Bioidentical Hormone Replacement Therapy
Bioidentical hormone formulations in measured doses (i.e., tailored to individual patients) can be obtained from a compounding pharmacy with a physician’s prescription. Bioidentical estrogen therapy has been utilized extensively in Europe and Japan for several years (Kano 2002).
Estriol. Estriol (E3) has shown beneficial effects in women at risk for cardiovascular disease.
Japanese scientists found that a group of menopausal women treated with E3 for 12 months had a significant decrease in both systolic and diastolic blood pressure (Takahashi 2000). Another placebo-controlled study demonstrated that E3 replacement for 30 weeks improved flow-mediated dilation (a measure of arterial relaxation) (Hayashi 2000). E3 accomplishes these effects by strongly activating nitric oxide signaling systems and stabilizing atherosclerotic plaques (Kano 2002).
E3 may further reduce cardiovascular risk through its beneficial effects on lipid profiles. One Japanese study found that E3 prevented a postmenopausal rise in total cholesterol while not inducing elevated triglyceride levels, a side effect frequently seen after treatment with conventional estrogen therapy (Itoi 2000). E3, in combination with a statin drug, can reduce carotid artery intima-media thickness (a measure of atherosclerosis) in postmenopausal women with elevated blood lipids (Yamanaka 2005).
E3 also increases bone mineral density, a vital parameter in post-menopausal women at risk for osteoporosis. In one study, women treated with E3 exhibited an increase in bone mineral density and improved climacteric (i.e., menopausal) symptoms with no increased risk of endometrial hyperplasia (Minaguchi 1996). In a second study, researchers treated postmenopausal and elderly women with either a combination of E3 and 1,000 mg/day of calcium lactate or 1,000 mg/day of calcium lactate alone. Bone mineral density significantly increased in women receiving E3 versus a decrease in those not receiving E3 (Nishibe 1996). In a summary statement, the researchers wrote, “the acceleration of bone turnover usually observed after menopause was prevented by treatment with E3 [estriol]” (Nozaki 1996).
E3 also supports sexual and urinary health. For example, one study showed that E3-treated women reported a 68% reduction in symptoms of incontinence compared to 16% in the placebo group (Dessole 2004). Women with recurrent urinary tract infections experienced a 91% reduction in infections following treatment with an intravaginal estriol cream compared to the placebo group (Raz 1993). Another study demonstrated that locally administered E3 therapy significantly increased the number of blood vessels surrounding the urethra, thereby improving its ability to maintain urine in the bladder until the desire to void the bladder is reached (Kobata 2008). The addition of E3 to standard therapy for prevention of urinary tract infections reduced the number of recurrences 11-fold, and the days of antibiotic therapy more than 12-fold in another study (Davidov 2009).
Stress incontinence refers to intermittent loss of urine with pelvic floor stress from laughing, coughing, etc. Pelvic floor muscle exercises are effective in reducing stress incontinence, and studies suggest that E3 adds substantially to the beneficial effect(s) (Ishiko 2001).
E3 can offer relief for women suffering from atrophic vaginitis, the symptoms of which include vaginal dryness, vaginal burning, and painful intercourse. After 4 weeks of treatment with an intravaginal estriol cream, researchers noted that “atrophy of vaginal epithelium and chronic vaginitis stopped or significantly decreased… The subjective complaints relating to the estrogen deficiency (vaginal burning and dryness, itching, dyspareunia [painful sex] and urinary dysfunctions) ceased. Side-effects and complications during the treatment were not found” (Koloszar 1995). More objective improvements to vaginal dryness and acidity have been demonstrated in recent studies (Chollet 2009).
Topical estriol creams applied to the face and neck can reduce many symptoms of aging skin (e.g., dryness and wrinkling). Animal studies demonstrate that estriol cream promotes collagen production and enhances skin’s elasticity (Ozyazgan 2005).
Studies have also shown E3 to be effective in the treatment of menopausal symptoms. In one study, women being treated with varying doses of E3 for six months had decreased vasomotor symptoms of menopause (e.g., hot flashes). The improvements were found to be dose-dependent. There were no detrimental effects on uterine or breast tissue (Tzingounis 1978). Other studies have shown similar results with up to 71% of patients reporting elimination of hot flashes and sweating and 21% reporting a substantial reduction (Lauritzen 1987).
Progesterone. Progesterone complements and balances the impact of estrogen in aging women. Combined with estrogen, progesterone substantially improved the amount of time women with a history of heart attack or coronary artery disease could work out on a treadmill before reducing blood flow to the heart. Use of non-bioidentical progesterone produced no effect (Rosano 2000). Another mechanism by which progesterone enhances cardiovascular health is its ability to maintain or even increase HDL levels in women receiving estrogen replacement therapy (Bernstein 2010; Ottosson 1985; Jensen 1987).
Progesterone has a major role in relieving menopausal symptoms as well. Four head-to-head studies comparing progesterone to non-bioidentical synthetic progestogen (progestin) reported that women experienced greater satisfaction, improved quality of life, and fewer side effects when switched from progestin to progesterone (Hargrove 1989; Montplaisir 2001; Ryan 2001; Lindenfeld 2002). The beneficial effects of progesterone compared to non-bioidentical progestin included a 30% reduction in sleep problems, 50% reduction in anxiety, 60% reduction in depression, 25% reduction in menstrual bleeding, 40% reduction in cognitive difficulties, and 30% improvement in sexual function. Eighty percent of women in the study reported overall satisfaction with the bioidentical progesterone formulation (Fitzpatrick 2000).