Female Hormone Replacement Therapy Johnson City TN

Bioidentical Hormone Replacement Therapy (BHRT) has reached national awareness just recently. Until 2002 mainstream physicians routinely prescribed conventional hormone replacement therapy (HRT), not Bioidentical Hormones replacement therapy (BHRT).

Conventional HRT was practiced to alleviate menopausal symptoms in women, such as hot flashes, mood swings, decreased sexual desire, vaginal dryness, and difficulty sleeping. Conventional HRT was also prescribed to prevent heart disease and osteoporosis.

In 2002 more than 160,000 women participated in the Women’s Health Initiative (WHI), the results of this landmark study identified grave dangers associated with conventional hormone replacement therapy in women.

This conventional HRT therapy caused dangerous consequences:.

• A 26% increased risk of breast cancer,
• A 29% increased risk of heart attack,
• A 41% increase in risk for strokes,
• And a doubling in risk for blood clots relative to the untreated group.
• Moreover, women receiving conjugated equine (horse-derived) estrogen experienced a six-fold increased risk for uterine cancer.

Women’s trust in the mainstream medical establishment declined significantly as a result of these serious risks of conventional HRT. Many women began to seek natural alternatives to hormone replacement (Roumie 2004; Schonberg 2005). This Data from the study forced many physicians to discourage the use of conventional HRT for the prevention of osteoporosis and cardiovascular disease in aging women (Sharma 2003, Azoulay 2004). These findings did not affect Bioidentical Hormone Replacement Therapy (BHRT).

Though many mainstream physicians were shocked by the results of the WHI study, Functional and Integrative wholistic physicians were not. The hormones utilized in the WHI study consisted of oral equine (horse) estrogen and a synthetic progestogen. Synthetic hormones chemical structure differs from the structure of hormones naturally produced by women’s body. Functional and Integrative wholistic physicians have discouraged the use of conventional HRT for many years and instead appreciated the value of Bioidentical Hormones.

Bioidentical hormones therapy BHRT is associated with far fewer side effects than conventional HRT and there is intriguing evidence that it may reduce the risk of certain cancers (Holtorf 2009).

The difference between Conventional Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT)

As women age their sex hormone levels decline. Traditional physician thought that HRT replacement will reverse menopausal symptoms. Menopausal symptoms include increased risk of heart attack and cancer (Wren 2009; Lenfant 2010; Lee 2010). The original understanding of menopause and the logic of HRT may be theoretically correct, however women hormonal symphony is far more complex.

Bioidentical Hormone Replacement Therapy doctors recognize that the hormonal symphony is a tightly regulated masterpiece. All steroid hormones are created from cholesterol in a hormonal cascade. The first in the cascade is pregnenolone, which is subsequently converted into other hormones, including dehydroepiandrosterone (DHEA), progesterone, testosterone, and the various forms of estrogen. These hormones are interrelated, yet each performs unique physiological functions. Biologically sound hormone replacement should focus on a woman’s total hormone balance, and not only on estrogen and progesterone.

Conventional HRT makes use of non-bioidentical hormones that differ chemically from those naturally produced by a woman’s body.

Conjugated equine estrogen (CEE) is obtained from the urine of pregnant mares (horses) (Bhavnani 2003). CEE is usually given in combination with progestin, a synthetic progesterone. These structural differences between conventional HRT: conjugated equine estrogens, chemical progestins, and the Natural hormones produced by women’s bodies explain the adverse affects associated with conventional HRT.

Another major problem with conventional HRT is the ratio of estrogens. The ratio of estrogens in Premarin® is about 75% estrone, up to 15% equilin (a potent horse estrogen), estradiol, and at least two other equine estrogens. These are very different from the ratios observed naturally in a woman’s body (Wright 1999);

Causes of Estrogen Dominance

Beginning in peri-menopause and continuing through menopause, the production of progesterone tends to decline more rapidly than that of estrogen. If the ratio between progesterone and estrogen is unbalanced favoring excess estrogen, a woman may become susceptible to an increased risk of fibrocystic breast disease and other health risks (Kubista 1990; Lee and Hopkins 1996), that is why Bioidentical Hormone Replacement can be so beneficial for women's health.

When considering Bioidentical Hormone Replacement Therapy one should pay attention to factors contributing to estrogen dominance such as:

• Exposure to estrogen-mimicking chemicals found in herbicides, pesticides, and petrochemicals (for example BPA, or bisphenol A) and PCB’s (polychlorinated biphenyl’s), used in some cosmetics, glue, plastic, and other modern materials (Tapiero 2002);
• Obesity, as well as increased intake of excess calories from simple sugars, fiber-deficient refined grains, and trans-fat from partially hydrogenated vegetable oil

Estrogen dominance is often associated with symptoms such as food cravings, bloating, weight gain, fatigue, mood swings, depression, cyclical migraine headaches, lack of sexual desire, menstrual cramps, short cycles, heavy menstrual bleeding, hair loss, fibroids, and endometriosis. Estrogen dominance has to be considered seriously while using BHRT.

Is Cancer Risk a Legitimate Reason to Deprive Aging Women of Healthy Aging?

Hormones like estrogen and testosterone affect cell growth and proliferation; unchecked cell growth and proliferation increase in the cancer risk in this population. This fear about cancer development is an important reason why more aging women chose not to restore their hormonal levels to more youthful levels. Does that mean aging women should simply accept the sex hormone deficiencies they face as a part of “normal” aging?

To better clarify the association between sex hormone restoration and the increased risk of cancer risk we asked a simple question: If estrogen caused breast cancer, we would expect to see very high rates of breast cancer in young women of childbearing age; In addition would we see dramatic decrease in breast cancer after menopause? However this simply is not the case. Clearly, aging and improper use of conventional HRT (not bioidentical hormones replacement therapy) is the primary cause of breast cancer;

Risk of Developing Breast Cancer by Age

• By age 25: 1 in 19,608
• By age 30: 1 in 2,525
• By age 40: 1 in 217
• By age 45: 1 in 93
• By age 50: 1 in 50
• By age 55: 1 in 33
• By age 60: 1 in 24
• By age 65: 1 in 17
• By age 70: 1 in 14
• By age 75: 1 in 11
• By age 80: 1 in 10
• By age 85: 1 in 9

The reason cancer risk increases with aging is that the genes that help regulate healthy cell growth can mutate. Bioidentical hormone replacement therapy may protects women from breast cancer.

To fully understand the hormone symphony, Estrogen should be better explained.

To fully appreciate the complexity of HRT, it is important to understand the various forms of estrogen and their effects in the body. The estrogen family includes more than 15 forms of estrogen naturally created in a woman’s body (Taioli, 2010). These include the three major players: Estrone is the criminal and cancer promoter, Estradiol, and Estriol is the cancer police.

Each of these estrogens has particular functions.

• Estradiol (E2), the predominant form in reproductive-age non-pregnant women, primarily aids in the cyclic release of eggs from the ovaries for potential fertilization and preparation of the uterus for pregnancy. Estradiol also has beneficial effects on heart, bone, brain and colon. Reduction in the level of estradiol causes common menopausal symptoms such as hot flashes and night sweats.
• Estrone (E1), produced in the ovaries but also generated in fat cells, is another relatively potent form of estrogen, and is the dominant estrogen in postmenopausal women.
• Estriol (E3) is secreted in large quantities during pregnancy by the placenta; however, it is a comparatively weak estrogen, and the form of estrogen least associated with hormone-related cancers. In Europe and Japan, estriol is frequently used for HRT (Head 1998; Kano 2002, Moskowitz 2006, Holtor 2009);

The three estrogens convert into many metabolites. Estrone, for example, may convert into three different forms:

• 2-hydroxyestrone
• 4-hydroxyestrone
• 16-alpha-hydroxyestrone

Scientists have identified 2-hydroxyestrone as a “good,” or chemoprotective estrogen; while 16-alpha-hydroxyestrone and 4-hydroxyestrone have been associated with cancer (Bradlow 1996; Muti 2000). The relationship between 2-hydroxyestrone and 16-alpha-hydroxyestrone is sometimes expressed as the 2:16 ratio.

By increasing the ratio of 2-hydroxyestrone to 16-alpha-hydroxyestrone, it may be possible to reduce the risk of estrogen-related cancers (Bradlow 1986; Taioli 2010);

3,3’-Diindolylmethane (DIM) and indole-3-carbinole (I3C), found in appreciable concentrations in cruciferous vegetables, favorably affect estrogen metabolism and help to optimize the 2:16 ratio.

Estrogen Receptors and a Closer Look at Estriol

As mentioned previously, estriol (E3) is the form of estrogen least associated with cancer. Estriol’s protective effects become apparent when examining the differing actions that each of the three primary estrogens exerts upon the estrogen receptors. On breast cells there are two distinct classical estrogen receptors that bind estrogens:

• Estrogen receptor alpha
• And estrogen receptor beta.
• In addition, there is one non-classical estrogen receptor, GPR30 (Paruthiyll 2004; Paech 1997; Katzenellenbogen 2000; Nilsson 200; Wang 2010).
  • The binding of estrogen hormones to estrogen receptor alpha promotes breast cell proliferation, which can exacerbate the spread of existing breast cancer.
  • The binding and activation of estrogen receptor beta attenuates breast cell proliferation and may slow the development of a cancerous tumor (Helguero 2005; Bardin 2004; Isaksson 2002; Weatherman 2001);

Estriol, on the other hand, binds to and activates estrogen receptor beta (Zhu 2006; Rich 2002). This critical fact helps to explain estriol’s “anti-estrogenic” activity, which led a noted researcher in hormone replacement therapy to state, “This unique property of estriol, in contrast to the selective ER [estrogen receptor] alpha binding by other estrogens. Because of its differing effects on ER alpha and ER beta, we would expect that estriol would be less likely to induce proliferative [potential cancerous growth] changes in breast tissue and to be associated with a reduced risk of breast cancer” (Holtorf 2009);

Estriol, through its estrogen receptor modulatory capacity, combats the proliferative effects of estrone and estradiol (Melamen 1997; Wang 2010). These scientific findings highlight the importance of emphasizing estriol in any BHRT program intended to restore youthful hormone balance and guard against breast cancer development.

Bioidentical Hormone Replacement Therapy (BHRT) is Women's Age Management

By the time a woman enters menopause, she may have already experienced two decades of hormonal imbalance. After menopause, when sex hormone levels decrease significantly, aging women are at increased risk of major diseases, including the following:

• Heart disease Rates of heart disease in postmenopausal women gradually climb until they equal the rates typically seen among men. A number of negative changes in cardiovascular health are provoked by menopause, including elevations in blood pressure, low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglycerides. At the same time, high-density lipoprotein (HDL) cholesterol levels drop significantly. Elevated levels of homocysteine, C-reactive protein, and interleukin-6 (an inflammatory cytokine) are all associated with estrogen deficiency (Cushman 2003; Davison 2003; Dijsselbloem 2004). Estrogenic activities are vital for maintaining integrity of the vascular endothelium, where atherosclerotic changes begin (Arnal 2009). Finally, lack of estrogen replacement in the postmenopausal state may predispose women to forms of cardiac muscle disease.
• Osteoporosis: Hormone deficiencies are clearly associated with bone loss and osteoporosis, beginning as early as the third decade of life. By the time women reach 50, they are at significantly increased risk of an osteoporosis. Estrogen deficiency results in increased inflammation, which cause increased bone breakdown and osteoporosis (Weitzmann and Pacifici 2006). Combined estrogen and androgen therapy increases bone mineral density (BMD).
• Alzheimer’s and dementia Loss of hormones is associated with neuronal degeneration and increased risk of dementia, Alzheimer’s disease, and Parkinson’s disease (Amtul 2010; Rocca 2008). Estrogen stimulates degradation of beta-amyloid protein, noted to accumulate in the brain of Alzheimer’s disease patients, by increasing production of protective proteins (Liang 2010). Deficiencies in pregnenolone and DHEA, which are both neuroprotective hormones, are also linked to reduced memory and brain cell death associated with Alzheimer’s disease. These two hormones play an important role in regulating neurotransmitter systems that are involved in learning, stress, depression, and many other vital functions.

Dr. Dalal Akoury describes the Progesterone’s Balancing Act in lieu of Bioidentical hormones replacement therapy BHRT in Women.

Estrogen is only a part of women hormonal story. Progesterone is equally important in the hormonal story. In a healthy young woman, progesterone serves as a balance to estrogen. While estrogen builds up during the first half of a menstrual cycle, progesterone levels do not start rising until the middle of the cycle. When properly administered Bioidentical hormones replacement therapy BHRT can help Women.

Studies have shown that progesterone has anti-proliferative effects on at least two different types of breast cancer cells, as well as leukemia cells (Formby 1998; Hayden 2009; Hilton 2010). Breast cancer is 5.4 times more common in pre-menopausal women with low progesterone than in pre-menopausal women who have favorable progesterone levels (Cowan 1981). Data suggest that while natural, bioidentical progesterone does not increase breast cancer risk, synthetic progestins used in conventional HRT do raise the risk; Bioidentical hormones replacement therapy BHRT is women age management

Natural progesterone has also demonstrated neuroprotective properties. Progesterone deficiency has also been linked to migraine (Colson et al 2005); Bioidentical hormones replacement therapy BHRT is Women Age Management

Bioidentical hormone replacement therapy formulations in doses tailored to individual patients can be obtained from a compounding pharmacy after a physician’s prescription has been submitted. The use of bioidentical estrogens has been utilized extensively in Europe and Japan for several years (Kano et al 2002); that is Bioidentical hormones replacement therapy BHRT.

• Estriol has shown beneficial effects in women at risk for cardiovascular disease.Japanese scientists found that a group of menopausal women treated with estriol had a significant decrease in both systolic and diastolic blood pressure (Takahashi 2000). Another study demonstrated that estriol replacement for 30 weeks improved arterial relaxation (Hayashi 2000). Estriol accomplishes these effects by strongly activating nitric oxide signaling systems and stabilizing atherosclerotic plaques (Kano 2002); This shows that Bioidentical hormones replacement therapy BHRT is essential for Women.
• Estriol may further reduce cardiovascular risk through its beneficial effects on lipid profiles. One Japanese study found that estriol prevented a postmenopausal rise in total cholesterol, and did not induce the elevated triglyceride levels, a side effect frequently seen after treatment with conventional estrogen therapy (Itoi 2000). Estriol, in combination with a statin drug, can reduce carotid artery intima-media thickness, a measure of atherosclerosis, in postmenopausal women with elevated blood lipids (Yamanaka 2005); that is why Bioidentical hormones replacement therapy BHRT is Women Age Management.
• Estriol also increases bone mineral density, a vital parameter in post-menopausal women at risk for osteoporosis. Bone mineral density significantly increased in women who received estriol, while those who did not take estriol experienced a decrease in bone mineral density (Nishibe 1996). In a summary statement, the researchers wrote, “the acceleration of bone turnover usually observed after menopause was prevented by treatment with E3 [estriol].” (Nozaki 1996);
• Estriol also supports sexual and urinary health. One study showed that estriol-treated women had a 68% reduction in symptoms of incontinence. Women with recurrent urinary tract infections experienced a 91% reduction in infections following treatment with an intravaginal estriol cream. Another study demonstrated that locally administered estriol therapy significantly increased the number of blood vessels surrounding the urethra, thereby improving its ability to keep urine in the bladder until urination is desired (Kobata 2008). The addition of estriol to standard therapy for prevention of urinary tract infections reduced the number of recurrences 11-fold. That demonstrates that proper use of Bioidentical hormones replacement therapy BHRT is helpful to Women.
• Stress incontinence refers to intermittent loss of urine with pelvic floor stress from laughing, coughing, etc. Pelvic floor muscle exercises are effective in reducing stress incontinence, and studies suggest that estriol adds substantially to the beneficial effect (Ishiko 2001).
• Estriol can offer relief for women suffering from atrophic vaginitis, the symptoms of which include vaginal dryness, vaginal burning, and painful intercourse. After 4 weeks of treatment with an intravaginal estriol cream, researchers noted,“atrophy of vaginal epithelium and chronic vaginitis stopped or significantly decreased… The subjective complaints relating to the estrogen deficiency (vaginal burning and dryness, itching, dyspareunia [painful sex] and urinary dysfunctions) ceased. Side-effects and complications during the treatment were not found.” (Koloszar 1995) More objective improvements to vaginal dryness and acidity have been demonstrated in recent studies (Chollet 2009); For healthy sex Bioidentical hormones replacement therapy BHRT is essential.
• Topical estriol creams applied to the face and neck can also reduce many of the symptoms of aging skin, such as dryness and wrinkling. Animal studies demonstrate that estriol cream promotes collagen production and enhances the elasticity of treated skin (Ozyazgan 2005); Remove your wrinkles through Bioidentical hormones replacement therapy BHRT is Women Age Management.
• Studies have also shown estriol to be effective in the treatment of menopausal symptoms. In one investigation of women given varying doses of estriol for six months, vasomotor symptoms of menopause, such as hot flashes, decreased. The improvements were found to be dose-dependent. There were no detrimental effects on uterine or breast tissue (Tzingounis 1978);

Progesterone complements and balances the impact of estrogen in aging women. Combined with estrogen, progesterone substantially improved the amount of time women with a history of heart attack or coronary artery disease could work out on a treadmill before reducing blood flow to the heart. Use of non-bioidentical progesterone produced no effect (Rosano 2000). Another mechanism by which progesterone enhances cardiovascular health is its ability to maintain or even increase HDL levels in women receiving estrogen replacement therapy (Bernstein and Pohost 2010; Ottosson 1985; Jensen 1987).

Progesterone has a major role in relieving menopausal symptoms as well. Four head-to-head studies comparing progesterone to non-bioidentical progestin reported that women experienced greater satisfaction, improved quality of life, and fewer side effects when they were switched from non-bioidentical progestin to progesterone (Hargrove 1989; Montplaisir 2001; Ryan 2001; Lindenfeld 2002). In a landmark study at the Mayo Clinic, the beneficial effects of progesterone compared to nonbioidentical progestin included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 25% reduction in menstrual bleeding, a 40% reduction in cognitive difficulties, and a 30% improvement in sexual function. 80% of women in the study reported overall satisfaction with the bioidentical progesterone formulation (Fitzpatrick 2000).; Progesterone is an essential part of bioidentical hormone replacement therapy.

What You Need to Know about Bioidentical hormones replacement therapy BHRT is Women Age Management? asks Dr. Dalal Akoury

• Non-bioidentical hormones replacement therapy BHRT are chemically different from hormones naturally produced within the body.
• Bioidentical hormones have the same molecular structure as the hormones produced naturally within the body. The body does not distinguish between supplemental bioidentical hormone replacement therapy and the hormones produced within the body. As a result, bioidentical hormones replacement therapy BHRT are properly utilized, and are able to be naturally metabolized and excreted from the body.
• A scientific literature review suggests that bioidentical progesterone may be superior to non-bioidentical, synthetic progestogens (progestins) in treating menopausal symptoms.
• Research on bioidentical progesterone has shown beneficial effects on cardiovascular health, including decreasing the risk of blood clots, protecting against atherosclerosis, and maintaining healthy HDL levels;

Three major types of estrogen are produced naturally in a woman’s body: estriol, estrone, and estradiol.

Estriol has been shown to improve bone density, promote youthful skin, and enhance sexual and urinary health.

Beyond Estrogen and Progesterone: The Complete Hormonal Picture; Bioidentical hormones replacement therapy BHRT is Women Age Management

In addition to estrogen and progesterone, it is also important to monitor levels of the hormones Pregnenolone, DHEA, and testosterone. Ideal bioidentical HRT goes beyond the mere suppression of symptoms caused by declining ovarian hormone levels. The real goal of Life Extension’s approach to female hormone restoration is to restore hormones to youthful levels. Such an approach has wide-ranging benefits throughout the body and significantly enhances physical and psychological well-being.

DHEA is a natural steroidal hormone secreted by the adrenal gland, the gonads, and the brain (Maninger 2009). Although women usually have less DHEA than men, both sexes lose DHEA over time, suggesting that its decline is age-related (Labrie 2010). Peak levels are typically reached when women are in their third decade of life, after which they begin to lose approximately 2% per year. Decreased levels of DHEA are associated with cancer, diabetes, lupus, and psychiatric illness (Genazzani and Pluchino 2010). Low levels of DHEA are also associated with higher levels of insomnia, pain, and disability (Morrison et al 2000).

DHEA has been shown to improve mood, neurological functions, immune functions, energy, feelings of well-being, and the maintenance of muscle and bone mass (Kenny 2010; Weiss 2009). A combination of DHEA and pregnenolone has been shown to improve memory (Ritsner 2010). DHEA may also improve insulin sensitivity and lower triglyceride levels (Genazzani 2010; Casson 1995).

AWAREmed Health and Wellness Resource Center suggests that maturing women strive to keep their DHEA-sulfate (DHEA-s) levels in a range of 250 – 380 µg/dL in order to promote optimal health and vitality;

Testosterone levels in women also gradually decrease with age (Schneider 2003). Loss of testosterone affects libido, bone and muscle mass, vasomotor symptoms, cardiovascular health, mood, and well-being (Simon 2001; Watt 2003). Testosterone therapy, in conjunction with estrogen therapy, has been shown to improve quality of life, vigor, mood, ability to concentrate, bone mineralization, libido, and sexual satisfaction (Al-Azzawi 2010; Simon 2001; Braunstein 2002; Cameron 2004). This combination therapy also helps reduce hot flashes, sleep disturbances, night sweats, and vaginal dryness (Guillermo 2010). Because DHEA converts into testosterone, it is possible to raise testosterone levels with DHEA (Cameron 2004; Schneider 2003).

Studies also suggest that testosterone, in the context of hormone restoration, may prevent or reduce estrogenic cancer risk in the treatment of women with ovarian failure (Dimitrakakis 2003; Zhou 2000). In addition, testosterone is effective in the treatment of decreased libido in women (Guillermo 2010).

Pregnenolone levels also decline with age. As the initial hormone in the overall steroid hormone cascade, pregnenolone is derived from cholesterol. As is the case with other hormones, a significant reduction begins when women reach their early thirties (Havlikova 2002). Pregnenolone deficiencies have been associated with diminished brain function and dementia (Mellon 2007).

It is very important that women have their hormone levels checked before beginning bio-identical hormone restoration therapy. To ensure safe and adequate levels, testing should occur one month after commencing HRT, and then again after two more months. Those women who wish to enhance their sexual desire and have already tried DHEA and pregnenolone therapy, should talk to their physician about options that may include small amounts of testosterone. Women should always consult a physician before beginning HRT, especially if they have had a hormone-responsive cancer (e.g., breast or endometrial) or are at high risk (e.g., have a first-degree relative with breast cancer);

Moving Forward with Bioidentical Hormone Replacement Therapy BHRT

Given the wealth of data supporting Bioidentical Hormone Replacement Therapy BHRT, a noted researcher in hormone replacement therapy proclaimed, “Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their… animal-derived [non-bioidentical] counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT.” (Holtorf 2009)

Compounded prescription bioidentical estrogen formulas include Bi-Est and Tri-Est. Bi-Est consists of estradiol and estriol, while Tri-Est contains estradiol, estrone, and estriol (Taylor 2001). Bi-Est typically consists of 80% estriol and 20% estradiol. Tri-Est usually contains 80% estriol, 10% estradiol, and 10% estrone. In some situations these proportions do not meet the needs of every woman. For example, the proportions observed naturally in reproductive age women were 90% estriol, 7% estradiol, and 3% estrone (Wright 1999). In these cases a prescription is tailored to the needs of the patient by an experienced physician, and is based upon the results of hormone tests and assessment of symptoms.

A comprehensive hormone restoration program should also include progesterone, DHEA, pregnenolone, and perhaps testosterone.

AWAREmed Health and Wellness Resource Center Physicians are experienced in bioidentical hormone replacement and can help women find an optimal dosing strategy based on the results of hormone testing and clinical evaluation. Most women find they respond desirably to bioidentical hormone replacement therapy when the dosing strategy combines aspects of both of the aforementioned approaches. Reclaim your life with Lifestyle by following AWAREmed Health and Wellness Resource Center

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