The Investigation

Women experience a range of physical and emotional changes when they enter the perimenopause stage. These symptoms vary greatly from person to person and may include: 

• Hot flashes
• Night sweats
• Low libido
• Increased anxiety
• Not sleeping well
• Low energy
• Weight gain
• Menstrual cycle irregularities
• Cyclical headaches or migraines
• Mood swings
• Memory loss 
• Brain fog
• Vaginal dryness
• Urinary tract infections 
• Hair thinning

For a lot of women, they hold the false belief that this is something they have to suffer through. There are treatment options out there but with conflicting reports and information, it can be a challenge to figure out the right one. This confusion and fear is another reason that so many women resign themselves to just suffering through this period of their life. 

In  episode 96 of Health Mysteries Solved, we spoke with Dr. Jim Hrncir about this issue. The response I got from that episode was fantastic but I could see that there were more questions too. So, I decided to invite Dr. Hrncir back to dive deeper into these questions around the safety and efficacy of compounding bioidentical hormones for treating the symptoms of perimenopause and menopause. 

An Advocate and Expert in Compounding Bioidentical Hormones

Dr. Jim Hrncir is a hormone expert and compounding pharmacist. In fact, he’s 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 available throughout the US. And, he’s one of the driving forces taking on big pharma (and congress) to clear the path for the use of bioidentical hormones in the US. 

He’s passionate about what bioidentical hormones can do for women’s health; not just in reducing symptoms but in supporting optimal health. 

The Benefits of Compounded Bioidentical Hormones (Beyond Reducing Menopause Symptoms)

While most women turn to bioidentical hormones to help them deal with the symptoms of perimenopause and menopause, Jim says that there are additional health benefits to bioidentical hormone replacement therapy (BHRT) that often get overlooked. 

He claims that his bioidentical hormone replacement therapy patients experience better health as well as a higher quality of life. 

According to Dr. Hrncir, women who are on bioidentical hormone treatments will have a reduced risk of heart attack and stroke (which, he explains, is the number one killer of women with 400,000 female deaths related to heart attack and stroke each year). He also says that bioidentical hormones help reduce osteoporosis. 

Breast cancer is often a concern for women and those on bioidentical hormones can see a decreased risk here too, according to Dr. Hrncir.

He also says that these hormones can help with anti-aging, colon health, brain health, and sexual health. 

In this episode, he shared some unbelievable statistics about the degree of risk reduction. Dr. Hrncir says that women who use these hormones “are going to have a 50% decreased risk of heart disease and stroke. A 50% decreased risk of osteoporosis. Twenty percent decreased risk in breast cancer risks… also 78% decreased risk in dementia. And, what about colon cancer? Reduce risk 50%. Longevity and antiaging, you know, none of us want to age faster than we have to. Plus, isn't it nice to know that these hormones, not only are they sex hormones, but they're also anti-inflammatory hormones, which means they're going to be reducing inflammation, not only in your body and your joints and your muscles, but also in your brain, you know brain inflammation leads to all kinds of disturbances including dementia.”

When Can Women Start Using Bioidentical Hormone Replacement Therapy

Dr. Hrncir says that women don’t need to wait to have symptoms of perimenopause before starting on bioidentical hormone therapy since the health benefits are reason enough to start. He feels that even women who are pre-perimenopause and who are post menopause can enjoy the health benefits of hormone therapy. He has his 84-year-old mother on bioidentical hormones. 

While some feel that they shouldn’t mess with nature because menopause is a natural process, Jim points out that our bodies are still operating on a much shorter life expectancy than we currently have. So, he feels there is no need to suffer through a reduced quality of life and with an increased risk of disease given that we are living much longer these days. 

Testing hormone levels early on can help to establish a baseline and track how well hormones are balanced. A baseline test might look at estrogen, progesterone, testosterone, adrenals, DHEA, DHEA sulfate, and cortisol. 

How Long Can Women be on Bioidentical Hormone Replacement Therapy

Women can start thinking about bioidentical hormone therapy when they reach the age of perimenopause and can stay on it for as long as they like, according to Dr. Hrncir. There have been studies that point to the health risks of staying on BHRT for more than five years, but in recent years the study that is often cited has reversed its findings, points out Dr. Hrncir. 

He believes that some people may still be hanging on to these old findings and he encourages his patients to look at the upsides and research that shows reduced risk instead.  

What’s in Bioidentical Hormone Treatments?

The treatment is to replace what a woman’s body is no longer making. After menopause, a woman's body makes estrone own automatically. The adrenals make DHEA which is then converted into estrone. Women also get estrone from fat tissues. So, there is no need to give extra estrone (plus estrone has three metabolites, two of which are risky). As women age, they stop making estradiol and estriol, for the most part. For this reason, most treatments are a combination of estradiol (the most potent estrogen in supporting the brain, heart and bones) and estriol (a protective estrogen). 

Dr. Hrncir loves something called Biest, which is a combination of estriol and estradiol. The ratio is up to the doctor. Some give 50/50 each while others might go with 80% estriol and 20% estradiol. 

How is Bioidentical Hormone Replacement Therapy Delivered? Pill or Patch?

Dr. Hrncir prefers transdermal applications although he doesn’t love the patch because he says many women are allergic to the adhesive. He also warms about estrogen being taken orally because, as he says, it goes from the stomach, right to the liver. This can induce clotting factors in the liver, which then go to a higher level and could increase the risk of forming a clot, like a DVT or Deep Vein Thrombosis.

Topically applied hormone replacement creams do not have the same risk of clots. This might be cream applied to the skin but there is also the option of getting a lower dose to apply to the labia. 

The labial application works quickly and effectively because the membrane absorbs the hormones easily. In his practice, he says about 90% of his patients are on transdermal hormones with the other 10% using the labial application. 

Transference (having the cream run off on others, pets, or clothing) is something to also consider when deciding which is right for you.&n...