If you are considering Bio-Identical Hormone Replacement (BHRT or BHT) this page contains more information that may help you make your decision.
Over 70 years of research has illustrated the benefits of pellet implants in administering hormones in both women and men:
Delivery of consistent, physiologic levels of hormones (shown to maintain and improve bone density)
They bypass the liver and don’t negatively impact clotting factors, blood pressure, lipid levels, glucose, or liver function.
Consistent improvement in:
Sex Drive and libido
Headaches and migraines
Hot flashes and night sweats
Mood and depression
Joint aches and pains
Adrenal and thyroid disorders
Some cancer treatment symptoms
WHAT IS BHRT?
An individualized approach to hormone replacement therapy, using biologically identical hormones (BHRT), pinpoints a person’s exact hormone levels, and what hormones are needed to balance their hormone deficiency. The differences between synthetic and biologically identical hormones are in their chemical structures and functionality. Biologically identical hormones have the same chemical structure as the hormones created naturally in the human body.
WHAT ARE BHRT FUSED- PELLET IMPLANTS?
Fused pellet implants are compounded using biologically identical hormones (most often Estradiol or Testosterone). The hormones are pressed / fused into very small cylinders, a little larger than a grain of rice.
WHERE ARE THE PELLETS IMPLANTED and WHAT CARE SHOULD I TAKE AFTERWARDS?
Pellet insertion is a relatively simple in-office procedure done under local anesthesia. The pellets are inserted subcutaneously (under the fatty lining of skin), either in the lower abdomen or the upper buttocks through a very small incision. The incision is then closed with Steri-Strips. Implants placed under the skin consistently release small, physiologic doses of hormones, which have been shown to have many benefits.
Vigorous activity should be avoided for 2-3 days, and activity involving the gluteus muscles should be avoided for a week. You may shower the same day as the procedure, but submerging in water (swimming or bathing in a bathtub) should be avoided for a week, or until the incision site has healed.
HOW LONG DO BHRT IMPLANTS LAST?
Fused Pellet Implants typically last between 3-5 months, depending on how rapidly the hormones are metabolized. Some patients begin to feel symptom relief within 48 hours, while others may take up to two weeks to notice a marked difference. The pellets do not need to be removed. They are completely absorbed by the body.
HOW DO I KNOW WHICH HORMONES I NEED?
Before starting any hormone replacement therapy, patients should work directly with a knowledgeable healthcare practitioner to have hormone testing done to evaluate their personal hormone profile. Based on existing hormone levels and health history, the practitioner will make a hormone replacement recommendation. Once pellets have been inserted, hormone levels will be reevaluated prior to the insertion of the next round of pellets. Follow up lab work is done after the initial pelleting to determine whether target hormone levels were reached. Once this is successfully achieved, the practitioner may suggest testing less frequently based upon patient feedback and prior hormone levels.
A deeper dive into information about bio-identical hormone replacement...
FROM THE U.S. NATIONAL INSTITUTES OF HEALTH:
Bio-identical hormone replacement therapy (BHRT or BHT) uses bio-identical hormones (BHs), which are derivatives of plant extracts chemically modified to be structurally indistinguishable from human endogenous hormones.
BHTs are compounded into different doses so they can be customized to a patient’s specific needs and are available via different routes of administration.
Typically, compounded preparations of BHs may include estriol, estrone, estradiol, testosterone, micronized progesterone, and occasionally dehydroepiandrosterone (DHEA).
It is generally accepted that estrogen-based hormone therapies share similar efficacies as well as risks. Many FDA-approved and regulated pharmaceutically-manufactured and branded conventional hormone therapies (CHTs) employ bio-identical hormones.
Since the publication of the Women's Health Initiative (WHI) trial reporting an increased risk of stroke, venous thrombosis, and breast cancer with conventional hormone therapies, the use of CHT has declined, and there has been increased interest in alternative bio-identical approaches.
THE BIO-IDENTICAL HORMONE DEBATE:
Are bio-identical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?
Holtorf K. Holtorf Medical Group, Inc., Torrance, CA 90505
BACKGROUND: The use of bio-identical hormones, including progesterone, estradiol, and estriol, in hormone replacement therapy (BHRT) has sparked intense debate. Of special concern is their relative safety compared with traditional synthetic and animal-derived versions, such as conjugated equine estrogens (CEE), medroxyprogesterone acetate (MPA), and other synthetic progestins. Proponents for bio-identical hormones claim that they are safer than comparable synthetic and nonhuman versions of HRT. Yet according to the US Food and Drug Administration and The Endocrine Society, there is little or no evidence to support claims that bioidentical hormones are safer or more effective.
OBJECTIVE: This paper aimed to evaluate the evidence comparing bio-identical hormones, including progesterone, estradiol, and estriol, with the commonly used non-bio-identical versions of BHRT for clinical efficacy, physiologic actions on breast tissue, and risks for breast cancer and cardiovascular disease.
METHODS: Published papers were identified from PubMed/MEDLINE, Google Scholar, and Cochrane databases, which included keywords associated with bio-identical hormones, synthetic hormones, and HRT. Papers that compared the effects of bio-identical and synthetic hormones, including clinical outcomes and in vitro results, were selected.
RESULTS: Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a synthetic progestin. Bio-identical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures.
Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins.
Estriol has some unique physiological effects, which differentiate it from estradiol, estrone, and CEE. Estriol would be expected to carry less risk for breast cancer, although no randomized controlled trials have been documented.
Synthetic progestins have a variety of negative cardiovascular effects, which may be avoided with progesterone.
CONCLUSION: Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.
Until evidence is found to the contrary, bio-identical hormones remain the preferred method of HRT.
Postgrad Med. 2009 Jan;121(1):73-85.
EXPERIMENTAL BENEFITS OF SEX HORMONES ON VASCULAR FUNCTION AND THE OUTCOME OF HORMONE THERAPY IN CARDIOVASCULAR DISEASE
Ross RL, Serock MR, Khalil RA. Division of Vascular Surgery, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts 02115.
Abstract: Cardiovascular disease (CVD) is more common in men and post-menopausal women than pre-menopausal women, suggesting vascular benefits of female sex hormones.
Experimental data have shown beneficial vascular effects of estrogen including stimulation of endothelium-dependent nitric oxide, prostacyclin, and hyperpolarizing factor-mediated vascular relaxation. However, the experimental evidence did not translate into vascular benefits of hormone replacement therapy (HRT) in postmenopausal women, and HERS, HERS-II, and WHI clinical trials demonstrated adverse cardiovascular events with HRT.
The lack of vascular benefits of HRT could be related to the hormone used, the vascular estrogen receptor (ER), and the subject’s age and preexisting cardiovascular condition.
Natural and phytoestrogens in small doses may be more beneficial than synthetic estrogen.
Specific estrogen receptor modulators (SERMs) could maximize the vascular benefits, with little side effects on breast cancer. Transdermal estrogens avoid the first-pass liver metabolism associated with the oral route.
Postmenopausal decrease and genetic polymorphism in vascular ER and post-receptor signaling mechanisms could also modify the effects of HRT. Variants of cytosolic/nuclear ER mediate transcriptional genomic effects that stimulate endothelial cell growth, but inhibit vascular smooth muscle (VSM) proliferation.
Also, plasma membrane ERs trigger not only non-genomic stimulation of endothelium-dependent vascular relaxation, but also inhibition of [Ca(2+)]i, protein kinase C, and Rho kinase-dependent VSM contraction.
HRT could also be more effective in the peri-menopausal period than in older post-menopausal women, and may prevent the development, while worsening preexisting CVD.
Lastly, progesterone may modify the vascular effects of estrogen, and modulators of estrogen/testosterone ratio could provide alternative HRT combinations. Thus, the type, dose, route of administration and the timing/duration of HRT should be customized depending on the subject’s age and preexisting cardiovascular condition, and thereby make it possible to translate the the beneficial vascular effects of sex hormones to the outcome of HRT in post-menopausal CVD.
Curr Cardiol Rev. 2008 Nov;4(4):309-22