Healthy Aging with Bioidentical Hormones By Meghan Chafee, APRN, and Alina Schneider, APRN J
ane is a 48-year-old female who presented to our clinic with complaints of fatigue, irregular menstruation, headaches, low libido, difficulty sleeping, and weight gain. After conducting a thorough medical history and physical exam, blood work revealed that Jane was low in progesterone, estrogen, and testosterone. She was started on a regimen of intradermal pellet bioidentical hormone therapy and within three months, Jane’s symptoms had improved dramatically.
Synthetic vs. Bioidentical Hormones
Hormones, including progesterone, estrogen, and testosterone, are chemical messengers that are secreted in the bloodstream and exert their effects on various tissues and body systems. Bioidentical hormones are those that have been manufactured to be molecularly identical to those produced in the human body—typically sourced naturally from substances such as wild yams. It is important to note that “bioidentical” does not refer to the source of the hormone, but rather the chemical structure of the hormone itself. This distinction is important, as conventional or synthetic hormones such as those used in traditional hormone replacement therapy are not molecu- larly identical to the hormones produced by the human body, and, as such, do not convey the same actions and effects as naturally occurring hormones. Bioidentical hormone replacement therapy, or BHRT, is used to treat a wide variety of concerns, most notably post- menopausal symptoms such as hot flashes, irritability, and vaginal dryness. In men, BHRT testosterone treatment can improve sleep, mood, and libido and decrease muscle wasting.
Why Would I Need Hormone Therapy?
Many hormones, including estrogen, progesterone, and testos- terone, decline naturally as we age. And although this decline is “natural” and part of the age-related process, with the general increase in lifespan, some women may spend up to 1/3 of their lives in a hormone-depleted state. Along with the symptoms associated with hormone decline such as hot flashes, vaginal dryness, and
mood changes, declines in hormones are associated with risk fac- tors for other diseases such as cognitive decline, decreased bone density, general inflammation, elevated blood pressure, and reduced glucose tolerance. In men, age-related declines in testosterone are associated with heart disease, atherosclerosis, neurodegenerative disorders, and decreased insulin sensitivity.
The Safety of BHRT
In 2002, the largest randomized clinical trial on hormone therapy in women aged 50–79 was published. The Women’s Health Initiative, or WHI, sent shock waves throughout the medical community, as its results originally demonstrated an increased risk of cardiovascular disease, blood clots, and breast cancer in patients undergoing tradi- tional hormone replacement therapy. These results led to a dramatic decrease in the use of hormone replacement therapy. Newer studies and analyses of the original WHI data, however, have found several flaws with the research design.
For one, only one formulation of synthetic estrogen (conjugat- ed equine estrogen, a hormone derived from horses) and one for- mulation of synthetic progesterone (medroxyprogesterone acetate) were evaluated. In addition, only the oral forms of these hormones were evaluated. When taking an oral form of hormone therapy, the hormone must first be processed and metabolized by the liver. This can significantly alter the chemical structure of the hormone, as well as its side effect profile. Other flaws in the research design include the limited enrollment of women under 60 years of age or fewer than 10 years from the onset of menopause. In addition, the study failed to look at other causes for its findings of breast cancer, heart disease, and blood clots, including smoking status and the presence of other chronic illnesses.
A Lobo et al. (2016) follow-up study reported that the find- ings of the original WHI have mostly been negated. Indeed, in 2020, the New England Journal of Medicine published a review article stating that in further analyses of WHI data, there was no
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