FAQs about HRT and BHRT
Bioidentical hormone replacement therapy can help relieve the symptoms of menopause and perimenopause. In this follow-up to his post about Relieving Menopause Symptoms, Dr. Stracks answers some of the most frequently asked questions about BHRT.
Q: What’s the difference between HRT and BHRT?
A: HRT is a generic term for hormone replacement therapy—the use of hormone therapy for women who are in menopause (meaning, they no longer have menstrual periods) or in perimenopause (meaning, their menstrual periods have started changing). There are many different types and brands of HRT on the market, and new types are still being developed. Bioidentical HRT (BHRT) means that the chemical structure of the hormone being used is the same as the chemical structure of the hormones that are already inside you.
By way of reference, birth control pills (also known as oral contraceptive pills, or OCPs) are actually a form of HRT; they’re synthetic forms of estrogen and progesterone that have been chemically tweaked so that they are patentable by pharmaceutical companies.
I favor BHRT over HRT. If I have the ability to replace a hormone that’s been lowered in menopause with a hormone that’s exactly the same as the one that’s missing, I always prefer to do that rather than use a synthetic form of a hormone, one that’s never entered your body before.
Q: Are bioidentical hormones natural?
A: Technically, yes. As I mentioned above, the advantage of BHRT is that the chemical structure of the hormone being used is exactly the same as the chemical structure of your own hormones. So yes, in this sense, it’s a natural product.
When most people ask this particular question, though, they’re wondering whether bioidentical hormones are made from natural ingredients. BHRTs are actually made in the pharmacy using chemicals and chemical techniques, so they’re not technically natural in that sense, but they’re still safe and effective (see below).
Q: Are bioidentical hormones safe?
A: Yes, absolutely. As I mentioned above, BHRT is done with hormones that are exactly the same as the ones you already have. If I have the ability to do this, to replace something that’s missing with the same substance, I absolutely prefer to do that rather than to use a synthetic version that your body has never seen before.
Q: Is HRT safe in general?
A: Yes, clearly. To give you some of the back story, up until the year 2002, HRT was considered the standard of care when women entered menopause. That year, results from the Women’s Health Initiative (WHI) were published that showed that women taking HRT were more likely to have invasive breast cancer and cardiovascular events.¹ The trial was ended, and most women taking HRT stopped doing so. It appeared at that point that HRT was too dangerous to use.
The WHI data has been continuously analyzed since then, however, and over time the danger that was posited in that 2002 paper now appears to be overstated. The cardiovascular effects were seen only in women who started HRT 10 or more years away from their last menstrual period or women who were using artificial (non-BHRT) forms of progesterone. Additionally, the risk of breast cancer with hormones has also been shown to be much lower than initially thought in 2002.²
The newer data paints a much different picture than the alarm raised in 2002. For those who are 10+ years from their last menstrual period, HRT conveys serious risk that must be discussed before starting therapy. For everyone else, while there is always some risk in using any medication, the overall risk of HRT is low.
Q: Does BHRT work?
A: BHRT does work well. Studies over time have looked both at whether BHRT is useful for managing symptoms of menopause and also at whether BHRT makes women healthier. Though the data on overall health is inconsistent, the evidence is quite substantial that BHRT works to lessen hot flashes, night sweats, fatigue, achiness, brain fog, slow metabolism, and low libido.³
Q: What’s the role of testing in using BHRT?
A: My philosophy is this: if a woman is not having menstrual periods and is having symptoms of menopause (e.g., hot flashes, night sweats, brain fog, fatigue, joint aches, slow metabolism, low libido, insomnia, and so on), then I know that her levels are low, and I don’t need a test to show that and can safely prescribe BHRT to get started.
Over time, I get about 90% of my information about how the hormones are working from the information my patients tell me about how they’re doing; about 10% of the information comes from lab work.
Additionally, I use blood work primarily to make sure the levels of hormones are not getting too high. If I really want to know precise levels, I’ll use a saliva hormone test, usually from the company ZRT. The saliva hormone levels can help us immensely when there are conflicting signals about whether hormones are too high or too low or in complicated situations where symptoms remain despite multiple attempts at changing doses.
Q: Which type of HRT should I use, HRT or BHRT?
A: At Cormendi Health, 99% of the time we use BRHT for patients who are using HRT. BHRT can include combinations of creams, patches, pills, and sublingual troches. Your particular regimen will be individualized for you, taking into account your symptoms, your health history, and your preferences.
Q: How do I use BHRT creams?
A: Creams are normally used daily and are applied to areas of the body including thighs, back, buttock, abdomen, or arm. The creams are meant to be rubbed in for 30-60 seconds, leaving a thin layer on the skin that is then absorbed gradually over the course of the next hour. As long as the cream is under clothing and your hands are washed well, it is ok to be around and touch family members including your partner and your children.
Q: Can I use pellets instead?
A: We do not use pellets at Cormendi Health but do understand that those are desired by some patients. If you are looking to use pellets, we can refer you to other providers.
Q: How quickly will I see relief?
A: Everyone is an individual, so individual results will vary. At Cormendi Health, our goal is clearly to get you relief as quickly as possible. That said, medical care is a process; there are times where the process can be slower and several months can go by before significant relief is seen.
Rest assured that we will do everything in our power to move quickly. We know how important your health is to you and how important it is to feel like yourself once again.
If you’ve been experiencing hot flashes, night sweats, low libido, brain fog, or other symptoms of menopause, Cormendi Health can help. Click here to schedule an appointment with Dr. Stracks to find out whether BHRT can help you.
¹ Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. (July 2002). "Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial". JAMA. 288 (3): 321-333. doi:10.1001/jama288.3.321.PMID 12117397.
² Chlebowski RT, Rohan TE, Manson JE, Aragaki AK, Kaunitz A, Stefanick ML, et al. (June 2015). "Breast Cancer After Use of Estrogen Plus Progestin and Estrogen Alone: Analyses of Data From 2 Women's Health Initiative Randomized Clinical Trials". JAMA Oncology. 1 (3): 296-305. doi: 10.1001/jamaoncol.2015.0494. PMC 6871651. PMID 26181174.
³ Gaudard, Ana Maria IS; Silva de Souza, Sulani; Puga, Maria ES; Marjoribanks, Jane; da silva, Edina MK; Torloni, Maria R. “Bioidentical hormones for women with vasomotor symptoms.” Version published: 01 August 2016. doi.org/10/1002/14651858.CO010407.pub2.