As healthcare providers, we have one primary goal in mind - to improve the health and well-being of our patients. As functional medicine practitioners, we like to have many "tools in our toolbox" when it comes to creating holistic treatment plans. Nutrition, herbal medicine, exercise, mind-body techniques, and many more options are available. Finding the right treatment for the right patient is what makes us effective and sought-out professionals in our fields.
Women are more likely to walk into your office. And what do women struggle with as they age? Perimenopause and menopause - and the uncomfortable symptoms that accompany this phase of life. If we reach into that "toolbox" for this group of patients, we have some treatment options that are helpful. But, Hormone Replacement Therapy (HRT) is the most effective treatment available for menopause symptoms. However, many practitioners are turning to Bioidentical Hormone Replacement Therapy (BHRT) as an even better option.
If you are working with this population of women, BHRT is something that you will want to learn more about and perhaps even incorporate into your practice.
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What is Bioidentical Hormone Replacement Therapy?
During menopause, hormone production drops significantly, leading to many uncomfortable symptoms. Many women turn to Hormone Replacement Therapy (HRT), which replaces the hormones that have declined by using synthetic hormones. However, holistic and natural-minded patients and practitioners have started to recommend Bioidentical Hormone Replacement Therapy (BHRT) instead.
BHRT uses processed plant-derived hormones that mimic the structure of your own hormones. There are BHRT forms of estrogen, progesterone, and testosterone. While BHRT sounds like the ideal alternative to HRT, the downside is that only a few forms of bioidentical hormones are regulated by the FDA and easily accessible through drug companies.
Often, practitioners send prescriptions to compound pharmacies that custom makes the bioidentical hormones. The FDA doesn't approve these compounded forms, which adds risk to taking them.
Who Can Offer Bioidentical Hormone Replacement Therapy in Their Practice?
BHRT requires a prescription, whether a practitioner is prescribing an FDA-approved or a compounded version of the bioidentical hormones. In the USA, prescriptive rights vary by state. This means that each state provides different laws regarding who can prescribe BHRT (or any compounded pharmacological agent) to patients.
Physicians have prescriptive rights in all states. Some states also allow nurse practitioners or naturopathic doctors to prescribe BHRT. Check with your state licensing board to see if you are eligible to write prescriptions for BHRT.
Why You Should Consider Offering Bioidentical Hormone Replacement Therapy in Your Practice
In a functional medicine practice, our goal is to help uncover the underlying root causes of our patient's symptoms and conditions. When it comes to menopause, a natural and expected phase of a woman's life, the root cause of the symptoms is low hormone levels. BHRT can directly help your patients, which is why it's something that practitioners should consider incorporating into their practices.
BHRT is controversial, mainly because compounded pharmacies do not have to adhere to the strict guidelines that FDA-approved drugs do. However, because of compounding, the bioidentical hormones can be more tailored to your patient's needs.
BHRT addresses the same symptoms that conventional HRT does. However, there is some evidence that BHRT has fewer potential side effects. Research shows that compared to their non-bioidentical preparations, bioidentical estrogens and progesterone have a reduced risk of blood clots.
Further research demonstrated that bioidentical hormones have a lower risk of breast cancer and cardiovascular disease compared to their synthetic counterparts and are more efficacious.
How to Get Certified in BHRT
It is not legally necessary to become certified in BHRT to prescribe BHRT in your practice as long as you are licensed in your state and have prescription rights.
However, if you are brand new to BHRT, it might be overwhelming (and inappropriate) to offer this new service without the expertise to back it up. Getting certified in BHRT can be valuable since many factors go into prescribing BHRT. A thorough certification program will discuss the ins and outs of who to prescribe to, when and in what form and dose, and for how long, along with many other details.
Many certification programs are available online for convenience. Some even offer Continuing Education credits to providers with specific credentials, which is always helpful to collect when learning something new for your practice!
What Forms Does BHRT Come in?
Bioidentical hormones are available in multiple forms, and each form serves a different purpose and may be used for different symptoms. The available forms include the following:
- Pills
- Patches
- Creams
- Gels
- Injections
- Implanted pellets
Practitioners can try different forms with their patients to find the best fit. However, some forms are meant for specific symptoms, such as local vaginal creams or gels for the symptom of vaginal dryness.
What Does a BHRT Treatment Plan Consist of?
After an initial consultation, hormonal blood work (salivary or urine hormone panels are available, too) will be taken to understand baseline hormone levels, specifically sex hormones, adrenal hormones, and thyroid hormones. After beginning BHRT, 3-6 months later, additional hormone panels are recommended and then annually or more if needed.
An initial consultation, medical history, current symptoms, and treatment goals are assessed. The first part of the treatment plan should be thorough education during the visit so that the patient fully understands this therapy. Education consists of typical hormonal changes to expect during menopause, causative factors of menopause symptoms, risks and benefits of HRT and BHRT, and the various available forms.
The treatment plan is to begin BHRT at the lowest effective dose and closely monitor symptom regression and side effects. Dosages are then adjusted accordingly, if necessary, at each follow-up visit. Functional medicine practitioners will assess other important bodily functions, such as gut and liver health, for holistic hormonal support.
Functional Medicine Labs to Test to Consider Using in Your Bioidentical Hormone Replacement Therapy Practice
Regarding BHRT, you must accurately monitor your patients' hormone levels. The best functional test to do that is the DUTCH Complete Test because it analyzes sex and adrenal hormones. It also assesses other essential health measures, such as sleep quality (via cortisol and melatonin markers) and several nutrient/neurotransmitter deficiencies (via organic acids). It even measures a marker for oxidative stress.
Hormones are communicators and are constantly interacting with each other. The thyroid hormones are also essential to monitor when your patients are on BHRT because low or high thyroid function may affect the required level of BHRT. A full Thyroid Panel is necessary for all BHRT patients.
Our liver is a vital organ that plays many roles. One of its more notable roles is detoxifying chemicals, toxins, and hormones. Ensuring a healthy functioning liver is required for patients on BHRT because all hormones, whether we produce them ourselves or take them supplementally, will be filtered through the liver. A Hepatic Function panel assesses the general function and health of the liver.
Gut health is intertwined with hormone health. Therefore, assessing the gut microbiome is an excellent idea for patients on BHRT. The GI-MAP is a comprehensive stool analysis that examines the gut microbiota DNA to give a detailed overview of the makeup of the microbes within the gut. Assessing the gut microbiome benefits hormone health and general wellness, making this an excellent tool for all patients.
Summary
Bioidentical Hormone Replacement Therapy (BHRT) is a great option for prescribing practitioners to offer to their menopausal patients. Specifically, functional medicine practitioners can utilize BHRT in combination with other holistic modalities to create well-rounded treatment plans to combat the symptoms of menopause.
Functional medicine testing offers great options for monitoring the effectiveness of the BHRT and total health and wellness.
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