by Lori Gleichman, for The Bulletin Special Projects
Reprinted from The Bulletin’s U Magazine – June 2009

Bioidentical hormone replacement therapy has allowed some women to take back their lives. Two women who don’t know each other still have a lot of life experience in common, like finding themselves again after years of feeling “not quite right.” Both use words and phrases like lethargic, fuzzy thinking, “tired all the time,” extremely irritable, trouble sleeping, and night sweats to describe their symptoms. In essence, they were miserable and didn’t know why.
In both cases, they consulted their regular physicians who diagnosed depression or early menopause and prescribed pills. In both cases, they felt they needed something different and eventually had their hormone levels tested. The tests registered in the zero to “barely there” range. And both finally found a solution to their problems: bioidentical hormone replacement therapy (BHRT).
To some, BHRT is mysterious and controversial, but to Aileen Walker, 43, and Tonya McKiernan, 44, it is a treatment that has provided tremendous relief. “For me, the change was almost immediate,” said McKiernan.”

Their Stories
McKiernan experienced surgically-induced menopause when her ovaries were removed due to cancer. After suffering a variety of symptoms for years, she finally questioned the depression diagnosis and had her hormone levels checked. “Essentially, I had no hormones at all,” she said.
Walker had a similar experience, even though it has taken about a year to get her hormone levels to the point where “I feel myself again,” she said. Walker started feeling badly in her early 30s, but the symptoms escalated— irritability, fuzzy thinking, and drastic changes in her body —after the birth of her second child, Zach, at 38.
“In retrospect, I was probably having hormone imbalances for years, but after Zach, everything amplified,” she said. Doctors prescribed birth control pills after testing her hormone levels, which registered at the “barely there” mark. This didn’t sit well with Walker.
“I knew there had to be other options,” she
said. She consulted with Dr. Evelyn Brust, ND, LAC at Preventative Medicine Clinic in Bend and was amazed at the detail that resulted from the testing process and the discussion. “We went through every single line on the blood labs and discussed what it meant and why it was important,” Walker said. Walker left with a prescription for bioidentical hormone replacement therapy that has evolved over the last year to match every symptom with the right level of hormone. “Now I feel much better overall on every level,” said Walker. “I never knew hormones could make you feel so bad—or so good.”

The Power of Hormones
In fact, hormones make up one of the most important systems in our bodies. They act as chemical messengers that carry information between groups of cells, regulating growth, tissue development, sexual function, and how our bodies use food and react to events.
For women, important groups that influence how we feel are estrogen, progesterone and testosterone. In balance, they work together for health and wellness of both body and mind; out of balance, women can suffer from symptoms that seriously impact the quality of life like hot flashes; sleeplessness, irregular, heavy and painful periods, migraines and mood swings. These symptoms can start as soon as a girl starts puberty and be a problem throughout the years not just as symptoms of peri-menopause or menopause.
Ron Rosen, MD, PC with Open Paths Integrative Medicine in Bend, has seen an increase of women seeking advice about these symptoms for themselves and for their daughters, who seek alternatives to suffering or synthetic hormones. “Women are educating themselves more about health issues and have more awareness of their own bodies,” he said. “They are more willing to deal proactively with things and questioning traditional approaches to hormone replacement therapy.”
Rosen encourages people to do their research, talk to physicians in detail about symptoms and concerns. If not satisfied, look for other options. “Different practitioners offer different information and alternatives,” he said. Brust agreed. “Many of us know intuitively when something is wrong, even if it can only be talked about in terms of how we feel,” she said. “I think the integrative medicine community pays more attention to listening to patients, as well as doing the ‘science’ of medicine.”

Is BHRT the Answer?
To determine exactly what is wrong, Brust spends times with a patient discussing symptoms. She then runs a series of lab tests to determine baseline levels of hormones and other body chemistries. She also does a series of screenings for the heart, bone density, mammograms and PAP smears to determine any other risk factors that need to be considered in BHRT. Finally, she has a conversation about short- and long-term risks and benefits.
“I encourage women to look at life right now—what is critical to be addressed to make them feel better—but also to look at the future,” she said. “BHRT is preventative for many diseases like heart disease and memory loss, but people have concerns about risks as well even though there have been no studies to date that show a link between BHRT and cancers or heart attacks.”

Treatment Options

If BHRT is right for you, you will likely be referred with a prescription to a compounding pharmacy, which specializes in combining components for individual needs versus a dispensing pharmacy which doles out medications manufactured in an industrial setting.
You will also discuss a delivery method as BHRT is generally applied topically in a cream, in a troche that dissolves under the tongue, or a suppository.The compounding pharmacists also often plays a consulting role with patients, monitoring their symptoms and working with the physician to “tweak” the prescription to just the right levels, explained Barbara Dembsky, owner/pharmacists with CustomCare Rx in Bend. Dembsky said that people considering bioidentical hormones need to understand two things. First, the chemical structures of bioidentical hormones are identical to those produced by the human body, not simulated like synthetic hormones such as Premarin or Prempro. Secondly, each prescription is compounded specifically for each individual receiving the therapy—BHRT does not offer a “one-size-fits-many” approach.
According to the International Academy of Compounding Pharmacists, the final bioidentical hormone product is not regulated by a state or federal agency, but bioidentical hormones—like all compounded medications— are made from FDA- and USP- registered materials. “Compounding pharmacists are highly trained and subject to state board of specification standards,” Dembsky said. Both McKiernan and Walker agree that they “just feel better,” and encourage women to talk to one another about their experiences with hormone imbalances. There is no reason to suffer from the symptoms, they say.
Relief can take time, added Dr. Brust, “but if BHRT is the right path for you, most will notice a difference in the symptoms that bothered you quickly, and you will start to feel better.”
For McKiernan, that meant a better and more fulfilling life. “I have energy. I think clearly. I have emotions now,” she said. “My mom says the old Tonya is back.”