention for the right individual at the right time and depending on the individual, can have little to no adverse effects.

WHAT IS THE FIRST STEP?

The first step is to get a baseline evaluation of the hormone levels using a salivary hormone test - this is not offered by conventional (allopathic) doctors who are part of the public health care system because it is not covered by the medical services plan. A saliva test accurately evaluates the levels of reproductive and adrenal hormones in a way that blood simply cannot (due to the fluctuating, cyclical nature of these hormones). Once a baseline reading has been determined, a treatment aimed at establishing balance of these hormones can be appropriately administered and a salivary hormone panel is repeated every 3-6 months to monitor the levels.

TREATMENT OPTIONS

In my practice, bio-identical hormones are not always the best treatment in this scenario. Once a hormone is given (whether natural or synthetic), the body will stop or significantly reduce its own endogenous production of hormones. In a woman who is no longer of reproductive age or who is significantly deficient in hormone due to a particular condition (or complete hysterectomy), bio-identical hormones may be the only option to achieve relief of symptoms. In others, I will first look at homeopathic, botanical, nutritional and other means by which to help stimulate the individual’s own glandular production of hormones.

In some cases, I will prescribe bio-identical hormones for a short period of time while working on treating the underlying cause of the deficiency - this may include addressing lifestyle and dietary habits, treating chronic microbial infections or toxicities in the tissues and/or glands of the hormonal systems that are affected, or addressing nervous system imbalances or dysfunctions (hot flashes, sleep disturbances and anxiety can all be symptoms reflective of an imbalance here). Sometimes the cause of the hormonal imbalance can be due in whole or in part to unresolved psycho-emotional issues and that may just be the area that needs to be addressed in order to treat the root cause.

THE CONNECTION BETWEEN AUTOIMMUNE DISEASE AND HORMONES

There is also a growing body of evidence that demonstrates a correlation between autoimmune conditions and hormone imbalance. We know that autoimmune conditions are far more prevalent in women than men. Clinical data suggests that women are more likely to be diagnosed with an autoimmune condition (thyroiditis, rheumatoid arthritis, lupus, polymyalgia rheumatica, celiac disease, multiple sclerosis, etc.) at a time when they are going through a hormonal “transition” (puberty, pregnancy, miscarriage, peri-menopause, etc.) as the symptoms become prominent at this time. As the data (along with evidence in my own practice) suggests, there is a causal relationship or a correlation between these findings and treating one aspect often leads to resolution in the other - as long as the root cause is identified and treated in the appropriate manner.

HOW DO I KNOW WHAT IS THE RIGHT APPROACH FOR ME?

Whatever the case, I believe in following naturopathic principles at all times when treating my patients no matter what the reason for the visit: treat the root cause, do no harm and treat the whole person - body, mind and spirit. I also believe in listening to my patient and his/her needs, providing treatment options and educating my patient on the advantages and potential disadvantages to every therapeutic approach. Bio-identical hormones are a natural and advantageous option over synthetic HRT, but that does not necessarily make it safe for everyone.

Anyone considering bio-identical hormones as a therapeutic intervention must be under the care and guidance of a physician who is trained in the use of bio-identical hormones. The appropriate physician should have a special interest and thorough knowledge of endocrinology (hormone balance). You must be carefully monitored and routinely assessed for potential adverse reactions or adjustments that may need to be made to the dosage of your prescription. Remember that “natural” does not necessarily mean “safe” or “appropriate” for you and your individual needs. Seek the guidance of a trained professional and find out what treatment approach is right for you.

Whether you are young or old, male or female, the right physician with the appropriate treatment can help you to stop suffering and start living life to the fullest!

- By Dr. Sharon Gurm BSc, ND