Bioidentical Hormone Replacement Therapies
Bio-Identical Hormones are precise duplicates of the hormones produced by the female ovary, particularly, estrogen and progesterone. Bio-Identical Estrogen and Progesterone are different from conjugated equine estrogens and medroxyprogesterone, which have slightly different chemical structures.
How can Bio-Identical Hormones Support Fertility & Reproductive Health?
Progesterone therapy can be utilized in the luteal phase of the cycle to help support secretory changes in the endometrium, and therefore support implantation. Sufficient levels of progesterone are necessary to allow for implantation of an embryo to occur and to support early pregnancy. In Women with luteal phase defects where lower amounts of progesterone are produced, supplementing with additional progesterone can help create a favourable environment for conception and maintenance of pregnancy. In the setting of IVF and IUI when gonadotropin hormone treatments are used, progesterone therapy has been shown to help increase clinical pregnancy rates [1, 2, 3].
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Hormone therapies can also be utilized when there are reproductive disorders or hormonal imbalances present. Hormone replacement therapies may be used for dysfunctional uterine bleeding, spotting, irregular cycles, endometriosis, PCOS, or menopausal symptoms (i.e. vaginal dryness, hot flushes, mood disorders, joint pain).
Frequently Asked Questions
When are bio-identical hormone creams recommended?
The creams are applied topically to provide transdermal absorption of the bio-identical hormone. The transdermal route is ideal when trying to achieve an increased level of hormone in the blood and trying to increase the delivery of the hormone to multiple organ systems.
When are Vaginal Suppositories used?
Vaginal suppositories are ideal when trying to deliver the hormones directly to the reproductive tract. It allows for greater concentration of the hormone in the uterus and reproductive tract when compared to the skin cream and transdermal approach. The suppositories are best used when the bio-identical hormone specifically needs to reach the reproductive organs (i.e. supporting implantation and secretory changes of the endometrium, treating vaginal dryness, luteal phase defects).
Where are Bio-Identical Hormones available?
Doctors of Naturopathic Medicine that have successfully completed the Ontario Prescribing and Therapeutics Course and respective Examinations are able to prescribe Bio-Identical Hormone Therapies.
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Naturopathic Doctors are licensed Primary Health Care Providers in Ontario and are trained to utilize a combination of techniques to help fertility patients. Their 7-8 year Post-secondary education includes, but is not limited to, extensive training in Chinese Medicine and Acupuncture as well as Botanical Medicine, Clinical Nutrition (Including Prescribing of Pharmaceutical strength nutritional supplements), Pharmacology, Healthy Diet & Lifestyle, Clinical Diagnosis and Treatment, and Medical Sciences. This allows them to offer a comprehensive treatment protocol that includes more than Acupuncture alone.
What can hormone therapies be used to treat?
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Bioidentical hormone treatments can be used for the treatment of various conditions. If you are experiencing symptoms such as vaginal dryness, irritability, depression, anxiety, decreased libido insomnia, hot flashes, or night sweats the use of bioidentical hormones may support your treatment. Bioidentical hormones can also be useful when treating osteoporosis once in menopause. The role of estrogen and progesterone in supporting bone health is vital. Long term use of combined hormone therapies (estrogen + progesterone) has been shown to significantly reduce the risk of fractures in Women.
Are Bioidentical Hormones harmful?
The use of any therapy has to be evaluated for its benefits against the potential risks. The answer to this question can vary greatly based on the individual patient. However, there are certain factors which would increase the risk of long-term harm from hormone replacement therapies. Hormone therapies should be used carefully, for long term use, when there is a personal medical history of cardiovascular disease, thromboembolism (blood clots which become dislodged and block blood flow to an organ of the body), obesity, or increased risk for breast/endometrial cancer. Using a combination therapy of estrogen + progesterone has a reduced risk for cancer than using estrogen alone when the treatment is being used for 3-5 years.
What can Short-term use of Bioidentical hormone treatments be used for?
The use of the lowest-effective dose (the lowest dose in which relief from troubling symptoms occurs) should be used to help in the treatment of hot flashes, vaginal dryness, vaginal atrophy, and there may be benefit in symptoms of anxiety or depression as well.
Can Progesterone treatments help reduce my risk of miscarriages?
Studies looking at Women who have had 2-3+ miscarriages concluded that the use of progesterone supplementation in pregnancy can help to reduce the risk of miscarriage and increase the chances of carrying the baby to term. In fact, it is suggested that Mothers supplementing with progesterone have around a 31% lower chance of miscarriage when compared to Mothers that did not use any progesterone. Additionally, the chances of carrying to term with a healthy baby (live birth rate) was around 11-24% higher in the groups of Mother supplementing with progesterone when compared to Mothers that did not supplement with any progesterone. The safety of using progesterone for both Mother and Baby is high, the risk of harmful outcomes is incredibly low, especially considering the immense benefit for those who have had multiple miscarriages.
Key Goals with Bioidentical Hormone Therapies
The treatment is focused on providing the right hormones for the correct symptoms, to the optimal candidate for these therapies (does not have an increased risk for conditions listed above), at the lowest effective dose for the necessary amount of time. Hormone therapies should be avoided or used with significant caution if there is an increased risk for cardiovascular disease, cancer, and blood clots. The therapies should be used for the treatment of symptoms actually shown to improve with the treatment of hormone therapies and avoid using the prescribed hormones for longer than required.
If you think you may benefit from the use of bioidentical therapies, schedule an initial consultation to discuss your symptoms, medical history, and treatment goals to determine if you are an optimal candidate for the bioidentical hormone replacement therapy.
References:
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1. Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin. (2008). Fertility and Sterility, 89(4), 789-792.
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2. Hill, M. J., Whitcomb, B. W., Lewis, T. D., Wu, M., Terry, N., Decherney, A. H., Propst, A. M. (2013). Progesterone luteal support after ovulation induction and intrauterine insemination: a systematic review and meta-analysis. Fertility and Sterility, 100(5).
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3.Shapiro, D., Boostanfar, R., Silverberg, K., & Yanushpolsky, E. H. (2014). Examining the evidence: progesterone supplementation during fresh and frozen embryo transfer. Reproductive BioMedicine Online, 29.