What are Bioidentical Hormones?

The three types of hormones typically prescribed for bioidentical HRT are estradiol and estriol, progesterone, and androgens. The precise components of each woman’s therapy need to be determined after physical examination, medical history, and laboratory testing typically not performed by traditional medicine. Close monitoring is essential to ensure that appropriate dosage adjustments are made.

Estrogens
“Estrogen” is a catch-all term that encompasses a group or related hormones, each with a unique profile of activity. When estrogens are working properly under normal circumstances, a woman’s circulating estrogen levels fluctuate based on her menstrual cycle. For compounded bioidentical hormone replacement (CBHRT), these hormones are prescribed to re-establish a normal physiologic balance whether it is due to menopause or PMS in younger women.

The three main estrogens in the female body are:

• Estrone – E1 (10-20 % of circulating estrogens) is the dominant estrogen produced after menopause.
• Estradiol – E2 (10-30% of circulating estrogens) is the most potent estrogen secreted by the ovaries and the main estrogen produced before menopause.
• Estriol – E3 – (60-80 % of circulating estrogens) is the least potent estrogen produced before menopause.

Know the differences between Estrone, Estradiol and Estriol for your health, including breast cancer!
After menopause, the ovaries produce very little estradiol, and the body compensates for this loss by producing more estrone from mostly abdominal fat and sometimes the liver. The problem with estroneis that it can metabolize to healthy 2-hydroxyestrone or unhealthy 16-hydroxyestrone. If it converts to 2-hydroxyestrone that’s great as it protects women against cardiovascular disease and cancer, but oftentimes it converts to 16-hydroxyestrone which can increase a woman’s risk of these adverse diseases.

Estrone can be forced to convert to the healthy 2-hydroxyestrone with certain supplements, diet and balancing hormones with CBHRT. Estriol also decreases significantly after menopause. Estriol is believed to be protective against breast cancer. It also causes little to no build-up of the endometrium (uterine lining), and is very effective in treating vaginal dryness, urinary symptoms, vaginal infections, painful intercourse and various conditions of the urinary tract.

Estriol levels are produced in large amounts in pregnancy and may be protective against breast cancer. High estriol levels are found in vegetarians and Asian women, who have a much lower incidence of breast cancer. Estradiol is the effective estrogen and is protective against osteoporosis, colon cancer, dementia and heart disease. So, estradiol and estriol are the estrogens that need replacing, while controlling estrone and preventing the conversion of estrone to 2-hydroxyestrone.

Symptoms of Estrogen Deficiency:

• Hot flashes
• Night sweats
• Fatigue
• Poor memory
• Foggy thinking
• Depressed mood
• Low energy
• Decreased concentration
• Decreased sex desire or libido
• Vaginal dryness
• Excessive daytime sleepiness
• Stress incontinence
• Urinary tract infections
• Osteoporosis
• Cardiovascular disease
• Dementia

Symptoms of Estrogen Dominance:

• Agitation
• Anxiety
• Weight gain
• Water retention
• Headaches
• Swollen or tender breasts
• Bloating
• Spotting or breakthrough bleeding
• Achy joints
• Excessive bleeding

Does topical Bioidentical Estradiol and Estriol increase your risk of breast cancer and cardiovascular disease?

The answer is no, no and no!!! There is no research linking bioidentical estradiol or estriol to breast cancer or heart disease. You will not be prescribed estrone.

Influence of oral Estrogen versus topical on Estrogen metabolism:

Oral estrogen, including estradiol and estriol, tend to convert to estrone via the liver which is what we don’t prescribe any type of oral estrogens. Remember, estrone is already produced more in menopausal women and as stated previously, can metabolize to the unwanted 16-hydroxyestrone. Oral Premarin and Prempro include estrone and other horse estrogens which are not bioidentical. Compared to transdermal estrogen, oral estrogens are also associated with a reduction in lean body mass and an increase in fat mass. Topical bioidentical Bi-est (two estrogens; estradiol and estriol) bypass the gastrointestinal tract and liver, so they are not converted to estrone.

Progesterone:

• Required during pregnancy to maintain the uterine lining.
• Prepares the breasts for lactation
• Stimulates osteoblast mediated new bone formation (increases bone mass and density)
• Protects against endometrial hyperplasia (from too much estrogen) which can lead to uterine cancer

Progesterone is a term used interchangeably, and incorrectly, to describe both natural bioidentical progesterone and synthetic progestins. Prescription synthetic progestins are not progesterone. Synthetic progestins block progesterone receptors and therefore do not act in the same way as bioidentical progesterone. Synthetic progestins have been shown in a large study to cause significant lowering of HDL, the “good” cholesterol, thereby decreasing the cardiovascular protective benefits of estrogen therapy. Natural bioidentical progesterone has never been shown to have any serious side effects. On the other hand, synthetic progestins can have significant and serious side effects at typical doses, including headaches, migraine, mood swings, weight gain, depression, acne, depression, menstrual irregularities and fluid retention. These side effects are a common reason for discontinuation of hormone replacement therapy (HRT). Only about 20 % of women continue synthetic HRT beyond 2 years of treatment.

Symptoms of Progesterone Deficiency:

• Insomnia
• Anxiety
• Agitation
• Irritability
• Anger
• Aggressiveness
• Weight gain
• Water retention
• Bloating
• Headache
• Achy joints
• Swollen or tender breasts
• Spotting or breakthrough bleeding
• Mood Swings

Benefits of Bioidentical Progesterone:

• Counteracts “estrogen dominance”
• Prevention of endometrial cancer in women using estrogen replacement therapy
• Builds bone density (so women who have had a hysterectomy still need progesterone)
• Promotes glucose utilization
• Improves sleep
• Improves libido

Route of Progesterone Administration
Oral or topical routes are acceptable forms of progesterone HRT. However, oral progesterone may work better for those with insomnia.

Androgens (Testosterone and DHEA)

• Enhance libido
• Enhance bone building
• Provide cardiovascular protection (lower cholesterol)
• Improve energy and mental alertness

Androgens are hormones important to the integrity of skin, muscle and bone in both males and females, and have an important role in maintaining libido.

Benefits of Androgen Therapy Offer Protection Against:

• Osteoporosis
• Loss of immune function
• Obesity
• Diabetes mellitus