When to take Bioidentical Hormones is a frequent question from my Clients. Does every post-menopausal woman need them? If so, which hormones are good and which to avoid?
First let’s differentiate between Bioidentical Hormones and Synthetic hormones.
Synthetic hormones have been used since the 1960’s. These are hormone “mimics” patented by big Pharma companies. Since they are protected by patents they cannot be naturally occurring hormones.
You cannot patent a natural substance
What are Synthetic Hormones?
Examples of synthetic hormones are Premarin (modified horse estrogen), Provera (synthetic ProgesTIN, not Progesterone) and most birth control products.
The “hormones” they contain FOOL the body into reacting a certain way. As they are foreign, they can create side effects. Synthetic “estrogens” come with a “black box” warning of strokes, heart attacks, blood clots and more but patients are seldom told about this. Or given other options.
Do a web search on your prescription hormones and BC pills. If they contain the exact wording Estrogen, Progesterone, Estriol or Testosterone, they are Bioidentical. If the spelling is off even a little bit they are not natural “human” hormones.
What are Bioidentical Hormones?
Estradiol (E2), Estriol (E3), Progesterone and Testosterone are made to be identical to the exact hormone in our body. Functional Wellness providers feel these have fewer side effects and are more effective at lower doses. They can be purchased in various forms including creams, pills, patches, shots and lozenges. Some are prescription and some are not.
Do ALL Menopausal Women Need Hormone Replacement?
No, absolutely not.
BUT, most doctors, including many Wellness Providers still pressure women to take them.
The theory is that you’ll “age” better, live longer, have more energy, better skin and sex life if you keep your hormones where they were in your 30’s or 40’s.
There are four problems with this.
1). There is a strong bias towards adding Estrogen and Testosterone, omitting Estriol and Progesterone. (More on that in a moment).
2). Not properly testing your current hormone levels or following up to check dose.
3). Women with hysterectomies are told they don’t need Progesterone, just Estrogen. This is very wrong.
4). Almost all ignore the fact (or don’t know) that healthy Adrenal Glands try to make these hormones for you during and after Menopause.
How to Test Your Hormones
Progesterone levels can drop dramatically in pre-menopausal and menopausal women. Especially those under chronic stress.
I often find women age 45 and older don’t have enough Progesterone to balance their Estradiol and Estriol. Using Salivary Hormone Testing on Day 21 of the Cycle, we see what a pre-menopausal woman is experiencing: PMS, Fibroids, swollen breasts, perhaps Endometriosis and more.
Post-menopausal women more than a year without cycles can saliva test on any Day.
The goal is to have balanced levels of all the hormones and in the correct 28 day rhythm. A blood test on a random day is a terrible way for a cycling woman to check functional hormone ratios.
Avoid OTC Progesterone Creams
Unfortunately, many women buy over-the-counter Progesterone cream and use it to excess. This is a BAD idea. You can become toxic with Progesterone. And throw off your ratios of Estrogen to Progesterone even more.
When to Take Bioidentical Hormones
Women experiencing difficult periods or menopause might use Bioidentical Hormones for a time while working with an experienced Functional Wellness coach to restore balance to the Liver, Adrenals, sleep, diet and lifestyle. But I often see well-intentioned docs putting women on WAY more hormones than needed and NOT retesting. And keeping women on them for many years.
How I Test Hormone Levels
I use a Diagnostechs Labs custom 15 item Salivary Test (I offer to clients at my cost). This checks Adrenal Cortisol four times in one day; the three estrogens (E1, E2 and E3), Progesterone; Testosterone; DHEA; Gluten; sIgA (an immune Globulin of the gut and respiratory tract); and Insulin levels before and after eating (Insulin affects hormones).
For women still cycling we test on Day 21 when Progesterone should be at its peak.
Blood work is what most doctors run but frankly I seldom see it as useful. The doc has already decided to put women on Estrogen and Testosterone and maybe Progesterone. The lab ranges are too large to be of much use anyway.
What Forms of Bioidentical Hormones are Best?
I have always preferred sublingual or vaginal.
Sublinguals work but must be expensively compounded. This pharmacy has info on Troches and why they’re better than pills.
Vaginal tabs or creams are easy to use and can be purchased without compounding. Although most doctors WILL have them compounded. This keeps the patient coming back to a doctor to prescribe and monitor. This is useful as too many women will dose too high and won’t know how easy it is to do Saliva Testing on their own and buy Vaginal Ovals with hormones.
Pills are widely available and I personally prefer them to topical lotions. But the Liver will remove much of this and the dose is higher to try to account for how much the Liver will take. It’s a guessing game.
Overall, Pregnenolone capsules can help provide all the Hormones, and Bioidentical Vaginal suppositories are available without prescription. Don’t use them without testing however.
Are Hormone Creams Safe?
Creams are a wild card in my mind. Yes they absorb into the skin, but how much gets into Hormone receptors for any individual woman is not clear. I have seen multiple Salivary tests showing NO appreciable progesterone despite a Client’s use of Progesterone cream for years.
The opposite is true too. A woman applies more and more cream in an effort to stop hot flashes and her hormones become more and more imbalanced.
A compounded cream from a reputable doctor should be safe. Do your own Salivary testing on the side to check your numbers.
What is Estriol?
Estriol is E3, the least known but most important Estrogen for bones and for nurturing the vaginal mucosa. If a Client needs some hormone support while we work on rebuilding the Adrenals to make hormones for us, I usually suggest a vaginal Progesterone tablet, often with E3 in the mix.
The Adrenals Make Bioidentical Hormones
After menopause, the Adrenals are supposed to take over the Ovaries’ job of producing hormones. BUT most of us have tired Adrenals unable to do more work.
This is why the Salivary Test I run includes Cortisol as well as the Female Hormones.
Rebuilding Adrenals is a key element in my work and one I have done for myself. Systemic Formulas Ga – Adrenal is the most important Adrenal rebuilder in my Online Store and Clinic. You can take it for several years and it won’t make you hyper like so-called “energy” formulas.
This Cortex only glandular is the one I prefer rather than whole glandular more commonly sold. (very affordable too). Whole glandular contain some Adrenaline as well as Cortisol. That makes me speedy and not feel right – the classic “tired and wired”.
I greatly prefer to help the body make its own hormones, or to keep the ratios of Estrogen to Progesterone balanced even if they are low. Not every woman needs to have high levels of hormones. Protecting the vaginal mucosa from atrophy is a good idea and small doses of E3 and Progesterone can do that.