Benefits And Risks of BHRT
What are the potential benefits of Bio-identical Hormone Replacement Therapy (BHRT)?
Symptoms of hormone imbalances that BHRT may help include: hot flashes, night sweats, loss of libido, vaginal dryness, urinary problems including incontinence, gynecomastia ( male breasts), loss of morning erections or erectile dysfunction, PMS, painful periods, irregular periods, fertility issues, endometriosis, fibroids, ovarian cysts, abnormal hair growth, thyroid dysfunction, fatigue, sleep problems, mood swings, depression, memory loss, anxiety, decreased muscle tone, increased belly fat, weight gain, hair loss, , change in odor, dizziness, bloating/swelling, allergies, brittle nails, irritability, panic disorder, breast pain, joint pain, headaches, loss of concentration, itchy skin, digestive problems, irregular heart beat and osteoporosis.
What are the potential risks or side effects of Bio-identical Hormone Replacement ( BHRT)?
Because all hormones interact with others, it is important in an effective hormone program to monitor not only the hormones prescribed but also other hormones that may be affected due to the hormone support. Side-effects are often related to the need to adjust your current hormone levels and are often minimal and manageable when restoring hormones to physiological levels (levels your body has seen before). Some patients report breast tenderness or swollen joints when first starting bio-identical hormone replacement therapy; these and other adverse reactions can be remedied by reducing the dosage until symptoms resolve, then gradually resuming. To make HIHS or BHRT safe and effective we at Skintology Health and Wellness Centre focus on:
- Customization with optimal dosing and adjustments accordingly
- Use of the hormone in the safest route
- Correction of other imbalances associated with hormones
- Proper follow up visits with lab testing
- Ongoing communication between you and hormone doctor
What about the risk of cancer?
When proper evaluation, prescription and monitoring are put in place, there are ways to use hormone support to be cancer protective. Research shows that human identical or bio-identical progesterone (synthetic progesterone ie. progestins) has a cancer protective effect.1 Estrogen is an important hormone, however in the improper form and or in excess, when not balanced with progesterone, will increase cancer risk. If you have had cancer, have cancer or a family history, time will be taken to review the benefits and risks in your individual case. Proper hormone management also includes preventive testing. For women testing includes but is not limited to: estrogen, progesterone, testosterone, LH, FSH, Prolactin, DHEA, Thyroid Indices, PAP tests, mammograms, BMD and pelvic ultrasounds. While for men testing includes but is not limited to: testosterone, DHT, DHEA, Thyroid indices and PSA levels for men.
What does the latest research say?
Hormone therapy has gone through an evolution of approaches, which has left many confused, including doctors. For decades hormones were prescribed to women for menopausal symptoms. The hormones initially used were synthetic versions. In 2002 The “landmark” Women’s Health Initiative (WHI) study was published, showing that when the synthetic hormones Premarin (conjugated equine estrogen) and Provera (progestin) were used there was an unacceptably high risk of breast cancer, cardiovascular disease including blood clots and stroke. Thus, the study was halted 3 years early and everyone was told that hormones were dangerous. However, when we re-analyze the data in detail, what the results of the WHI indicate is that synthetic oral forms ( vs transdermal) forms of hormone replacement therapy (HRT) did seem to pose a risk. However the limitations of the study were that the women were older ie average age 63 and 10+ years post-menopausal where there would already be a significant increase risk of breast cancer, cardiovascular disease and stroke, and only synthetic versions were used. Thus the results of the WHI are not transferable to bio-identical hormone replacement therapies ( BHRT) or to younger healthier women.
- In 2007 The Mayo Clinic Cohort Study of Oophorectomy and Aging ( MCSO) was run and the results showed that estrogen protects brain function and the earlier you begin estrogen support the greater the reduced risk of dementia is in women who have lower levels of estrogen, in this case due to the removal of ovaries.1 This was supported by other studies and called the timing hypothesis.2,3
- The Kronos Early Estrogen Prevention Study ( KEEPS) was published in 2012, was a 4 year randomized trial that used low dose oral Premarin (conjugated equine estrogen), transdermal estradiol and Prometrium (bio-identical progesterone) . This study was significant because it was run with lower doses of estrogen, younger ( ie average age 52) and healthier women vs the WHI. The results showed a neutral blood pressure and favorable impact on cardiovascular health markers HDL, decreased LDL and increased TG. In addition when a transdermal ( topical form) estradiol was used, there was the benefit of improved blood sugar levels. Thus the KEEPS showed many favourable effects of hormone therapy (improved hot flashes, night sweats, depression, libido , and bone density) in newly menopausal women and did not show any adverse effects such as breast cancer, endometrial cancer, myocardial infarction, or stroke. It is important to keep in mind that this study was only run over 4 years and included younger women.
- The BMJ- Danish study was a 16 year study run with 1006 healthy women with an average age of 50. In the 10 years of randomized treatment women who received hormone therapy (bio-identical estrogen and progestin) there was a significant reduction in mortality, heart failure, myocardial infarction, and there was no increased risk of cancer, blood clots or stroke.
More research is needed to assess human identical hormones or bio-identical hormones, the method of use, it’s benefits or risks and the impact of its use on different age categories. At this time what we know is that HRT do pose a risk of breast cancer, cardiovascular disease and stroke when introduced to an older age population. When bio-identical hormones are used on a younger population we see that there is not an increased risk of breast cancer, blood clots or heart disease. Hormone therapy when used earlier after menopause can significantly reduce the risk of mortality, heart failure, and myocardial infarction. In addition, hormone therapy can help hot flashes, night sweats, osteoporosis, libido, memory, cognition, bone density and overall wellness.
1. Harman SM, Brinton EA, Cedars M, Lobo R, Manson JE, Merriam GR, Miller VM, Naftolin F, Santoro N., KEEPS: The Kronos Early Estrogen Prevention Study, Climacteric, 2005 Mar,8(1):3-12,PMID:15804727
2. Rocca et al., Molecular and Cellular Endocrinology, 2014
3. 2007 The Mayo Clinic Cohort Study of Oophorectomy and Aging (MCSO)