Women's Health - Bioidentical Hormones


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Bioidentical Hormone Replacement Therapy (BHRT)

Bio-Identical Hormone Replacement Therapy (BHRT) has changed the manner in which women age. In the past, women died more frequently in childbirth; PMS was an imaginary problem; and menopause, with all of its age related infirmities, was just another stage of life to be endured and lived with. Today women do not have to accept hormonal imbalance as a ‘fact of life’. Natural hormone replacement therapy has helped improve not only the quality of women’s lives, but also how long they live them.

Studies have shown that pellets are far more superior to conventional hormone replacement therapy for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance. Pellet implants have been used to treat migraine and menstrual headaches. They also help with vaginal dryness, incontinence, urinary urgency and frequency. The goals of BHRT are to alleviate the symptoms caused by the natural decrease in production of hormones by the body and to bring the body back to hormonal balance. Another goal of BHRT is to imitate the body's natural processes as much as possible, thereby eliminating most of the unwanted effects and long-term risks of the traditional synthetic hormone-replacement therapies.

When describing replacement hormones, the word "Bio-Identical" is used to refer to the structure of the hormone molecule, not its source. When analyzed biochemically, the molecules of estrogen, progesterone and other hormones produced from wild yam precursor molecules are found to be absolutely indistinguishable from those the human body produces itself. Thus the crucial variable defining "Bio-Identical" is not the origin of the hormones, but its chemical structure.

Hormone replacement implants

An extremely effective form of bio-identical hormone therapy is subdermal pellets. For women who are having difficult menopause transitions due to problems with absorption, marked fluctuations in hormone levels or who have lost their ovaries surgically at a young age (perhaps due to endometriosis or pelvic inflammatory disease), hormones in this form can restore a quality of life and function which has been lost. Economically, this is more efficient than multiple medical visits, time lost from work, or the suffering of severe menopausal symptoms such as disturbed sleep, depression, anxiety, fatigue, muscle aches, hot flashes etc. It cannot be overemphasized that patients who are inadequately replaced will have many more visits for symptoms such as heart palpitations, migraines, urinary dysfunction, visits for sexual dysfunction, chronic aches and pains. These patients will probably have many unnecessary tests for arthritis, for chronic fatigue syndrome, for lupus, and many other complaints.

Pellets solve the problem of unpredictable absorption of a complex compounds through the skin or the bowel. This is a major problem when bio-identical hormones are compounded and taken either orally or through the skin. Each pellet consists of a bioidentical hormone, which releases into the blood stream and attains a steady state. Each pellet lasts from 3-4 months. The use of pellets has dramatically decreased the amount of physician visits by these patients for other related problems. Once patients have been stabilized, most patients requiring pellets two to three times a year and requiring very little in the way of other medical therapy in between times. The ovary also produces male hormones, which are similar to testosterone. Another source of androgen (male hormone) in a woman is the adrenal gland, which produces a substance known as dehydroepiandrosterone sulfate. There is a dramatic fall in both of these products around the time of menopause. The resulting loss of androgens causes a decrease of energy and decrease in sex drive and vaginal lubrication in a percentage of women. For women who have problems with low male hormones, one can add a testosterone pellet along with the estradiol. This is particularly useful for women whose ovaries have been surgically removed. This provides an androgen level which is compatible with that of the normal range of female patients. DHEA pellets are also available. DHEA is a testosterone related hormone that declines with age in both men and women. Levels decline further in people on steroids and in sicker patients. DHEA increases libido, supports bone density, controls blood sugar, supports immune function and prevents depression. It is often taken as an oral supplement.

Benefits include:

A feeling of well-being, increased energy, increased sex drive.

Non-oral testosterone may also be safer to use because there is also less lowering of HDL-cholesterol (good cholesterol) because the testosterone in the pellets by-pass the liver.

Stability of hormone blood levels compared to the fluctuation experienced with injections, pills, or patches.

Androgens, such as testosterone. also add to bone density. Some studies have show as much as a 25% increase in bone density.

Hormone deficiency is a common cause of hair loss and treatment with estradiol and testosterone implants can help to re-grow hair.

Estrogen hormone pellets should be used with caution in women who have their uterus because unopposed estrogen to the uterus may increase the risk of uterine cancer unless the patient faithfully uses progesterone.

The implant procedure consists of injecting a small amount of local anesthesia in the skin of abdominal wall or the outer thigh. A tiny nick is made in the skin with a scalpel. A large needle is placed through this incision and the pellets are inserted. The incision is then closed with a Steri-Strip, and pressure is applied until bleeding stops, and the area is then covered with a dressing. We have not had any major problems in terms of side effects from this type of procedure. Some expertise is required in terms of placing the pellets so that underlying structures are not traumatized.

Why Do Some Patients Prefer Hormone Pellet Therapy Over Other Treatment Methods?

Subcutaneous pellets are a useful, no-hassle delivery option for bioidentical, natural hormone replacement therapy. They are effective for several months and do not require daily dosing. Pellets provide a constant blood level of hormones while avoiding the daily fluctuations that occur with all other methods of administration.

What Are The Benefits of Hormone Pellet Therapy?

  • Effective for both men and women.
  • Documented and researched in medical journals since the 1940's
  • Provides constant blood levels
  • Greater capacity to get in shape
  • Relief from anxiety and depression
  • Increased energy, focus, mental clarity and concentration
  • Increased sexual arousal and sex drive
  • Increased bone density
  • Hassle-free with virtually no side effects
  • No pills, patches or creams
  • Lasts up to 6 months

How long until a patient feels better after pellets are inserted?

Some patients begin to ‘feel better' within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness.

How long do pellets last?

Most women maintain their hormone levels for 4 months after a set of pellets is inserted. We find that pellets need to be inserted more often in the beginning of pellet therapy and less often after a few insertions. Some women do not need pellets more than every 6 months or so, and some need pellets every 3 months. Timing of pellet insertions is an individual matter. The pellets do not need to be removed. They completely dissolve on their own.

Do patients need progesterone when they use the pellets?

Most times when estradiol is prescribed, progesterone is also prescribed even if the patient has had a hysterectomy. Hormone therapy with progesterone is not just used for menopause. Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, and sleeping disorders.

What is the role for testosterone implants (pellets)?

Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to; relieve migraine or menstrual headaches, help with symptoms of PMS (pre menstrual syndrome), relieve anxiety and depression, and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus). In a postmenopausal woman who does not find sufficient relief with her estrogen and progesterone replacement, or wants to optimize her libido, this implant should be considered.

Will my sex drive be the same as it was when I was in my 20's?

Doubtful. Sex drive and sexual response has many components, and is thought to be 70% psychological. The correct combination of estrogen and testosterone may renew a woman's interest in sex and increase her ability to respond to stimulation and attain an orgasm. Many other factors are also involved. Life stress, physical illness, relationship issues and previous sexual dysfunction all affect sexual feelings and response. We all need to remember that sex drive is tied to procreation. Menopausal woman are not meant to procreate, so there is an intrinsic drop in the desire for sex and the response to sexual stimulation. This can be partially reversed by hormones, but not completely

How are hormones monitored during therapy?

Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, testosterone and DHEA. Thyroid hormone levels may also be evaluated. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician. Women receiving hormone pellets will be asked to return for blood levels in a few months. The results of these blood levels will be evaluated by a Physician or Nurse Practitioner and a recommendation will be made for timing and dosage of the next pellets. We base our decisions about dosage and timing on symptoms as well. Some women feel better with higher levels of hormones than others. All of these factors are taken into account when tailoring a hormone pellet regimen to an individual woman.

If you begin to experience hot flashes, night sweats, moodiness or inability to sleep before you are scheduled to come in for a blood hormone level, please move your appointment up. You may need your pellets sooner than anticipated.If you do bleed irregularly on pellets, please schedule an appointment to see if an ultrasound or an endometrial biopsy need to be performed.

How much does this cost?

The cost for the insertion of pellets is between $230 and $600 depending on the dose of the hormone and the number of pellets needed. Pellets need to be inserted 2 to 4 times a year depending on how rapidly a patient metabolizes hormones. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective.

Who should not take hormones?

Generally speaking, women who have a personal history of breast cancer are not candidates for hormone replacement therapy. There is no evidence in the literature that estrogen increases the risk of recurrence of breast cancer, but Oncologists are reluctant to approve estrogen therapy in a woman who has had breast cancer, particularly if the tumor was estrogen receptor positive. Women who have a strong family history of blood clots or have personally had a blood clot, you are not a candidate for estrogen therapy. Please share your personal and family history at the time of your consultation and determine if you are a candidate for hormone therapy.

Will insurance cover the procedure?

Most physicians require payment for this service. Patients may want to contact their insurance companies to see if their costs will be reimbursed. A Health Savings Account (HSA) or Flexible Spending account may also be an option for some patients. Always remember, prevention is much more cost effective than disease.

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