Dr Theodora Mantzourani

What are bioidentical hormones?

They are hormones chemically identical to the natural hormones produced by the human body. Although their primary ingredients come from plant sources such as yam or soy they are subjected to extensive laboratory modifications to be made "bioidentical". 

Their advantages compared to synthetic hormones and other hormones as Premarin used in conventional HRT are their ability to bind with the same receptors in the human body and to follow the same metabolic and elimination pathways as naturally produced hormones.            

Therefore, their actions can be more "physiological".       

Additionally, they can be measured in bodily fluids- blood, urine, saliva- allowing your doctor to monitor their levels throughout your treatment and avoid over- or under-replacement. Conventional HRT hormones cannot be measured in bodily fluids and dosage remains fixed and unmonitored. BHRT refers primarily to the replacement of sex hormones- oestrogen, progesterone and testosterone. However, for better results your doctor will assess and restore the status of other vital hormones such as thyroid, DHEA, melatonin etc.

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What are the health benefits of BHRT?

Efficient treatment of hot flushes and sweats, prevention of osteoporosis and bone fractures, improvement of incontinence and vaginal dryness, improvement of sleep and mood, improvement of memory, concentration and thinking, improvement in wrinkles, skin texture and hair, improvement of body composition and muscle mass, improvement of libido and sexual function.

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What are the risks and safety profile of BHRT?

A big study called the Women's Health Initiative (WHI) in the late 90s monitored the risks of breast cancer, heart disease, stroke and blood clots in women receiving  synthetic (non-bioidentical) HRT compared to women not receiving HRT. The study was terminated prematurely due to increased risk of all the above listed conditions and HRT got out of favour resulting in many women being left without treatment despite severe menopausal symptoms and poor quality of life. 

Ten years after the termination of WHI many expert societies including British Menopause society have reviewed the evidence and revisited the WHI findings concluding that HRT/BHRT confers significant benefits for menopausal symptoms, bone health and possibly heart disease prevention if started early in menopause. Further studie showed that oestrogen creams/gels-unlike oral oestrogens-do not cause blood clots and bioidentical progesterone does not share the same ad risk profile as synthetic progestins like Provera with regards to breast cancer.

Your doctor will assess your individual risks before starting any BHRT treatments to ensure maximal safety and will address your concerns and questions. Despite promising emerging evidence, our advice is that all hormones and supplements may pose risks if used without professional supervision and without prior assessment of individual patient suitability.

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Who is eligible for Bioidentical Hormone Replacement Therapy(BHRT)?

Menopause/Perimenopause for women and andropause in men are the main periods of hormonal imbalance in life. Depending on the severity of symptoms menopause and andropause may lead to distress, frustration and poor quality of life. Genetics, lifestyle choices such as diet and physical activity and environmental toxic exposures may all affect the way our bodies function throughout menopause and andropause. BHRT is very effective in alleviating the symptoms of menopause and andropause making life more enjoyable. 

Hormonal imbalances may also occur throughout life and present as "stress", "fatigue", "weight gain", acne or sexual dysfunction. Hormonal imbalances at a younger age are usually managed well with individualized programmes combining diet, targeted nutritional supplementation, stress management and exercise prescription. BHRT is most effective and safe if combined with specially designed lifestyle medicine interventions and this is what we do here in our clinic.

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When should I start feeling better?

It varies from person to person. Some people may notice significant changes within six weeks while for others it make take longer- up to 3 months. It also depends on what symptoms are predominant: some symptoms improve faster than others