Bio Identical Hormones
WHAT IS A BIOIDENTICAL HORMONE?
Bioidentical hormones have the same chemical and molecular structure as those that are produced by the human body as opposed to ‘synthetic’ hormones which are structurally different. Bioidentical hormones therefore fit receptor sites on cells perfectly, like a ‘lock and key’ and the physiological effects are consistent with the normal responses of the body with better tolerance and fewer side effects. They originate from plant sterols derived from mexican yam and soya beans and are therefore natural. The plant sterols are extracted and synthesised into fine powders which are then made into various hormone preparations. Synthetic hormones may bind to other receptors and cause adverse side effects such as weight gain, acne and bloating.
The recommended licenced HRT prescribed on the NHS about 8 years ago was synthetic HRT with oral conjugated equine estrogens (derived from the urine of pregnant mares) and synthetic progesterones or progestins- this was the cocktail used in the Women’s Health Initiative study in 2002 which associated HRT with an increased risk of breast cancer, cardiovascular disease and strokes. Retrospective analysis revealed that the study was poorly designed, the women were postmenopausal, had existing health conditions and synthetic estrogen and synthetic progesterones were used orally. A meta-analysis published in the BMJ (British Medical Journal) in 2008 showed that oral estrogen therapy increased the risk of blood clots 2 to 3-fold compared to transdermal treatment. The French E3N- Epic study in 2005 assessed 55,000 women on HRT and found no increased risk of breast cancer with bioidentical estrogen used alone or combined with oral micronised progesterone (OMP). A follow up in 2008 of over 80,000 women showed the breast cancer risk was highest in the group that took synthetic progestins, followed by estrogen only but there was a ZERO increased risk with transdermal estrogen and OMP.
It took until 2015 for the NICE (National Institute for Health and Care Excellence) to reflect this research about bioidentical hormones and the BMS (British Menopause Society) consensus statement in 2019 was also in agreement that bioidentical hormones are the gold standard. Unfortunately, oral and synthetic forms of HRT are still available on the NHS and being prescribed, contrary to scientific evidence. Regulated bioidentical or bodyidentical HRT is available on the NHS and in other private menopause clinics. Bodyidentical HRT is prescribed in standardised doses but there are limited modes of delivery if treatment is not well tolerated.
The Marion Gluck Clinic is an international leader in bioidentical hormone balancing treatments and collaborates with the Specialist Pharmacy, which is the UK’s first and market leading compounding pharmacy where high-quality hormone medications are made up for each individual client in personalised doses. There is a range of formulations available including transdermal creams, sublingual losenges, sublingual drops, rapid dissolve tablets and vaginal creams so we can find the right formulation for each patient for optimum efficacy and convenience. There are a range of bases available, including hypoallergenic, vegan and PEG free. The Specialist Pharmacy is regulated by the General Pharmaceutical Council.
WHAT DOES A BIOIDENTICAL DOCTOR DO?
A bioidentical hormone doctor uses either standardised bioidentical hormone preparation (body identical or regulated bioidentical HRT) or individualised doses of bioidentical hormones made by a compounding pharmacy (compounded bioidentical HRT). Ideally testosterone and DHEA are included as part of a BHRT protocols. A BHRT initial consultation is 45 to 60 minutes where a detailed assessment is made of your health and concerns by your consultant. Testing is carried out as appropriate via blood tests and cutting-edge functional medicine testing such as the Dutch test. Comprehensive hormone testing includes estradiol, progesterone, testosterone, and DHEA (dihydroepiandosterone) as well as general physical and metabolic health. Once results are available, a personalised treatment plan is formulated and there is a discussion about the specific combination of bioidentical hormones needed to restore health and not a ‘one size fits all’ blanket approach. Continuity of care is guaranteed and followed up occurs in partnership with your trusted consultant. The integrative approach means that other aspects of your health will be addressed. Patients are monitored regularly to see if the hormone formulation needs to be adjusted according to blood tests and symptom checking. Once you are stabilised on treatment, you will be followed up at 6-month intervals.
All the hormones of the endocrine system interact with each other- cortisol, estrogen, progesterone, testosterone, DHEA, thyroid hormones, and insulin in an intricate dance to achieve homeostasis and respond to a changing environment and the integrative approach takes this into consideration and much better physiological balance is achieved.
Bioidentical hormones can help with the following symptoms:
Fatigue and low energy
Joint pains
Hot flushes and night sweats
Insomnia and sleep disturbances
Anxiety and irritability
Mood swings and depressed mood
Low libido
Decreased focus and concentration
Poor cognitive function, memory loss and brain fog
Vaginal dryness and irritation
Erectile dysfunction
Hair loss and skin changes
Conditions that can be helped by achieving hormone balance:
Perimenopause
Menopause
Premenstrual syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Endometriosis
Fibroids
Polycystic ovarian syndrome (PCOS)
Postnatal depression
Adrenal fatigue
Andropause
Long term health benefits:
Prevention of osteoporosis
Prevention of cardiovascular disease
Prevention of neurodegenerative diseases such as Alzheimers Dementia
Reduction in risk of bowel cancer and diabetes
Improvement in quality of life such as energy levels and confidence
Improvement in sexual function
Improvement in metabolism and stability of weight
With any form of hormone treatment, safety is paramount. We endorse regular screening investigations such as mammography, cervical screening, and annual pelvic ultrasounds to check ovarian health and endometrial lining thickness. It is also important to support general health to encourage detoxification of hormones and clearance from the body, for example, estrogen is cleared from the liver, so optimising liver health by keeping weight down and alcohol consumption at sensible limits is key. Nutrition is a vital foundation for good hormonal health as is exercise, good sleep, active relaxation and management of stress, the tenets of lifestyle medicine.
The functional medicine approach sees gut health as central to overall health, metabolic balance, and immunity- it has an impact on all physiological processes including clearance of hormones. Any form of gut imbalance can be the root cause of a multitude of conditions such as thyroid imbalances or estrogen dominance. An imbalance of gut bacteria is called dysbiosis and this can cause the gut lining to become leaky and trigger immune responses and inflammation. We will evaluate gut health and offer functional testing and gut restoration programmes as needed.
The Marion Gluck Clinic continues to provide education and resources to support your hormone health with regular blogs, social media posts and a patient newsletter.
Practitioners:
Dr Ghazala Aziz-Scott, Dr Shashi Prasad