FAQs About Bio-Identical Hormone Replacement Therapy

(August 2010)

As part of our range of new services, Bio-Identical Hormone Replacement Therapy (BHRT) will now be offered at the Raby Institute for Integrative Medicine. BHRT is the use of hormones, which are chemically identical to the ones produced naturally by our bodies, to treat the symptoms of conditions caused by unbalanced or insufficient hormone production. This service provides patients with an alternative to using synthetic hormones, which have recently been associated with increased risk for heart disease, stroke and cancer.

While BHRT has received its fair share of press lately, including coverage on Oprah, it is a practice that has actually been around for at least 20 years. As a new practitioner at the Raby Institute of Integrative Medicine, one of my areas of interest and advanced training has been in BHRT. Over the next several newsletters, I hope to give you a better understanding of the role hormones play in our bodies, what differentiates BHRT from more traditional hormone replacement therapy (HRT), and who can benefit.



Hormones play an important role in our proper functioning, acting like little messengers through out the body, turning on or off certain signals. The messengers stimulate, strengthen and maintain the vitality and integrity of many tissues in the body. A s certain hormone levels decline, the organs that they affect change in function. An example familiar to many women is

Estrogen hormone

menopause, during which levels of estrogen and progesterone decrease. As these hormones decrease, women are at a higher risk for Osteoporosis. Decreases in estrogen also result in symptoms such as hot flashes, night sweats, vaginal dryness, lack of concentration, forgetfulness, and even incontinence. Drops in progesterone can lead to anxiety, insomnia, heavy periods and infertility. Testosterone deficiency is another example of a condition in which decreases in a hormone effect the body's proper functioning. Although most commonly thought of a as a "male" hormone, testosterone is also present in women and contributes to their sex drive, emotional well-being, self-confidence, motivation and supports the body to build and maintain muscle mass.


Hormone replacement therapy was developed in the early 1940s for the treatment of menopause symptoms like hot flashes, night sweats, headaches, joint pain, mood swings, vaginal dryness and fatigue. Doctors began "replacing" deficient estrogen and progesterone with synthetic versions of our natural hormones with brands like Premarin and PremPro. There was an initial debate regarding the safety of using synthetics, however since these products did alleviate discomfort for most patients the debate died down. It wasn't until 2002, when the results from the Women's Health Initiative were published in the Journal of the American Medical Association (JAMA) that the long-term effects of synthetic hormones came into question again. The Women's Health Initiative uncovered that synthetic hormone replacement actually increased the risk for heart disease, stroke and cancer. After the widespread press release of these results, many women and their doctors began to re-think this method of hormone replacement.


BHRT has been used by forward-thinking doctors and women for as many as 20 years. This treatment uses hormones that are identical to the form of hormone the body already makes - even though they are made synthetically in a lab. The difference is that the bio-identical version is highly individualized for each patient. The body recognizes the bio-identical version of progesterone as though the ovary or adrenal gland had made it itself. Traditional hormone replacement, introducing a synthetic hormone like Progestin to mimic the body's own progesterone, can create potential problems because the synthetic hormone fits like the octagonal peg in the round hole. For many women this is enough to cause undesirable side effects that can be as serious as increased risk for cancer and heart disease.


Although not without its own side effects, BHRT does strive to more exactly match each patient's unique hormonal balance allowing the replacement hormone to be better utilized. It is this high level of customization that makes BHRT more challenging. BHRT takes time and some attention to get the doses right and to avoid overdosing. Most doctors just don't have the time to spend with patients or sufficient training in the practice to accurately and effectively use BHRT.


Not everyone needs BHRT, which is why it's critical to get your levels measured. Many women experience declining hormones in their mid-30s, while for others, menopause symptoms don't appear until after 50. Women are not alone in experiencing significant hormonal shifts later in their lives. Symptoms of andropause, the male equivalent of menopause, can also be treated with BHRT.

Though there are risks, hormone treatment is very safe if done properly. We monitor our patients closely and adjust as necessary to make sure each patient is receiving the proper dosages. It can take several months of adjusting before all the hormones are in sync, but the benefits of relief most often outweigh the risks of conventional hormone therapy. Schedule an appointment at the Raby Institute to find out whether BHRT is right for you.


Contributed by Nikol Margiotta, DN, FAARFM, ABAAHP

1. Rossouw, JE. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 288(3):321-33.

Interested in finding out whether BHRT is right for you? Schedule an appointment with Dr. Margiotta soon by calling 312-276-1212 or emailing the Raby Institute at appointments@rabyinstitute.com.


"Through the skill and intellect Dr. Raby brings to the healthcare profession it is clear that she continues to do research and study about the relationship between integrative medicine and traditional medicine."
- Raby Institute patient