HRT is all over the headlines; "bioidentical" is the latest buzzword used by public figures-many of whom have no medical training. Get the facts from a gynecologist who wrote the book on understanding hormones.
The best way to understand Bioidentical Hormones is to simply take away the term "bioidentical." Don't get me wrong, I love the term...it is descriptive, positive, and sounds very--"healthy." The problem is that while it is meant to describe a hormone that is molecularly identical to human hormones, it (the word bioidentical), is a distraction from the clarity of facts that women (and men) must have to understand hormonal aging and what options, benefits and risks are out there for those who need help.
The first rule of understanding HRT is: Menopause is not a disease.
Unlike a low acting thyroid, or a failing adrenal gland, as human women our ovaries are programmed to retire. The most likely reason that this retirement is remote from our life expectancy is that (unlike most other mammals) our young have an incredibly long latency period...it takes longer to raise our offspring to maturity than any other known species. In order for us not to simply reproduce and slither off to die (like some cold blooded creatures presumed to be less evolved), our reproductive capacity must be "turned off," some 13-20 years before we are likely to die. We are the only species who are not pleased that our reproductive vitality becomes "off duty." It's no wonder we are less than thrilled with ovarian decline when we look at some of the changes our sex hormones bring to us as teens and tweens:
Positive Changes our Bodies undergo with Puberty that Peak in the Mid Twenties, (greatly enhanced by estrogen and testosterone):
* Height maximizes
* Breasts develop
* The waistline is carved out
* Hair is stimulated to be thicker, longer, and more full
* Skin becomes more elastic, especially in the genital area
* Collagen and bone density peak
* Muscle mass increases
* Metabolism becomes more efficient
* Libido evolves and peaks
* Verbal memory is enhanced
* Sleep is hormonally supported
Now think of these changes in reverse (as with menopause):
* Loss of height
* Breasts deflate (or worse, get enormous)
* Waist disappears
* Hair thins, grays, or falls out
* Skin thins
* Collagen declines, bones begin to thin
* Muscle mass declines
* Metabolism slows
* Libido falls
* Verbal memory declines
* Sleep quality lessens
The bottom line is: The signals that we are fertile become less distinct, and what our human eyes see as attractive and feminine is clearly tied to what is fertile.
But what about those parts of the cycle that no menopausal woman misses?
Most of us are relieved to no longer have a period, or PMS. The second half (the days after ovulation) of the hormonal cycle-- the progesterone dominant days are usually not missed by most, in fact, menopausal zest described by many women can be a welcomed relief from the part of the cycle intended to nurture a pregnancy, or the hormonal resetting time of the period itself. In fact there are many women happy to resign from the hormone associated duties that maintain an active sex life facilitated by their brain's vitality and that of the adrenal glands (which also secrete a decent amount of sex hormones).
But just as many women have banked on the effects of their reproductive hormones, assuming the positive effects were their own, not to abruptly dwindle or retire. Their relationships, their jobs, their hobbies, even their personal identity is often tied to the seemingly fleeting feminine aesthetic. What are their choices and what does "bioidentical" mean to them?
The bottom line is that reproductive vitality has benefits and risks. Since a woman's own estrogen, progesterone, and testosterone have risks, so does any hormone that works with the same receptors...in fact, the more bioidentical, the more it will work as a "human" hormone.
What are the risks? There are several, but the major problems are:
* Estrogen increases the ability of blood to clot (an adaptation that was meant to be helpful to our species), and in the absence of progesterone, thickens the lining of the uterus.
* Progesterone increases insulin resistance (the hormone's goal is to elevate blood sugar for the fetus; the result is an increase in heart disease, diabetes, and possibly some cancers).
* Testosterone can be converted to estrogen
For the positive effects of these hormones, see the above (long) list associated with puberty until the mid twenties.
After the famous Women's Health Initiative revealed some of the lesser understood risks with HRT, many women abruptly stopped their hormonal therapy. However, renewed hot flashes, insomnia, osteopenia, changes in libido and other symptoms have caused many to look at options again and "bioidentical" makes HRT sound new and different...and seemingly safer. Negotiation with nature is not always a bad thing, but every negotiator needs to know the terms, and needs to keep up with the terms if they change. There is ongoing research that may change the pendulum swing every day.
Let's use my favorite analogy; hormones are like fertilizer in a garden. If your garden has weeds, especially if they are out of control (poor health, smoking, hormone related cancer, high risk of heart disease, and others) it is not wise to fertilize. While the fertilizer itself can be toxic if it is not balanced, if too much is used, if it is poor quality, etc., most gardeners do use it. It can help cultivate the more desirable plants, it can help strengthen hybrid plants and improve their health.
If you feel that you may benefit from hormone replacement therapy your doctor will be happy to discuss it with you and there are several "bioidentical" options for her, or him to prescribe, if you opt to accept the risks with the benefits. In the meantime do your best to cultivate the garden that is your body and fertilizer or not; it will flourish.