MENOPAUSE AND BIOIDENTICAL HORMONES
Menopause And Bioidentical Hormones
Menopause is anormal physiological event associated with an age-related reduction in hormonal secretion from the ovaries, menopausal symptoms and signs affect about 80% of women,20% of them severely.
The climacteric symptomology can produce:
Central nervous system:
•• Vasomotor symptoms (hot flushes, night sweats)
•• Mood disturbances (anxiety, depression)
•• Cognitive function (memory loss, cognitive difficulties)
•• Sleep disturbances (delayed onset, frequent wakenings)
•• Vulvovaginal atrophy, dyspareunia
•• Sexual dysfunction
•• Urgency, stress incontinence
•• Urinary frequency
•• Joint/muscle pain
•• Loss of muscle mass (sarcopenia)
•• Loss of bone mass (osteopenia, increased risk for
This Symptoms can negatively impact a woman´s well-being and health expectancy, HRT is indicated.
Traditional HRT refers to replacement of hormones with synthetic and semisynthetic hormones, such as the marketed progestins, are completely synthetic; others, such as conjugated equine estrogen, are semisynthetic and derived from animal sources.
Bioidentical hormones are derived from plant sources and are termed bioidentical because is claimed that they are structurally identical to endogenous hormones, not jus human hormone receptor binders. BHRT is sometimes referred to as natural hormone replacement therapy. Like synthetic and semisynthetic hormones, bioidentical hormones are derived in a laboratory, not harvested from endogenous sources.
Hormone Replacement Therapy (HRT) Goals
Prevention for Alzheimer disease; Osteoporosis; Heart disease; colon cancer and vaginal atrophy. (This is very controversial on some points but there is scientific evidence for each of the points mentioned).
Why is the “idea” of preferring Bioidentical Hormones instead of Synthetic or semi-synthetic Hormones?
Women´s Health Initiative (WHI);
Was initiated by the U.S.
National Institutes of Health (NIH) in 1991. The Women's Health Initiative (WHI), sponsored by the National Heart, Lung, and Blood Institute (NHLBI), is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer, and osteoporosis in postmenopausal women. These chronic diseases are the major causes of death, disability, and frailty in older women of all races and socioeconomic backgrounds.
In July 2002, the principal results of the WHI trial were published in the magazine JAMA. From 1993 to 1998, 161,809 postmenopausal women aged 50 to 79 years had been enrolled in a set of clinical trials designed to investigate the use of HRT to prevent hearth disease, breast cancer, colorectal cancer, and fractures in postmenopausal women. On May 31, 2002, at a mean follow -up of 5.2 years of the trial was stopped early, because the rate of invasive breast cancer among the participants in the HRT arm exceeded the stopping boundary. When the trial was stopped, the global index statistic was 1.36, indicating that continuation of therapy would result in more risks than benefits.
Interest in Bioidentical Hormones appears to have increased since 2002 when the trial was stopped. Estriol, specifically, is believed by bioidentical hormone to decrease breast cancer risk.
The Endocrine Society has defined Bioidentical Hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body” (Endocrine Society. Bioidentical hormones: position statement. 2006.)
The term bioidentical is a pseudoscientific neologism that refers to endogenous hormones, including estriol, estrone, estradiol, progesterone, testosterone; DHEA, thyroxine, and cortisol. Natural alludes to the fact that these are native human hormones. In fact, these hormones are synthesized or semi synthesized. Extracted from soybeans (glycine max) and diosgenin wild yam (dioscorea villosa).
Many bioidentical hormone products that require a prescription are prepared by compounding pharmacies. Compounding pharmacies use commercially available drugs to create formulations that are not commercially available.
Menopause Hormone Therapy still remains a dominant therapeutic modality in climacteric medicine. The core medical skill is the ability to choose the optimal HRT depending on for the given patient. Such choice is base on an understanding of various clinicl and metabolic effect of HRT depending on the composition, dosage, medical antecedents, age, and the method of application.
Compounded bioidentical hormones are made by a compounding pharmacist from a health care provider’s prescription and are available in various routes of administration, including oral, sublingual, and percutaneous or as implants, injectables, and transdermal creams.
You can choose the method you like best; But, it is believed that the treatment with "subcutaneous implants" or "Pellets" is better (this name is because they resemble small pearls).