By Sarah A LoBisco, ND
I just finished a two part blog series on When Should a Woman Consider Hormone Replacement? What is the REAL Risk? In it, I discussed the factors to consider for a comprehensive wellness approach to hormone balance. I also advocated for addressing the cause of imbalanced hormones vs. simply modifying its symptoms.
Dr. Mercola also recently posted a great summary of considerations when deciding on if one should use hormones:
- Surgically-induced menopause vs. natural menopause vs. using HRT for preventive purposes Your age
- The form of hormone you take (bioidentical vs. synthetic). For example, the WHI study used one specific formulation of HRT called Prempro, which contains potent horse estrogens that are manufactured from the urine of pregnant mares, in combination with a synthetic (read FAKE) form of progesterone (medroxyprogesterone acetate). It’s likely that bioidentical natural formulations would have resulted in a different outcome…
- The manner in which you administer the hormone
The Importance of Testing & the Caveats
When putting something as powerful as a hormone in your body, it is definitely wise to follow up with testing from a practitioner. This practitioner should understand the shortcomings and usefulness of hormonal lab values and how to interpret them for your specific needs.
For example, women can have genetic differences in how they body breaks down and assimilate hormones, including topical creams. These are termed single nucleotide polymorphisms (SNPs) and testing for these can provide information on how a women will metabolize hormonal therapy, which can affect outcomes.
Other factors in hormonal assessment include the capacity of the liver to breakdown hormones, tissue reserve of hormones, fat storage of hormones, and hormone converting enzyme pathways. Furthermore, nutrient deficiencies, stress, genetic predispositions, or lifestyle patterns all have an effect on hormones.
Here are some caveats with testing hormones:
- Serum labs don’t always account for an accurate full picture of free and bioavailable hormones. Most only test serum levels, not tissue or fat reserve.
- The age factor: The feedback mechanisms for estrogen production differ with age. In premenopausal women blood levels affect feedback to production of more estrogen. In postmenopausal women, estrogen is formed in peripheral tissue and related to adrenal production. Therefore, assessing hormone levels should take this into account when choosing serum, urine, or salivary hormone tests.
- Salivary cortisol or hormonal salivary panels don’t always account for all metabolites, excretion rate, and storage of hormones in distant sites.
- For example, cortisol can breakdown to cortolones and cortols based on favored enzyme pathways.
- Furthermore, without looking at adrenaline and noradrenaline urinary metabolites, it is hard to get a full picture of adrenal health.
As you can see, this is a very topic. That is why it’s important to have someone you trust guide you in what a healthy hormone picture looks like for you.
For more discussion on bio identical vs. synthetic hormonal replacement, see my blog on this page.
For references to this blog, please see my homepage blog: When Should a Woman Consider Hormone Replacement? What is the REAL Risk II?