Menopausal symptoms: Bioidentical hormones work best when they are put together individually. Swiss preventive physician Dr. Andreas Bernhardt explains what is important here.
Bioidentical hormones are on the rise. Their prescription has increased rapidly in recent years. The Swiss preventive physician and specialist in bioidentical hormone therapy relies on extemporaneous formulations - preparations individually prepared by pharmacies. Fixed dosages are not effective. What is important here? How can a woman in the menopause benefit from it?
Before we take a look at the dosage form, one more basic question.
What is bioidentical hormone therapy (BHT)?
While conventional hormone replacement therapy (HRT) uses synthetic hormones - chemical compounds that only trigger hormone-like effects in the body - BHT uses hormones from natural sources such as the yam root. They correspond one-to-one to the molecular structure of the body's own oestrogen, progesterone etc. Due to their identical structure and function, they fit exactly onto the receptors intended for them, the docking sites on the cell, and can therefore perform their natural task with the corresponding effect.
Which bioidentical hormones are important during the menopause?
- Progesterone
- Estradiol
- Estriol
- DHEA
- Testosterone
- Possibly also pregnenolone
How are bioidentical hormones produced?
The yam root with the diosgenin it contains - a precursor of the human hormone progesterone - serves as the basis for the production of bioidentical hormones. They are obtained in the laboratory through a simple chemical conversion. The hormones progesterone, oestrogen and testosterone therefore only come from natural sources.
In what form can we take bioidentical hormones?
Bioidentical hormones are used either in tablet or capsule form, but can also be applied to the skin as a gel or used as vaginal suppositories. The dosage is determined by the doctor. In contrast to synthetic hormone preparations, which are offered as ready-to-use medicines, it is advantageous with BHT not to work with fixed dosages, but to respond individually to the patient in the prescription. With such extemporaneous prescriptions, which are prescribed by the doctor, the medicines, similar to substance mixtures prescribed by a dermatologist, are prepared on site by the pharmacy in the dosage specified by the doctor and often filled in capsule form. Various methods are used, such as the Rimkus method. In all cases, hormone preparations require a prescription.
What is the Rimkus method?
The Rimkus method was developed by German gynaecologist Dr. Volker Rimkus. In the early 1990s, he discovered that conventional hormone replacement therapy did not always achieve the desired effect. The Rimkus method uses only naturally derived progesterone, oestrogen and testosterone in capsule form. The capsules contain the hormones dissolved in olive oil.
This has a particular advantage: a drug that is swallowed usually enters the bloodstream via the intestines and liver. Substances are broken down very rapidly in the liver, which means that only a small proportion of the medication enters the body. Olive oil makes the hormones bioavailable by allowing them to pass through the digestive system unaffected and act via the lymphatic system. This results in rapid absorption and higher active levels. However, preparations that are produced strictly according to Rimkus are rigid dosages that are always combined with copper and zinc. According to Dr. Bernhardt, the addition of copper and zinc is often not even necessary - and rigid dosages are therefore unfavorable.
How is the hormone composition determined individually?
In an initial anamnesis, the patient describes her previous medical history, her life circumstances and her current symptoms. The hormone status is determined by means of a blood test, which is more precise and scientific than a saliva test, as Dr. Bernhardt emphasizes. The laboratory analysis and medical history are a prerequisite for the further course of action. The hormone prescription is based on specific target values that are targeted during treatment. The hormones in the capsules are also mixed individually as required.
How is treatment with individualized formulations carried out?
The patient takes the individual hormone mixture for one month, after which the hormone status in the blood is checked again. The current situation is discussed again and the therapy is adjusted with a new formula. The procedure is continued at longer and longer intervals until the hormones are balanced and the patient is completely satisfied with her optimized condition thanks to the BHT. The biohormone therapy process is complex: as the method is highly complex, it usually takes around six months to reach the optimum state. If you wish, you can take the hormones for the rest of your life, accompanied by regular check-ups, explains Dr. Bernhardt. This is because the aim of the better ageing approach is to bring hormone levels up to mid-life levels. Maintaining these levels can prevent or reduce the occurrence of chronic diseases, which, according to international studies, are linked to the increasing and prolonged drop in hormone levels during the menopause.
A patient example:
What does bioidentical hormone therapy help with? A menopausal woman with hot flushes and poor sleep due to an isolated progesterone deficiency: The patient was prescribed 30 mg of bioidentical progesterone to take in the evening before going to bed. The check-up after one month showed that the levels had risen, but were not yet at the target value and symptoms were reduced but still present. She was then given 20 mg progesterone in the morning and 50 mg progesterone in the evening. The adjustment was successful.
It is important to increase the dose of the hormones slowly. Dr. Bernhardt warns that even bioidentical hormones can cause side effects if they are taken in excess.
Conclusion: Individually formulated medicines enable optimal, targeted and personalized care for patients. Biohormones influence hormone balance and the menstrual cycle. The dose is continuously adjusted with regular checks until the desired success is achieved - namely freedom from symptoms. Bioidentical hormone therapy is a highly complex matter that should always be in the hands of a doctor who specializes in BHT!
About Dr. med. Andreas Bernhardt:
Dr. Bernhardt is a specialist in general internal medicine with international training in endocrinology and better aging. He is a member of the Swiss Anti-Aging Society (SSAAMP) and the renowned Endocrine Society (Washington, D.C.). His focus is on bioidentical hormone therapy as part of a holistic longevity concept. As an expert on the German-speaking platform wechselweise.net he is committed to raising awareness in the DACH region about hormonal changes in men and women during the menopause - with the aim of promoting health and quality of life in the long term.