The Use and Safety of Bioidentical Hormones
In the past year, Naturopathic doctors have been given the rights to prescribe bioidentical hormones, specifically estrogen and progesterone creams or suppositories, and natural desiccated thyroid. What this means is that we are able to treat patients with more complicated hormonal conditions more effectively.
My approach is always to first start with nutrition, digestive health (absolutely key for hormone detox!), stress reduction and exercise. The next step is herbs to balance hormones and support peripheral hormonal systems (adrenal, thyroid, blood sugar regulation). As a final step, we now have the ability to add natural bioidentical hormones, which when used appropriately and with adequate monitoring are extremely safe.
What are bioidentical hormones?
Bioidentical are exact molecular structure of hormones your body produces, and they behave in an identical way at the receptor. They can be prescribed at a dosage that is precicely what your body needs to maintain normal physiological levels.
Are bioidentical hormones safe?
This is always the first question asked about hormone use, and one that i take very seriously. In a thorough review of medical literature, the answer appears to be yes.
According to a large French study in 2008, the use of estrogen along with progesterone, is not associated with the development of breast cancer. (On the other hand, using estrogen alone or estrogen with synthetic progestin does increase the risk.)(1)
In fact, the use of human identical progesterone has actually been shown to slow the growth of estrogen-receptor and progesterone-receptor positive breast cancers. Furthermore, low progesterone levels alone appear to be associated with the development of breast cancer (2). John Hopkin’s University Medical School followed 1000 women who were treated for infertility over 20 years. They divided women into two groups: 1) Infertility associated with deficiency of progesterone; and 2) Women with normal progesterone levels. The results were that in the progesterone deficient group, there was a 5.4 fold increased risk of premenopausal breast cancer, and a 10 fold higher rate of death from cancer of all kinds(3). Optimizing progesterone levels appears to be an important step in cancer prevention.
Specific conditions that can be treated with bioidentical hormones:
Progesterone levels are very commonly low during perimenopause, while estrogen levels remain high, creating a strong estrogen dominant state with heavy, difficult and somewhat irregular periods. Progesterone cream is used to improve sleep quality, reduce menstrual flow, regulate menstruation. If needed, a small amount of balanced estradiol/estriol (‘biest’) cream can be used to slightly increase estrogen levels, in addition to the continuation of progesterone cream.
In cases of hot flashes, difficulty focusing, mood swings and other menopausal symptoms, we begin only with bioidentical progesterone cream. In many cases progesterone alone is enough to greatly reduce hot flash intensity and frequency. Hot flashes are known as a vasomotor symptom, meaning it is not all about estrogen levels – supporting the adrenal glands, reducing stress and providing progesterone will often work even better.
With endometriosis, bioidentical progesterone cream can provide an alternative to progestin-only oral contraceptives which are commonly recommended to women with this condition. Many women find the side-effects with bioidential progesterone to be significantly less than a synthetic progestin, and equally effective at managing their difficult periods. Since endometriosis is an estrogen-dominant condition, the addition of extra progesterone, along with nutritional and herbal support to help with estrogen detoxification is a safe and more natural approach to managing pain and inflammation.
Polycystic ovarian syndrome
While working on lowering insulin resistance through diet, hormone treatment specifically progesterone, can be used to restore regular menstruation and prevent thickening of the endometrium which can be associated with endometrial cancer. By reducing estrogen dominance cysts on the ovaries will be reduced over time and symptoms of high androgens, such as acne may improve.
Many cases of difficult premenstrual syndrome can be treated with a steady dose of bioidentical progesterone cream in the second half (luteal phase) of the menstrual cycle. Symptoms such as mood swings, depression, anxiety and sleeplessness tend to improve the most with progesterone use. Dosage is tailored individually to achieve levels in an optimal hormone range.
Progesterone support for fertility and miscarriage prevention:
In cases of low progesterone, bioidentical progesterone cream can be a useful tool to support fertility and also reduce the risk of miscarriage. It can be safely continued through the first trimester of pregnancy.
Vaginal dryness is a condition that is quite simply treated with a topical estriol cream (the weakest, safest estrogen), and a low dose of progesterone. Progesterone is added based on studies showing that estrogen of any type use alone can increase cancer risk.
The use of desiccated thyroid as an alternative to Synthroid or Eltroxin is an option for patients who are not feeling optimally on their medications containing only the T4 hormone. Desiccated thyroid contains both T4 and T3 which in many cases will clear up any remaining hypothyroid symptoms such as fatigue, difficulty losing weight, hair loss, poor temperature regulation, dry skin and nails. Support for thyroid may also include nutrients such as iodine and selenium, and herbs to optimize thyroid function and lower anti-thyroid antibodies.
1. Fournier A, Berrino F, Clavel-Chapelon. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1): 103-111.
2. Mohammed H, Russell A, Stark R et al. Progesterone receptor modulates Era action in breast cancer. Nature 2015. doi:10.1038/nature 14583.
3. Cowan LD, Gordis JA, Tonascia JA, Jones GS. Breast cancer incidence in women with a history of progesterone deficiency. J Epidemiol. 1981;114:209-217.