The problem with bioidentical hormone replacement
No, it's not cancer risk. We can monitor that risk pretty closely with salivary hormone levels so that the balance between estrogen/testosterone and progesterone (breast cell proliferation) and estradiol and progesterone (uterine) is optimal.
The risk is your doctor not realizing the therapeutic window that needs to be achieved and that blood monitoring is not all that helpful. Too little hormones is a problem, but so is too much. Often, excessive levels of hormones lead to the same symptoms as too little (save for hot flashes): water retention, weight gain, cognitive change, insomnia, irritability.
When we start hormones with the anticipation of it being the only measure that needs to be taken to achieve health, we get into trouble. You cannot ignore the impact that diet, stress and lack of exercise have on health and excpect the hormones to "cure-all". Doing this leads often to starting out with a hormone dose that's too high or continuing to push the dose because we don't feel better all the while ignoring the food sensitivity or heavy amounts of unmanaged stress.
Checking for excess levels in blood doesn't cut it. I once heard the director of a lab quote that hormone levels have to reach 10 times the overdose amount in order to show up in blood as too high. 10 times you ask? That's exactly what we see in saliva. Most women we see in the office on BHRT regimens that are not feeling well have an estradiol level >100 (nl 4-10) and progesterone >2000 (nl 100-300). The lab can't even quantify the number it's so high!
I recently saw a client that had these excessive levels, couldn't understand why she was gaining weight and fatigued and her thyroid was normal. We focused on her hormone replacement regimen and checked salivary levels. They were all undetectably high. After several months of gradually lowering, she came into the office to report that the most recent drop in progesterone dosage (which finally got her saliva level below 1000 for the first time in years) she immediately stopped craving carbs and has started losing weight.
I love BHRT. I have found it to be the missing piece in a lot of women's journey toward health. But it cannot be the only piece, and it cannot be blindly given with no monitoring for balance. Start low and go slow, but also focus on the trifecta of optimal health: stress management, whole foods nutrition and digestive balance. Then make dosage changes based on how you are feeling and the tissue levels of hormone (saliva, not blood).
Contributed by:
Dr. Jeffrey Gladd
Owner
Dr. Jeffrey Gladd graduated from Indiana University School of Medicine in 2001. He then went on to train in family medicine...
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