In our bodies, our hormones work on a lock and key mechanism. Our own hormones fit the lock exactly allowing the proper message in the amount needed by the body to get through. Bioidentical hormones fit the lock almost exactly like our own hormones, allowing them to mimic the actions of our own hormones and keep the body in its balance. Synthetic hormones that do not have a bioidentical structure do not usually fit the lock as well and must “force” their way in. These hormones are often made from different substances including pregnant horse urine (thus the name “Premarin”). Their fit on the hormone receptor is not exactly as the body likes, therefore their function is less than optimal. They may also block out other natural hormones from reaching that receptor.
Can I get bioidentical hormones from a regular pharmacy, such as CVS, or do they need to be compounded?
Some bioidentical hormones do not need to be compounded. One example of this is Elestrin or Divigel, which are bioidentical estradiol. Prometrium is another example of a bioidentical progesterone that is available at any pharmacy. The disadvantage of these hormones is they only come in 1 or 2 doses and can’t be changed if those doses do not work for you. Prometrium is not a slow-release progesterone and often women complain it does not help them stay asleep through the night. Compounded bioidentical hormones can come in whatever dose the patient needs because the pharmacy can “compound” or create whatever dose is needed. The one size fits all method does not always work when addressing hormone imbalances.
I have heard that compounded bioidentical hormones are not FDA approved. Why is that?
In order for the FDA to approve a drug, they must test that drug in a specific dosage and combination. Because a compounded hormone can come in patient specific-personalized doses that the physician determines is needed by each individual patient, it is not possible to test each of these doses. Bioidentical hormones that are not compounded and only come in one or two doses (like the Prometrium example above) are FDA approved. However, this does not mean they are safer than the compounded versions of these hormones.
How soon can I expect to feel better after I start my hormone therapy?
The amount of time needed to see a positive change in symptoms after starting therapy is different for everyone. Bioidentical hormones sit on the hormone receptor site for about 3 months. This means that it takes about 3 months for a change in hormones to saturate that receptor site. It is usually best to wait about 3 months before changing doses (up or down) because that is about how long it will take for the current dose to actually take effect.
Common complaints from our patients are insomnia, hot flashes, night sweats, depression, and irritability. While these symptoms definitely can arise from hormonal imbalance, other factors such as diet, exercise, and stress can also play a huge part. In our hormone programs, we educate and empower you on lifestyle changes that can be made to enhance the effects of hormone therapy. Our patients that make these changes, as well as take their prescribed hormone regime, tend to feel better more quickly.
I still feel a change is needed in my current hormone prescription. What do I do?
You can contact Sheila Vuckovic (Wellness Supervisor), and she will help you decide if you need to come in for a visit. You can contact her via email at Sheila@womensspecialtyhealthcare.com.
How do I get refills on my bioidentical hormones?
It is better to call your pharmacy first before calling our office when a refill is needed. The pharmacy will contact us if you are out of refills. The pharmacy should have our fax number on file, but if not, please feel free to provide it to them (fax 855-752-9179). All hormone prescriptions are good for one year from the start date of your hormone program. You are required to come in once per year after your first year, to allow us to evaluate your progress and decide if any changes need to be made.
What kind of testing do you do to track my hormone levels?
In most cases saliva testing will be recommended. Your hormone levels fluctuate greatly throughout the course of your monthly cycle and this testing allows us to track these fluctuations. Even if you are no longer having monthly cycles, your hormones levels will vary daily and saliva allows us to get an average of the hormone levels over the course of a few days. Checking hormone levels in blood looks at your levels on that specific day and can be appropriate for some patients. More often than not, specific hormone levels are better assessed in saliva. Once you are on hormone therapy, those hormones only stay in the blood for a short time (in some cases, only a few minutes) before they are absorbed into the tissues, which may lead to overmedicating if levels are not tracked through salivary testing. Typically, the hormones that we prefer blood testing for are thyroid and pregnenolone hormones.
We will sometimes also track hormone levels using urine testing. These tests show how you metabolize hormones and are particularly helpful for our patients who have a family history of breast cancer since these tests show how well your body gets rid of excess estrogens.
Does insurance cover bioidentical hormone therapy or any of the testing?
Some of the testing is covered, depending on your insurance carrier. There are no insurance billing codes for bioidentical hormone counseling so these visits do not go through insurance. Contact Sheila for more information.