People often ask me “what is your secret”? I always say there is no secret, just a combination of things that make a huge difference to how one ages. I call it the Toolbox, filled with the tools that build a happy, healthy, youthful body.

But the truth is that the decline of hormones is probably the most ageing thing of all. As oestrogen levels plummet, skin thins, dries out and wrinkles. The dewy, plump appearance of skin seems to disappear overnight. Energy levels are low and often anxiety and depression set in.  A few decades ago women started taking HRT and for awhile it offered  great release from menopausal symptoms. But then it was reported that there were dangerous risks associated with it. There’s now a generation of women who have used no HRT at all.

But there’s a natural alternative and it’s a game changer.

Bio-identical Hormone Replacement Therapy (BHRT) has the potential to safely and effectively help unpleasant symptoms and actually slow down the ageing process. So I guess this is as close to a “secret” as we’re going to get!

However, what exactly is it, is it really safe and how does it affect ageing?

Here, Dr Yehudi Gordon, one of the top gynaecologists in the UK,  summarises the most recent evidence (both scientific and experiential) about BHRT. He explains how it’s different from conventional HRT.

This is everything you need to know. And trust me, you need to know this.

(NB Unfortunately it’s easiest to get this privately but it is possible to get blood tests of hormone levels on the NHS and to get some form BHRT)

It is surprising how few women (and men) know about the latest thinking and available treatments in relation to hormone balance. From teenage years to the 80’s and beyond, women experience the effects of aging but most are unaware that the natural hormone balance can be out of kilter causing a wide range of symptoms – both physical and psychological.

‘Ultimately like all anti-aging treatments bioidentical hormone therapy will always be part of a larger story. Of course BHRT doesn’t prevent ageing, but it slows it down. The most important thing is that people’s quality of life improves. How you look in the mirror when you go out in the morning is one thing, but how you feel is a whole other ball game’ (Vogue April 2015).

Part 1: Bioidentical hormone therapy
– The why, what, who, how and where

We age because of our DNA and lifestyle and because our hormone levels decline

Hormones are chemical messengers that circulate in the bloodstream and affect the function of every organ in our body. There are moment-to-moment fluctuations in hormones, as well as minute- to minute, day-to-day, seasonal and then changes due to major life events such as puberty, pregnancy, adulthood, and the menopause. There is a progressive drop in hormone levels as both men and women age and as the levels decline we lose our energy, strength and vitality.

What are bioidentical hormones?

Bioidentical hormones are exactly similar in molecular structure (i.e. identical) to the hormones that your ovaries and adrenal glands secrete into your bloodstream. They are produced in the laboratory from plants, usually yam or soya. The human body has had millions of years to adapt to metabolising and processing bioidentical hormones; they are part of our normal health and physiology.

What is BHRT (Bioidentical hormone replacement therapy)?

BHRT is treatment using bioidentical hormones to replace or re-balance hormonal deficiencies. BHRT is not a drug and a BHRT lozenge or cream is not classified as a drug. See next section.

How is BHRT different from conventional HRT (hormone replacement therapy)?

Premarin is the commercial name of a hormone replacement medicine that has been marketed since 1942. It is derived from pregnant mares’ urine and although its molecular structure may bear some similarity to that of human hormones, it has been altered. Today, conventional HRT (hormone replacement therapy) may include some bioidentical hormones but most branded and patented HRT consists of synthetic hormones that have a different molecular profile to those produced in the body.

Bioidentical hormones replace the natural hormones produced in the body. The foreign molecules in conventional HRT are drugs and have been shown to cause a number of serious side effects. They increase the risk of breast cancer, heart disease, stroke and blood clots in certain age and lifestyle groups. In contrast, because the human body processes bioidentical hormones as if they were its own, they are better tolerated and have few side effects when taken in the correct dose.

In short, BHRT is safer and has a more positive risk-benefit profile.

Why do you need BHRT?

General health reasons

Hormones are essential for the normal functioning of your body. If the amount produced drops or the balance between the various hormones alters, the body does not function well. The cells in the organs in your body function optimally if they are provided with nutrients (oxygen, water and vitamins and minerals, essential fats and proteins). Cells also contain specific receptors that are stimulated by each hormone and every cell functions best when the hormonal environment is balanced.

The hormones include:

Thyroid:

The thermostat for regulating cell energy

Sex hormones:

Oestrogen, progesterone and testosterone for the optimum functioning of many body cells including the uterus, vagina and breast

Adrenal hormones:

DHEA provides energy and is also converted to sex hormones; cortisol is essential for responding to stress.

In general before the menopause (aged 35 to 50 years), bioidentical hormones are mainly used to balance oestrogen and progesterone in your body. At this time many women have an excess of oestrogen, called oestrogen dominance. This is the cause of many of the symptoms listed in the next section.

It is commonly believed that post menopause (50 years onwards) when the symptoms have ended there is no real need for hormone therapy. The reverse is true. After the menopause, BHRT is mainly used to replace oestrogen, progesterone and testosterone as the ovaries progressively produce fewer and fewer hormones. Many women have zero or low levels of these three hormones by the age of 60. These hormones are essential to slow down deterioration in bone, muscle and skin health as well as protecting the body and promoting vitality. These hormones may also improve the function of the heart and blood vessels and the brain.

Specific symptoms reasons

BHRT helps age-related conditions such as:

• hot flushes
• dry or wrinkled skin
• low energy
• muscle weakness
• memory
• cognition
• low libido
• anxiety, panic attacks, irritability, mood swings or depression
• insomnia
• headaches and migraine
• muscle and joint pain
• urinary and vaginal discomfort and infection
• discomfort with sex

Medically recognisable conditions may improve, such as:

• fertility
• pre-menstrual tension
• painful menstruation
• menorrhagia with heavy bleeding
• irregular periods
• endometriosis
• bone loss and osteoporosis
• sarcopenia with loss of muscle mass and power

Why should you not consider HRT?

Conventional HRT

There is widespread confusion and uncertainty amongst doctors, health professionals and users about conventional HRT. This resulted from a very large study of HRT users in the USA (Women’s Health Initiative, WHI), the published results of which in 2002/2003 raised concerns about the risk of breast cancer, heart disease and blood clots. This study received a great deal of publicity and as a result the number of women in the UK taking HRT fell by 66%. So a generation of women have been denied the positive benefits of hormones in their menopausal years.

More recently there has been an about turn and a retraction of part of the study conclusions though this has received little publicity and the older scares dominate the agenda. The WHI study was conducted amongst overweight women in their mid-sixties who are unrepresentative of the UK population who would benefit from HRT.

Today there is a more favourable shift to conventional HRT but guidance is still in place for use only for menopausal related symptoms.

BHRT

BHRT on the other hand has a wider application across the age range and is much safer than conventional HRT in relation to the ‘big scare’ diseases:

• BHRT does not have the same dangers of heart attack/stroke and thrombosis as conventional HRT. In many instances the hormones increase the good cholesterol, dilate the blood vessels, and do not increase blood clotting thereby possibly even reducing cardiovascular risk.
• Breast cancer risk is mainly related to the use of progestin (altered progesterone in conventional HRT). The risk of breast cancer is not increased using BHRT creams or lozenges. Biest, a commonly used bioidentical oestrogen is a combination of oestradiol and oestriol and oestriol is thought to reduce the risks of breast cancer.

In conclusion, the serious health risks associated with HRT do not apply to BHRT.

Are there adverse effects of BHRT?

Some women on BHRT do report adverse effects such as:

• weight gain
• skin changes
• mood changes
• bloating
• breast tenderness
• headache

These are uncommon when the BHRT treatment is introduced in very low doses and gradually increased over weeks or months. The adverse effects usually diminish with time as the dose of hormones is adjusted for each person and often decreased. Most women find that the benefits far outweigh the disadvantages.

 How is BHRT used?

Non-orally (cream or lozenge)

BHRT is best when it is delivered non-orally, as is commonly used in European countries and increasingly worldwide, based on an extensive literature indicating less risk and a more favourable outcome.

The hormones are usually applied as creams or used as lozenges. The hormones are then absorbed through the skin or the mouth and enter the bloodstream unaltered. They are then identical to the hormones produced by the ovaries, and adrenal glands. Absorption from the lozenge is higher than with the creams. They can also be taken vaginally.

All hormones, even BHRT, taken as pills by mouth, are absorbed into the bloodstream then the liver changes the molecules. The altered molecules can have an adverse effect on metabolism.

Doses and monitoring

A full medical history provides the background to assess whether hormone treatment is needed, and what balance is optimal for each person. With hormone treatment the accent is on symptoms, backed up by a physical examination and tests, particularly hormone levels in the blood. Symptoms and blood levels help to fine tune the hormone doses for each person.

The BHRT philosophy is to use the lowest dose of hormones for the desired effect on symptoms and on health of body organs such as muscle and bone, skin, heart and cardiovascular system. In theory the lower the level in the blood the fewer the side effects:

• For oestrogen, the target blood level is the same as the first three days of the menstrual cycle, before the levels rise at ovulation.
• For progesterone, the target blood levels are equivalent to the first few days following ovulation.
• There are established ranges for blood levels of testosterone in women.
• There are established ranges for blood levels of DHEA in women.

Starting and continuing treatment

Every man and woman is unique and BHRT supplementation is formulated and adjusted to each person’s individual needs.

An initial consultation and a follow-up appointment, usually after a blood test, assess the need for BHRT. At the review of symptoms and blood hormone levels a program of either cream or lozenge will be recommended.

A nutrition program of foods and supplements and exercise will be part of the program.

Check-ups will be required every two or three months in the first year to monitor symptoms. Blood tests, after taking the cream or lozenges for some time, are useful to ensure that the levels of hormones in the blood are optimal and stable. It often takes months to discover the optimal hormone doses. After that checks are less frequent unless symptoms change.

 How long should BHRT continue?

This question is often asked irrespective of the start date of BHRT (forties, fifties, sixties, seventies and even eighties). The simple answer is there is no reason to stop treatment. As explained in this hand out the dose is low and to date there is no evidence of serious side effects.

What is the cost of BHRT?

The average cost of using a cream or lozenge varies on the doses and number of times they are used each day.

In March 2015 the costs were:

• Cream: each tube contains 160 doses and cost £85-£95 (53 – 59p per dose)
• Lozenge: each pack contains 140 doses and cost £90-£100 (64 – 71p per dose)
• BHRT is often taken twice a day and two doses cost less than one cappuccino (£2.25).

The London Specialist Pharmacy prepares the creams and lozenges according to a prescription written by a doctor suited to individual needs. The creams and lozenges are sent to the woman by mail. The constituent hormones can subsequently be changed according to the way that symptoms respond or the test results of blood levels indicate.

Some BHRT hormones are also available on the NHS.

BHRT – part of bigger picture

BHRT is not a magic bullet and cannot work in isolation. Just as a car needs petrol, oil, brake pads and safe tyres, so the body needs good nutrition, exercise and emotional balance for BHRT to function optimally.

Nutrition

Nutrition (defined as eating the ‘right food’ containing vitamins and minerals, essential omega fatty acids and proteins derived from natural, unprocessed food and supplements) is one of the cornerstones of health. Healthy eating enhances the beneficial effects of BHRT hormones on every cell in the body. Changes in eating pattern and lifestyle, often combined with supplements of vitamins and minerals, Omega three essential fatty acids and vitamin D3, can have a remarkable combined effect. Supplements and healthy eating may also reduce the long-term risk of cancer, heart attack and strokes and dementia.

Exercise

Optimal aerobic and anaerobic exercise also enhances the effect of the hormones and foods.

Emotions

Deep-seated emotional and lifestyle issues can have a major effect on natural hormone production by the body. On the other hand balancing the hormones can change emotions and feelings resulting in reduced irritability, anxiety and greater internal feelings of wellbeing.

There are a variety of traditional and newer techniques to help restore emotional balance. The negative effects of issues relating to very early childhood or traumatic events during life can be modulated and modified.

Emotional balance can have a major role in improving the success of BHRT and reducing the doses of the hormones.

 Road map to enhanced wellbeing

1. Every day 50 billion of our cells die and 50 billion are born – we replace almost every body cell within 2 years (there are a few exceptions). Balancing hormones and nutrients provides resources for the new cells to develop and function
2. Use bioidentical hormones to balance existing levels or to replace depleted levels of oestrogen, progesterone, testosterone and DHEA
3. Give your body good building blocks (vitamins, minerals, omega essential fatty acids, proteins and vitamin D)
4. Reduce the hidden ‘poisons’ (e.g. processed foods, pesticide protected foods, hormones and antibiotics given to animals, plastic packaging)
5. Use exercise to increase blood flow, oxygen and nutrients that nourish the body organs and cells. Exercise releases the feel good endorphin hormones that enhance wellbeing and physical activity
6. Rest enhances recuperation and repair
7. Remember that BHRT can alter emotional feelings and vice versa – the two are interdependent