Bio-Identical Hormone Therapy: Benefits, misconceptions, and everything in-between

      Over the past few years, I have seen an increasing number of patients who are curious about how hormonal fluctuations might be impacting their mood, sleep, energy, menstrual cycles, sex drive, and memory. These conversations are important, empowering, and I’m glad that we’re finally discussing the way hormones affect us during every stage of life.

Patients are often under the impression that hormones are only significant during peri-menopause; when accompanied by hot flashes, night sweats, and irregular periods. This is only a small piece of the puzzle.

Hormones surge as we approach ovulation, making us feel more energetic, experience a higher sex drive, sharper cognitive focus, and better mood. After we ovulate, progesterone is secreted by the follicle (egg), and we continue to experience better mood, sleep, and a general pep-in-our-step. If the follicle is not fertilized, it degrades, causing progesterone and estrogen to decline. This is why the days (or week) leading up to menstruation tend to be more challenging and uncomfortable.

As we age, our follicles age with us, so they don’t produce as much progesterone as they did when we were in our teens and twenties (sorry… c’est la vie!). Low progesterone can cause low mood, irritability, heavier periods, more painful periods, low sex drive, migraines, fatigue, and/or brain fog. Patients often describe this as, “I just don’t feel like myself”.

De-Mystifying Bio-identical Hormones

     Bio-identical hormones have the same molecular structure as the hormones that are naturally produced in the human body. Examples include estradiol (the predominant form of estrogen), estriol (pre-menopausal form of estrogen that promotes vaginal elasticity), and micronized progesterone (commercial name: Prometrium).

In the past, synthetic (not bio-identical) hormone replacement therapy was prescribed before high-quality, long-term research was available. Studies have since found that estrogen hormone therapy increases the risk of blood clots and certain cancers, but taking progesterone with estrogen significantly reduces these risks. We have also learned that bio-identical progesterone is safer, more effective, and has fewer side-effects than progestin (the synthetic, non-bioidentical form of progesterone).

All that to say, current bio-identical hormone therapy options are well-researched, safe when prescribed correctly, and extremely effective when used appropriately.

What you need to know about BHRT

     I prescribe bio-identical progesterone for insomnia, low mood, irritability, apathy, migraines, heavy or painful periods, irregular cycles, and brain fog. It is safe, and consistently effective for treating hormone-related mood, sleep, and menstrual symptoms.

If needed, I prescribe estradiol (topical cream or patches) for hot flashes and/or night sweats with progesterone, or I prescribe estriol (vaginal gel) for vaginal dryness/pain on intercourse.

Do not use estrogen (Bi-Est, Estradiol cream, Prevegyne) without also taking progesterone, unless you have had a hysterectomy. Taking/applying estrogen without progesterone significantly increases the risk of cancer.

The Importance of an Individualized Approach

     A comprehensive approach to hormonal wellness may include reviewing your symptoms and health history, evaluating relevant lifestyle factors, and considering laboratory testing when clinically appropriate. Hormone testing is not always necessary to identify typical perimenopausal or menopausal changes, and results must be interpreted in the context of symptoms and life stage.

It is also important to understand that fatigue, low mood, changes in weight, and difficulty concentrating are not necessarily caused by hormone imbalances. Looking at the bigger picture can help identify other potential contributors and guide appropriate care.

My goal is to continue to encourage conversations about hormones, how to safely use bio-identical hormone replacement therapy, and how BHRT can support our health in a positive way.

Whether you are curious about bio-identical hormone therapy, looking for answers to unexplained symptoms, would like to order lab testing, or interested in taking a proactive approach to your health, understanding your options is an important first step.

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