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Hormone Replacement Therapy: Synthetic or Bio-identical?

By Carlos Eduardo Ramírez, MD, Gynecology –

Perimenopause and Menopause

Hormone Replacement TherapyThe perimenopausal period starts about five to seven years before the menopause. During this stage your reproductive hormonal cycle becomes irregular and erratic hence causing your menstruation to behave in the same manner.

Menopause is the point in life when a woman stops menstruating. Once you have not had a menstruation cycle for one year.  This is a sign of a decrease in the amount of estrogen and progesterone produced by the ovary.

The symptoms typically include:
•    hot flashes           • night sweats
•    insomnia              • vaginal dryness
•    osteoporosis        • thinning of the skin
•    hair loss                • memory loss
•    mood swings

Most menopausal symptoms are caused by declining hormone levels for which it makes sense to provide hormone replacement therapy.

Synthetic Hormones
Most commercial hormones are synthetic hormones, made to simulate the action of the natural hormones.
Although in many cases they provide benefits some patients may experience side effects (headaches, water retention, weight gain, acne, loss of libido and depression) or have medical complications that may limit its indications.

Research in this field has evolved its usage and the practice has modified in terms of the doses, uses, indications and contraindications of hormone replacement therapy. The combination of synthetic estrogen and progesterone may increase the risk of cardiovascular problems, pulmonary embolism, and breast cancer. However, they remain the medication of choice for the treatment of hot flashes, osteoporosis and colon cancer prevention. This is why it is recommended for use in patients who need it, with the lowest possible dose and for the shortest time possible, with the average treatment time of approximately five years.

Bio-identical Hormone Replacement Therapy (BHRT)
Unlike synthetic hormones, bio identical hormones are those derived from plants. Their chemical composition resembles natural hormones in the body with the benefit of minimal side effects.  Most patients benefit from commercially available preparations.  However, specific, tailor made dosages can be prescribed according to patients needs.

This type of hormones are usually associated to restorative medicine, a interdisciplinary approach that seeks to improve the quality of life based on an individual approach to each patient based on the biochemical, genetic and environmental composition.

Bio-identical hormones are modified to make as similar as possible to the natural, human molecule (estradiol, estriol, progesterone and testosterone). The estrogens derived from plants are known as phytoestrogens. Soybean and potato are some vegetable sources used in the production of hormones derived from plants.

While most patients benefit from commercially available preparations, bio-identical hormone replacement therapy may be individual, in which the doses prescribed is based on symptoms and hormone levels of each patient.  Once the doctor has this information, he or she can prescribe the hormones tailored, or custom made for the patient to a pharmacist using a compounding pharmacy.   Other hormones such as testosterone can also be added to the hormone replacement therapy.   Testosterone usually helps to increase sexual desire, energy levels, and maintain the structure and muscle tone.

These hormones can be taken by the patient through creams or gels or by means of small pellets or tablets which are inserted beneath the skin by a specialist.

I recommend that you start replacement therapy during perimenopause if the symptoms are affecting your wellbeing. To evaluate which method is best for you consult with your gynecologist.

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