What is Perimenopause?

HRT or hormone replacement therapy is when a licensed medical provider prescribes a hormone product. This could be the birth control pill, a hormone secreting IUD, or any hormone product. But mostly when people refer to HRT, they are referring to the prescription hormones women get when needing support in perimenopause or menopause.

BHRT or bioidentical hormone replacement therapy is the same thing as HRT! Most people think “bioidentical” means that the product was made by a special compounding pharmacy, and it doesn’t. Bioidentical/ body identical/human identical mean just that; that the hormone prescribed is molecularly identical to what we make in our bodies (however they are made in a lab). The first thing you should know is that we have FDA approved versions of bioidentical hormones that all healthcare practitioners prescribe. That is why mostly these days we just say “HRT” which means the same thing as “BHRT” because the products are almost all, (in particular when it comes to treating perimenopause or menopause) bio/human identical.

The only non-bioidentical synthetic estrogen still in the market place is called premarin and of course there are many non-bioidentical progestin products found in birth control pills and hormone secreting IUDs.

Bioidentical hormones are made using natural ingredients and are available through standard FDA prescriptions or through certified compounding pharmacists who must adhere to strict regulations. The types, combinations and dosages of bioidentical hormones are customized to fit each individual patient and will be discussed in the course of your treatment. Hormones are powerful chemical messengers that must be prescribed; thus it is very important to receive a comprehensive individual medical risk assessment before proceeding with treatment. Ongoing monitoring with blood work is important to ensure that patients are optimized and are well within safe limits. The frequency of the monitoring is entirely dependent on the case.

Often we think of replacing hormones as  way to balance things, as a way to address immediate nagging symptoms – and it does. However there is a much bigger role that having adequate levels of hormones plays, it helps us not only to age well but also it helps to prevent many of the diseases of aging such as cardiovascular disease, osteoporosis, muscle wasting, gynecological infections and conditions, Alzheimer’s disease dementia, memory loss, and even some cancers.

Hormones are proteins that behave like powerful chemical messengers. They are delivered to body tissues through the blood. Working together like a finely tuned symphony, they regulate everything from reproduction and emotions to general health and well-being.

Maintaining the proper balance of hormones in the body is essential to good health. Factors that affect hormone levels include your stage of development (puberty through menopause) as well as sleep, diet, stress, exercise, medications and the environment.

Women of all ages can suffer hormone imbalances.

• Do you have PMS, heavy or irregular periods?
• Have you suddenly gained weight and are unable to lose it?
• Do you have mood swings, hot flashes and night sweats?
• Are you feeling stressed, tired and have trouble sleeping?

I work with teens who are having challenging periods all the way up to women at the end of their lives; our hormones are our kryptonite, they play a huge role in overall health at every stage of our lives.

In young women it is often poor nutrition, emotional stress, an erratic lifestyle, too much alcohol, the use of birth control pills, or the early onset of menopause that leads to hormonal imbalance. In mature women, perimenopause, menopause and untreated postmenopause are the most common causes of hormonal symptoms.

Other contributing factors – at any age – include genetics, lack of exercise, obesity, poor quality sleep, trauma, inflammation, thyroid and adrenal problems, ovarian failure, as well as exposure to pesticides, chemicals, environmental pollution and toxins.

In most cases, the symptoms of hormonal changes can be improved through lifestyle changes and natural therapies. Often, however, working with a menopause clinic/menopause specialist who has experience working with HRT (hormone replacement therapy which is the same as bioidentical replacement therapy as explained above)  may be required for optimal lasting results.

1) Assessment: We begin with an initial hour long deep dive assessment, reviewing all your symptoms in detail, your medical and family history, and then discussing your goals.

2) Lab Work: I then order appropriate lab work which leads us to your first follow up.

3) Follow Up: In the first follow-up, I’ll teach you about your lab results, explaining what I think is happening (the diagnosis) and then going over my rationale for the kind of treatment I am proposing: writing out your individualized treatment plan and doing hormone prescriptions (if indicated), and off you go – the beginning of getting back to feeling like yourself again.

3) Treatment Plan: My unique scope of practice means that treatment plans include everything from lifestyle medicine (nutrition, stress management, movement) to botanical medicine, and if indicated, prescribing hormone replacement therapy (same thing as bioidentical).

4) Second Follow Up: The second follow up involves reviewing how the treatment plan/ prescriptions went, how each symptom responded to treatment, going over any questions, and making adjustments as needed. From here, follow ups are on an as-needed basis.

If HRT/ hormone replacement therapy is right for you, you will feel like yourself again – vibrant, energetic and on top of your game! With HRT, you are really supporting yourself as you age by reducing much of the physical and mental deterioration that comes with this time in life and paving the way to have some of the best years of your life!

Hormone balancing help both in the short and long-term. Hormone replacement therapy helps reduce the risk for the top three diseases associated with aging for women: heart disease, osteoporosis, and dementia.

Hormones are made in a laboratory and the components are from plants; typically yam or soy, to make a hormone that is structurally identical to those naturally produced in the human body.

In Canada, hormones require a prescription from a medical doctor, naturopathic doctor WITH a prescribing licence (this is an additional license on top of the regular ND medical license) or a Nurse Practitioner. After a thorough consultation and laboratory testing, Dr. Smith may prescribe a hormone or a combination of hormones to address your unique needs. The prescriptions are filled at a regular pharmacy if you elect to use FDA approved versions of bioidentical hormones, or by a compounding pharmacy if you require a customized formula (compounding pharmacies are useful when women have unique dosing needs).

Prescriptions of any hormone product are prescriptions and therefore covered by your insurance.

Depending on many factors, I will help you find an amenable route of administration. The choices are varied and include but are not limited to: gels, patches, creams,  suppositories, injections, capsules. Certain routes of administration work better for certain conditions.

Yes. A lot of research shows that bioidentical/ human identical hormones have little in common with the side effects and risks of the old fashioned “synthetic” hormones. Today, bioidentical hormone replacement therapy is recommended as the standard of care for peri/menopause for this very reason, it’s just that there is a massive delay in getting the word out. The North American Menopause Society (NAMS), the British Menopause Society (BMS) and many others around the world like these organizations, do a complete literature review every 5 years and then comment on HRT and safety in a position statement. The last two position statements have conclusively stated that HRT (which again, is the same as BHRT) is the safest and most effective way to treat symptoms of menopause.

There is a growing body of evidence that absolutely supports the safety of HRT showing it can lower a patient’s baseline risks for breast cancer, cardiovascular disease, dementia and osteoporosis. Other research has found that hormones have a favourable action on blood vessels and even decreasing the risk of dementia (which is 3x more common in women!). These positive results have spurred further studies on human identical hormones, and will hopefully fuel the trend for physicians to ONLY use these forms of hormone replacement, and learn how to help patients with immediate symptoms, but also prevent or reduces the risks of certain diseases.

Finally, studies of both bioidentical/ human identical estrogen and progesterone are showing that they are not associated with an increased risk of blood clots.

Unfortunately it is taking the medical community a long time to separate the body of evidence supporting these human identical hormone products from the old fashion “synthetic” ones which have high risks associated with them.

Most of the time I order blood work because that is what the majority of the research is based on. In some cases I may also use saliva, DUTCH or genetic testing, but this is rare as it is not usually necessary.

No, but often people have insurance for either my time or labs or both, please contact your insurance provider to find out ahead of your visit.

No. Studies have demonstrated the beneficial effects of bioidentical estrogen and progesterone