This post is for you if you’re hormone-curious or already using bioidentical hormones. These days women have the option to use these innovative human-matched hormones for relief from symptoms like hot flashes, insomnia, and mood swings. Many women also choose to use bioidenticals for the anti-inflammatory, protective, and longevity benefits. Maintaining physiological levels of estrogen, in particular, can protect your brain, bones, and heart, and prevent your skin and vaginal tissues from dryness and atrophy.
However, women often go on BHRT without addressing crucial underlying issues that will make them safer and more effective. By the way, bioidentical hormones have a safe profile if prescribed correctly by a provider who understands your history and how to monitor you. However, even if they are low-risk, they are not 100% risk-free. So if you use hormones, see a knowledgeable prescriber who does in-person physical exams, only use bioidenticals (no thank you to horse urine estrogen derivatives), and follow these steps below.
5 Steps to take before using bioidentical hormones
1. Support your own hormone production
Improve your own hormone production so that you need less from your prescription. You still make hormones after menopause! You just make less of them. Your sex hormones (estrogen, progesterone, testosterone) are made from cholesterol in the mitochondria of your cells. This means you need adequate cholesterol (yes low cholesterol, below 150, can be a problem) and you need healthy mitochondrial function. You can assess your cholesterol with a fasting lipid test, and your mitochondria with a functional urine test like the Organix. If mitchondrial functions is not up to par, it may be due to low nutrient status, oxidative stress, or damage from toxins.
2. Improve your hormone signaling
Hormone production is signaled by messenger chemicals from your brain, specifically your hypothalamus and pituitary glands. This communication system can go off-line when your sleep, exercise, or stress are dysregulated, and result in unbalanced cortisol and/or melatonin. For women on hormones, the exercise sweet spot is at least two hours of cardiovascular exercise per week along with strength training. But overtraining can derail your cortisol so be careful. The sweet spot for sleep is 7-9 hours. The sweet spot for stress is when it’s managed. American women go go go, even when we have time off. Incorporate more unstructured and unscheduled time in your life to relax and play.
3. Make your hormone receptors work
Often the problem with low hormone symptoms is not that the production is too low, or that the intake of replacement hormones is too low, it’s that the receptors don’t function well. What stops hormone receptors from functioning well? Inflammation! Inflammatory cytokines gum up hormone receptors and block your precious hormones from attaching. This is what happens with insulin resistance. With inflammation, there are two projects:
- Hunt for sources of inflammation, such as dysregulated blood sugar (low or high), obesity, high stress, sleep apnea, anemia, allergies, inflammatory food, gut dysbiosis, and chronic infections.
- Make sure your intake of EPA and DHA omega-3 fats are sufficient. EPA and DHA act like hormones in your body, they are your own natural ibuprofen. You can do an Omega Check at Quest or Labcorp to find out your omega 3 level and supplement to correction. The dose on a bottle of fish oil may not be the right dose for you as an individual!
4. Break down and get rid of your hormones
You break down hormones in your liver through phase 1 and phase 2 liver detox. Then in phase 3, your liver ejects hormone metabolites via your bile into your GI tract, where your beneficial gut bacteria break them down more and poop them out. It’s crucial to break down hormones efficiently through your liver-bile-gut-poop pathways! If not, toxic estrogen metabolites can back up or get reabsorbed.
Some women don’t metabolize hormones through their liver efficiently, due to genetics, fatty liver, or alcohol use (in fact alcohol significantly increases your breast cancer risks). This is where the DUTCH Complete Hormone test comes in. The best part of this test is to see how you metabolize estrogen. It’s important to favor the safe 2OH pathway (phase 1) and to have good methylation (phase 2). Here’s an example of a DUTCH estrogen metabolite map:
Whether you can run a DUTCH test or not, I recommend all women on hormones take liver support. There are many good liver support products, and you can choose one that matches the findings from your DUTCH test.
For gut bacteria, I recommend all women on hormones do a Functional stool test like the GI Map to assess and optimize their microbiome. Look for a marker called “beta-glucuronidase” which should not be high. This marker means you may be reabsorbing estrogens, which is not a good thing. Lastly, you need to have healthy bristol type 4 poops every single day before taking hormones, even topical hormones or pellets.
5. Learn about and nix endocrine disruptors
If you’ve gotten this far, you’re probably familiar with the concept of endocrine-disrupting chemicals that we are all bathed in from our environment. The gist of this is that these chemicals act as xenoestrogens (foreign estrogens) They land on estrogen receptor sites and wreak havoc while blocking good estrogens. Take charge of what is in your control by eating organic foods, using clean beauty and household products, avoiding hair dye and nail polish, and NEVER eating or drinking out of ANY plastic. Heated plastic is the worst – think water bottles left in the car. If you want to learn more about how to avoid endocrine disruptors, check out the guides on Environmental Working Group.
Want some help getting your ducks in a row for successful hormone treatment, or to avoid hormone replacement altogether? I’m the person who can help you functionally master these steps!