(480) 973-9042
The following is a list of my top 10 benefits of bioidentical hormone replacement therapy, or BHRT for women. I am defining BHRT in this blog as bioidentical estrogen and progesterone. We very commonly optimize other hormones including testosterone, thyroid, and DHEA. Those hormones also have many potential benefits for women, but the current blog will focus specifically on bioidentical estrogen and progesterone.
1. Treatment of Menopausal Symptoms
Hot flashes and night sweats are the classic vasomotor symptoms of menopause, but numerous other symptoms can occur including fatigue, poor sleep, brain fog, joint pain, anxiety, and heart flutter. For many women these symptoms actually start in the perimenopausal years before menopause formally begins. Estradiol and progesterone are the most effective treatments for these symptoms, and at the appropriate doses most women experience complete resolution. Treatment of menopausal symptoms is the first thing that draws many women to BHRT, but as the list below shows, there are numerous other long-term benefits.
2. Protection from Heart Disease
Oral bioidentical estradiol has a profound effect on decreasing risk of heart attack and stroke in postmenopausal women.
The largest and longest randomized controlled trial to date of oral bioidentical estradiol in menopausal women is the DOPS (Danish Osteoporosis Prevention Study) study, which showed that women on oral estradiol had more than 50% less cardiovascular disease than women not on BHRT. By comparison, in women statin therapy typically results in a 10-20% decrease in cardiovascular disease compared to placebo. Consistent with this finding, other smaller randomized controlled trials show that oral bioidentical estradiol effectively reduces atherosclerotic plaque in postmenopausal women compared with those on placebo.
I review this and other studies is detail in my blog titled “Estrogen and Cardiovascular Disease”.
3. Protection from Dementia
BHRT is highly effective at treating brain fog and memory issues that are so common in the early menopausal years.
But a larger question looms: does BHRT decrease the incidence of Alzheimer’s and other forms of dementia in menopausal women? This is a very difficult question for clinical research to answer, and to my knowledge no randomized controlled trials have been published to date that speak to this question in BHRT.
I always acknowledge to my patients that the data in this area is inconsistent. But behind this inconsistency there is reason for optimism. A small RTC showed that women using bioidentical estradiol had reduced amyloid-B deposition than women on placebo, and the reduction was even more impressive in women who were APOE4 carriers (Kantarci, J Alzheimers Dis. 2016).
A population study in Cache County, Utah showed that HRT users had a 41% decreased risk of Alzheimer’s disease compared to nonusers, and those who used HRT for more than 10 years had a 59% decreased risk compared to nonusers (Zandi, JAMA. 2002).
Finally, the Women’s Health Initiative (WHI) is the largest RCT to date of synthetic HRT (i.e. non-bioidentical HRT). Long-term results from the WHI showed that death from Alzheimer’s disease was reduced by 26% (P=0.01) in women receiving Estrogen (Premarin) vs. placebo (Manson, JAMA 2017).
Most recent systematic reviews conclude that when HRT is started < 10 years after menopause it leads to a decreased risk of Alzheimer’s disease, while no effect is seen when HRT is started > 10 years after menopause. Most of the studies analyzed in the systematic reviews used synthetic HRT as opposed to bioidentical HRT, as there is a paucity of studies evaluating BHRT for this outcome. However, as bioidentical HRT always compares favorably to synthetic HRT in other outcomes (e.g. cardiovascular disease, breast cancer, blood clots), there is great reason to be optimistic that BHRT will lead to even better results than synthetic HRT when it comes to decreasing risk for Alzheimer’s disease.
4. Improved Body Composition
The loss of estrogen with menopause is associated with an increase in visceral adipose tissue (abdominal/truncal obesity). Numerous RCT’s show that HRT reduces abdominal fat deposition and increases lean body mass. This highly desirable effect of HRT is a long-term and not a short-term effect of HRT, demonstrating that HRT is best thought of as a marathon and not a sprint.
5. Improved Metabolic Health and Decreased Risk of Type 2 Diabetes
Large, randomized clinical trials consistently show that HRT use in menopausal women improves insulin sensitivity, lowers fasting glucose levels, and decreases risk of type 2 diabetes. Furthermore, HRT use improves glycemic control in postmenopausal women with established type 2 diabetes. Interestingly, just as oral estrogen is more powerful than transdermal estrogen for cardiovascular protection, at equivalent doses oral estrogen is also more effective than transdermal estrogen at improving insulin sensitivity and lower glucose levels.
6. Improved Sleep
Oral bioidentical progesterone is incredibly effective at improving sleep quality. In fact, this is probably the BHRT benefit that elicits the most consistent and enthusiastic response from my patients.
7. Improved Mood
Many women who have never experienced mental health issues in the past begin to have symptoms of mood swings, depression, and/or anxiety in their perimenopausal and/or menopausal years. Other women who do have a history of such issues may find their symptoms are worsened during this time. Numerous studies demonstrate the effectiveness of HRT in treating depression and anxiety associated with menopause. Bioidentical progesterone, in particular, has unique calming and anti-anxiety properties and is especially effective at treating symptoms of premenstrual syndrome (PMS).
8. Prevention and Treatment of Vaginal Atrophy
Symptoms of urogenital atrophy, also known as Genitourinary Syndrome of Menopause (GSM), are inevitable in women not receiving HRT. It is more a matter of “when” than “if”. Symptoms and complications of GSM include vaginal dryness and irritation, incontinence, pain with intercourse, and urinary tract infection.
Because the entire genitourinary tract is lined with estrogen receptors, a deficiency of estrogen creates negative changes in the vagina’s environment. The vaginal entrance becomes smaller and thinner, the vaginal walls become weaker, the skin becomes thinner, and the vagina itself becomes shorter and narrower. Estrogen treats this by restoring vaginal tone and elasticity, increasing blood flow, and enhancing the vagina’s lubricating ability.
9. Bone Health and Prevention of Osteoporosis
Over 30% of women experience a fracture related to osteoporosis in their lifetimes. The prevalence of osteoporosis at age 65 is about 30%. No matter what the total bone loss is over a woman’s lifetime, the greatest percentage of that loss will occur in the first 5 years of menopause.
Clinical studies consistently show that estrogen is the most effective way to increase bone mineral density (BMD) and prevent osteoporotic fractures in menopausal women. While no head-to-head studies exist comparing estrogen to bisphosphonates, there is ample evidence that estrogen is more effective, comes with numerous other benefits as outlined in this blog, and does not have the same worrisome side effects that bisphosphonates do.
10. Impact on Breast Cancer
While synthetic progestin was shown to increase the risk for breast cancer in the WHI and other studies, estrogen alone has consistently been shown to be protective against breast cancer. In fact, long-term data from the WHI showed an approximate 50% reduction in breast cancer mortality in the estrogen alone arm compared to placebo. We know of no other intervention that leads to a reduction of this magnitude.
Less data exists on bioidentical progesterone, but population studies consistently show it to be at least neutral, if not protective, of breast cancer, and in vitro studies show that progesterone is apoptotic to breast cancer cells (i.e. kills breast cancer cells).
I review the relationship between BHRT and breast cancer in greater detail in my blog titled “Estrogen and Breast Cancer”.
Honorable mention:
Skin Health
Another benefit of BHRT is its positive impact on skin health. Estrogen plays a vital role in protecting the skin by minimizing the significant thinning and atrophy associated with menopause. It contributes to maintaining thicker, more resilient skin by stimulating the production of hyaluronic acid and collagen. These elements enhance the skin’s ability to retain water and moisture in its deeper layers, which in turn bolsters the outer layer, promoting elasticity and preserving overall firmness. I have heard a number of patients tell me after starting menopausal BHRT that “my skin is glowing!”
Looking for hormone therapy for women?
At Valley Healthspan, we specialize in personalized BHRT for women using bioidentical estrogen and progesterone to address menopause symptoms, protect heart and brain health, improve sleep, mood, body composition, and more.
Call (480) 973-9042 or request a consultation online today.
