The Case: 

• Jill is suffering from hormone imbalances which her doctors chalk up to perimenopause
• She was experiencing hot flashes, irregular periods, PMS, dry skin, mood swings, and extreme brain fog
• She wasn’t sure if these were all connected but she knew she didn’t like the doctor’s advice of waiting it out. 

Every woman experiences perimenopause and menopause differently. There are some common symptoms like hot flashes and irregular menstrual cycles, and some symptoms attributed to this hormonal shift that may or may not be related, like brain fog and dry skin. 

Jill and I both agreed that we needed to find out the root of her issues  

The Investigation

When Jill came to see me, I took a look at her history and labs. I saw her declining hormones, so I knew that at least some of the issues could be because of this. I also know that as hormones decline, they affect our organs (including the thyroid) and can be triggers for autoimmunity like Hashimoto’s.

I knew some of the symptoms could be thyroid related (dry skin and mood swings) but was the thyroid the root cause or simply being affected by the hormone shifts of perimenopause? It was important to find this out before deciding on her treatment. 

Solving Hormone Imbalance Mysteries

When it comes to female hormones, there are so many angles, confusion, and misinformation because the story is quite complex. No wonder Jill was struggling to figure out what was going on. 

I knew just who to turn to for help with Jill’s case. Jim Hrncir is one of the pioneers of modern pharmaceutical compounding. Jim is responsible for the formulation of many bioidentical hormones, as well as dermatological, nutritional, and anti-aging compounds widely used throughout the U.S.

Compounded Bioidentical Hormones vs. Hormones 

The main difference between hormones that a traditional doctor might prescribe (that you would get at a regular pharmacy) and compounded bioidentical hormones is that synthetic hormones first and foremost synthetic and foreign to the body and are one size fits all while compounded hormones are identical to our own hormones and customized to the specific need of the patient. Bioidentical hormones are just as the name suggests, they are exactly the same structure as the hormones that your body has been making your whole life.

The second consideration when looking at synthetic hormones vs. bioidentical hormones is the detoxification process. We produce hormones, typically every day and the body has to metabolize and detoxify them. And so, whether it's our own hormones or other hormones, we have to make sure that they're leaving the body properly. The difference is that synthetic hormones take 21 days to be metabolized compared to the mere hours it takes for bioidentical hormones to move through the system. 

Risk Factors and Misinformation about Bioidentical Hormones

It’s a common misconception that bioidentical hormones increase a woman’s risk of breast cancer, heart attack, stroke, dementia, and colon cancer - especially for those using these hormones for more than 5 years. Dr. Hrncir says this bad information comes from a study that was done in 2002. While it was a large study, the data was miscommunicated to the media and it stuck. 

Other researchers have tried to correct the damage of this study but many people still believe that hormones pose a risk. Dr. Hrncir believes that bioidentical hormones, because they are a match to what the body is already producing, are much safer than synthetic hormones that are created from non-human sources. For example, he explains, Premarin is created using the urine of a pregnant mare (horse). The second piece of false information to come out of that study, according to Dr. Hrncir, is that women should not be on bioidentical hormones for more than 5 years and this does not seem to hold true. 

Testing and Managing a Hormone Imbalance

Continuing to monitor hormone levels is an important part of the process. The DUTCH Test (a urine test) looks at the metabolites to gauge how well the bioidentical hormones are being metabolized. This is especially important for anyone with the MTHFR defect because the methylation pathways are necessary to detoxify the hormones. Thankfully the methylation pathways can be supported and there is alot you can do to help. To learn more about the MTHFR and ways to understand and support it, please check out  Episode 34. 

Blood tests and saliva tests may also be used and additionally Dr. Hrncir always has patients do a lifestyle questionnaire because test levels alone don’t tell the whole story. 

Treatment of a Hormone Imbalance with Compounded Bioidentical Hormones

As mentioned, this hormone therapy is customized to meet the patients needs and their hormone signature. Different hormones will be administered in different ways. Dr. Hrncir prefers to deliver estrogen transdermally. He encourages his patients to move the cream application site around the body so one area doesn’t get a build up. In some cases, patients will apply the cream to the labia with the side benefit of treating vaginal dryness, supporting the bladder (and spontaneous leakage), and decreasing UTIs and bacterial vaginosis. Other hormones may be delivered in time-release capsules. 

Why aren’t Compounded Bioidentical Hormones as supported by the FDA

This is a very big question and good fodder for conversation. Dr. Hrncir has reason to believe there is bias against compounding in the FDA because it doesn’t fit the business model of Big Pharma. Be sure to listen all of the way to the end of this episode for more on this. It’s not just hormones related to menopause, there are many other hormones (including thyroid) that can be compounded and may be at risk. 

Jim is passionate about keeping compound bioidentical hormones available to the public. If you agree, you can visit this website to add your voice to the cause. 

Mystery Solved

Hormone changes are no joke and can cause so many different symptoms making it difficult to know what’s really going on. 

Jill saw all the research and felt natural hormones were the way to go for her. She wanted to feel better and prevent diseases that may result from low hormones. But first, we had to figure out which symptoms were related to her hormone imbalance. 

We ran a DUTCH test to get her baseline and look at her estrogen metabolism.

Her overall hormones were low but we were able to evaluate their pathways. For her, she was converting a bit more to the 4-hydroxy estrogen which was not ideal, her homocysteine was high and her methylation capability needed support. 

We tested her thyroid and while everything was in the lab range, her TSH was a bit out of the optimal range at 3.5.

Before starting compounded bioidentical hormone therapy, we had to fix a few things to make sure she would be able to metabolize the hormones once given. This included adjusting her diet to support a healthy gut biome. And, adjusting a few nutritional imbalances. 

We started Jill on DIM (Diindolylmethane) twice per day. 

We made sure she was getting enough methylated B vitamins including folate and B12 by giving her  Homocysteine Supreme by Designs for Heal...