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Bioidentical Hormone Therapy
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Bioidentical hormone therapy (BIHT) is a term that was coined in the past ten years but it is not a new concept. I have been prescribing BIHT in my practice since 1985. This refers to the concept of prescribing hormones which are identical to the hormones that are intrinsic to a woman’s body namely estradiol, progesterone and testosterone. These preparations may be custom made by a compounding pharmacist and are called BiEst or TriEst. There are also some proprietary prescription hormones, which are bioidentical ( Estrace, Vivelle, Prometrium, Climara, Alora ). The important fact to know is that the most commonly prescribed hormone in the United States is Premarin or PremPro and these products are not bio-identical hormone therapy because they come from the urine of pregnant mares. PremPro is a combination product which contains Premarin and Provera. In men, bioidentical hormones would consist of testosterone.
The decision to initiate hormone replacement requires a thorough assessment of your health care risks with your physician so that you have a clear understanding of the benefits and risks associated with hormone therapy. All hormone therapy, including Bioidentical Hormone Replacement Therapy carries some side effects. Because BIHT mimics the normal physiology of the human female, it is often better tolerated than Premarin products.
Another important concept in BIHT is that of individual variability. There is no one cookbook formula that can be applied for all women. Appropriate doses are developed based on symptoms and monitoring of blood hormone levels for each woman. In women with an intact uterus, it is also important to mimic the cyclicity of estradiol and progesterone. Taking estrogen with a sequential dose of progesterone will likely result in a light monthly period, which is necessary to prevent harmful buildup of the endometrium, the lining of the uterus. Giving estrogen without progesterone to a woman with an intact uterus is associated with a two to three-fold increase in endometrial cancer. It is important that you work with a physician who is knowledgeable in prescribing this form of therapy. 
For more information read our Feature Article - Bioidentical Hormones - An Endocrinologist's Viewpoint
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