Bio-identical or body-identical hormone therapy is hormone therapy that uses estradiol and progesterone exactly identical to the body’s own hormones.
It’s a modern type of hormone therapy and quite different from old types of hormone replacement therapy such as Premarin and Provera.
Here’s what you need to know.
Perimenopause or “second puberty” are the two to ten years before periods actually stop. Symptoms include heavy periods, insomnia, anxiety, and night sweats, and are the result of losing progesterone, not estrogen.
Progesterone drops during perimenopause because you start having more anovulatory cycles, which are cycles when ovulation did not occur and progesterone was not made.
Other names for anovulatory cycles include:
- hormone imbalance
- estrogen and progesterone imbalance
- dysfunctional uterine bleeding
- unopposed estrogen
- estrogen dominance.
Estrogen does not drop during perimenopause but instead, can be up to three times higher than it was during previous decades. The high, fluctuating estrogen of perimenopause can contribute to symptoms of anxiety, migraines, and histamine or mast cell activation.
Because estrogen is already high during perimenopause, taking more estrogen is often not helpful. Instead, progesterone can be a better option.
Progesterone for perimenopause
Micronized or bioidentical progesterone can relieve the mood and sleep symptoms of perimenopause including anxiety, insomnia, hot flushes, and ability to cope with stress. It works by calming the brain and nervous system by converting to the neurosteroid allopregnanolone (ALLO) which acts on GABA receptors.
Progesterone has a few advantages over estrogen:
- It’s better for sleep and migraines.
- It’s safer for breasts.
- It’s easier to stop because it’s not addictive like estrogen.
👉 Tip: There’s no progesterone in any type of hormonal birth control.
Micronized progesterone is available as a compounded capsule or the brand names Prometrium, Utrogestan, or Teva generic capsules. They’re sedating so should be taken at bedtime.
Progesterone can also make periods lighter and is a good alternative to progestin drugs such as the pill and the hormonal IUD. Read For healthcare providers: managing menorrhagia without surgery.
For more information about the benefits of progesterone, read the following articles by Professor Jerilynn Prior:
Estrogen for menopause
As perimenopause progresses to menopause, symptoms of low estrogen can occur including daytime hot flushes, vaginal dryness, weight gain, and depression. At this stage, estrogen can be helpful, but only in combination with progesterone.
My approach is to start progesterone first and if that doesn’t relieve all the symptoms, look to a low-dose transdermal body-identical estradiol product such as Vagifem, Estradot, or Sandrena.
👉 Tip: Even without a uterus, progesterone is beneficial for mood and breasts.
Transdermal body-identical estradiol is safer than oral estrogen but the safety of estrogen, in general, is still up for debate. The best plan is to speak to your doctor about your symptoms and risk factors and make a plan. Here are a few more things to keep in mind:
- Vaginal estrogen is safe.
- Transdermal body-identical estradiol (such as Estradot) is safer than oral estrogen.
- Oral micronized progesterone is safer than progestins according to Professor Eden from the Women’s Health & Research Institute of Australia.
- Estrogen is safest when commenced at the onset of menopause (when periods stop) rather than later in life.
Bioidentical or body-identical is the safest kind of hormone therapy
Estradiol and progesterone that are identical to the body’s own hormones are better and safer. They’re called body-identical or bioidentical.
Bioidentical is the term for compounded hormones used during all the decades when compounding was the only way to access estradiol and progesterone identical to the body’s own hormones.
Your doctor prefers the term body-identical because she prefers approved medications to formulas made by a compounding chemist. She has concerns about the quality of compounded formulations and does not agree that hormone formulas can be “individualized” based on blood, saliva, or urine tests. I agree with the last point. There is no way to “tailor” menopausal hormones based on any kind of testing.
In summary, the best and safest strategy is to start with progesterone on its own, and then, if symptoms persist, add a low-dose transdermal estradiol formula such as Vagifem or Estradot 25.
Lifestyle and supplements can also be helpful. Read Rescue prescription for perimenopause where I discuss natural strategies such as:
- reducing histamine foods
- quitting alcohol
- exercising regularly.
Ask me in the comments.