Bioidentical hormone replacement therapy can be an important treatment option for women with osteoporosis or osteopenia. In fact, a current review [March, 2018, Epub ahead of print] by three American Gynaecologists proposes that hormone therapy (HT) “should be considered for the primary prevention and treatment of osteoporosis in appropriate candidates. Hormone therapy (HT) should be individualized and the once ‘lowest dose for shortest period of time’ concept should no longer be used. ” (1)
The decision to take hormone replacement therapy is an important one and can be very complex. You need to work closely with a bioidentical hormone replacement therapy doctor skilled in this treatment before you commit to this path.
In this blog post, I will cover the following topics:
- How bioidentical hormone replacement therapy can optimize the health of your bones and help you manage osteoporosis.
- The relationship between hormones and osteoporosis.
- How hormones affect bone health during puberty.
- The benefits of bioidentical hormone replacement therapy.
- How to choose a bioidentical hormone replacement therapy doctor.
- Bioidentical hormone replacement therapy cost.
- My personal experience with bioidentical hormone replacement therapy.
Let’s start with role of hormone replacement therapy for osteoporosis and then cover the relationship between hormones and osteoporosis. From there we will get later get into the costs of the treatment and how to find a doctor for bioidentical hormone replacement therapy.
Please note that the term ‘bioidentical hormone replacement therapy’ is interchangeable with ‘hormone replacement therapy’ in this blog post.
[This post was updated on March 20, 2018.]
Hormone Replacement Therapy for Osteoporosis
There are, in general, four variables that affect the health of your bones:
- Your genetic makeup. Have you inherited strong bones from your parents? Unfortunately, you cannot control these one so you have to learn to live with the skeleton that you were given. The good news is that you can influence the remaining three variables.
- Your nutrition. In past blog posts, I have spoken about different nutrition topics including: vitamin K2 for osteoporosis, milk for osteoporosis, nitrate rich foods, calcium and osteoporosis, prunes for osteoporosis, sodium and osteoporosis, omega 3, and protein and bone health. I have provided a diet plan for osteoporosis that you can follow.
- Your osteoporosis exercise program and specifically how you load and weight bear on bones. There are over 100 blog posts on osteoporosis exercise on this site. For most readers, a good place to start is Exercise for Better Bones.
- Your hormones and specifically hormone replacement therapy for osteoporosis. The balance of this blog post is dedicated to hormones and osteoporosis.
Hormones and Osteoporosis
Research shows that there is a strong relationship between hormones and osteoporosis. This is illustrated in studies done on bone formation during puberty and studies that look at bone formation for premenopausal women and postmenopausal women.
Hormones, Puberty and Bone Health
Over a quarter of the bone that a person will build in their entire life happens during the 2 years surrounding the start of puberty. (2) By the end of adolescence an individual’s skeletal mass has almost doubled. (3) Sex steroids play an important tole in the optimal development of muscle and bone.”Unfavourable body composition during sexual maturation results in sub-optimal bone mass and strength in both early adulthood and later life.” (4)
Hormones, Osteoporosis, and Premenopausal and Postmenopausal Women
Studies show postmenopausal women, who are experiencing a depletion of estrogen, are never able to build bone as effectively as postmenopausal women, women who have a healthy estrogen levels.
The postmenopausal women can exercise just as hard as the premenopausal women, and follow the same nutrition plan, but they do not have the hormones that the premenopausal women have to help support the growth of the bone.
When you think about hormones and osteoporosis, you need to consider your stage of life and your hormonal level.
Osteoporosis and Young Women
As we mentioned above, puberty is an important time in bone formation. Young women need to pay attention to when they start their menstrual cycle.
Activities such as ballet, gymnastics or may keep their percent body fat very low and delaying the onset of menarche. This is not good for bone health since it restricts the critical time during puberty when bone formation is rapid.
Unless these young people are considering a lifetime career in athletics or ballet, you may want to help them understand the importance of having sufficient amount of body fat in order to allow the body to feel that it’s surviving well enough that it can actually start having a regular menstrual cycle.
Finally, the regular occurrence of a menstrual cycle is a very good indicator that bones are being well supported by hormones.
Depo Provera and Osteoporosis
Is there a relationship between Depo Provera and osteoporosis? It turns out that there is.
Certain birth control choices, such as Depo Provera, can stop menstrual cycles from occurring. This may be practical for young athletes but it has been shown that it can be detrimental to bone at an important time in life to build bone.
Young women in puberty and women close to menopause, have limited time to rebuild bone. Depo Provera can rob them of this critical time to build bone.
Transgendered Youth, Estrogen, Testosterone and Osteoporosis
Transgendered youth who are either given estrogen or testosterone during sex change can lose bone. It is important that they work closely with their physician and they stay on their hormonal prescriptions that they are given. These hormones will have a really significant impact on their bones. In the article, Hormone therapy for transgender patients, Unger states: “Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy.” (5)
Benefits of Bioidentical Hormone Replacement Therapy
I have been on bioidentical hormones for a number of years and I want to share my personal experience and the three main benefits of bioidentical hormone replacement therapy. I call them the three “S’s”. The three main benefits are:
Strength and Bioidentical Hormone Replacement Therapy
One of the main reasons why I started bioidentical hormones was to maintain the strength of my bones and muscles. I found that once I hit menopause I was not able to lift as hard. I was not recovering as well from my workouts.
Tests showed that my bone loss was at a very high rate because of my genetics, my petite stature, and being a Caucasian. We know that, in general, women will lose bone between 1 and 5% a year. I was losing 5% a year. That was way too fast for me. And I had a lot of years left ahead of me.
Since starting the bioidentical hormone replacement therapy, I feel much stronger. My stamina, particularly when I exercise, has improved. My bone density scores have stopped declining.
It is exciting to see that since starting menopausal hormone replacement therapy (MHRT) that a study has come out to show that not only does it have a positive affect on bone mineral density (BMD) but that it also preserves bone microarchitecture. The positive effect on bone microarchitecture and BMD was maintained even two years after stopping MHRT. (6) In other words, bone quality is maintained with this treatment option.
Sex and Bioidentical Hormone Replacement Therapy
Sex was the second motivation. I’ve had a great marriage for 28 years and sex has been a really important part of that marriage. Hope my kids aren’t listening.
I wanted sex to continue to be an important part of our relationship. However, having sex without hormones was like having sex with a big blanket between us. I couldn’t feel a whole lot of anything. I could see my husband enjoyed it, but I wasn’t part of the picture on enjoyment. And I thought, “Well that is not going to work very well for the next few decades of my life.” That needed to change!
Since starting the bioidentical hormone replacement therapy, I feel much engaged during sex and feel more sensations.
Sleep and Bioidentical Hormone Replacement Therapy
The third benefit of bioidentical hormone replacement therapy was sleep. A really important part of having good health is having a good restorative sleep. I have always been a good sleeper, but with menopause and hot flashes, I wasn’t sleeping as soundly as I was used to, or as I wanted to.
Since starting the bioidentical hormone replacement therapy, my sleep is back to what it was before menopause set it. I sleep much deeper and uninterrupted through the night.
Those are the three reasons that I decide to embark on the journey of bioidentical hormones.
Osteoporosis and Hormone Replacement Therapy
Can hormone replacement therapy alone improve osteoporosis? Do you need to supplement the bioidentical hormone replacement therapy with other things?
Bone quality, bone density and consequently, bone strength, are all products of hormonal balance, exercise, diet and good genetics. If one is lacking or weak it impacts the effect of all the others to be able to build bone to it’s optimum level.
By taking bioidentical hormone replacement therapy you are trying to reduce the effect of your own hormonal decline. At the same time, it becomes more important to optimize your nutrition and exercise. They all play an important role.
During the first seven to ten years of menopause, your body is adapting to the loss of hormones. This is why women lose the most bone during this period. Without hormones, it is very difficult to build bone. Your goal should be to maintain bone and if you are “maintaining” you are “gaining”.
With or without hormones, specific exercises will optimize your bone health.
Bioidentical Hormone Replacement Therapy Doctors
Once I decided that I wanted to start hormone therapy, my biggest challenge was locating bioidentical hormone replacement therapy doctors close to where I live and then choosing one. I had to find a doctor comfortable with bioidentical hormone replacement therapy and could determine the type of hormones and quantity that I should take.
Bioidentical Hormone Replacement Therapy Physicians
Before locating a bioidentical hormone replacement therapy doctor, I was reading books (read my review of The Hormone Cure) and doing research on bioidentical hormone replacement therapy. My first thought was to start with my general physician.
I approached him with my concerns. To no surprise, he did not have a lot of knowledge in bioidentical hormone replacement therapy for osteoporosis.
He was sympathetic to my concerns. He was willing to do a hormone blood test on me, look at my testosterone, estrogen, and progesterone levels. However, when the test results came in he was not too sure about the next steps. The tests found that the hormone levels were so low in some areas.
Naturopathic Hormone Balance
I approached a naturopathic doctor who I knew had experience in naturopathic hormone balance. Because we live in Canada, she cannot prescribe hormones. However, she wrote up recommendations for my doctor to follow.
My doctor would prescribe a couple of hormones. I would start feeling a little bit better. However, I didn’t know if I was at my optimum level.
When I asked him if he would do another blood test, he would ask, “Well, are you feeling better?”
I would say, “Yes.”
But I never knew if I was feeling at my optimum. I never knew if my levels were at their optimum. Finally, he wasn’t willing to do another blood test.
That was too erratic for me and, in the end, did not work. I didn’t feel like I was moving in the right direction I wanted to move on to another approach
Found: A Bioidentical Hormone Replacement Therapy Physician!
With the encouragement of my husband we started looking outside of Ottawa for a bioidentical hormone replacement therapy physician. With some work we found a doctor who specialized in bioidentical hormone replacement therapy in Toronto.
It has meant a four hour train trip to Toronto, but it has been well worth the journey.
I hope this has given you a little bit of guidance into the need to be persevering and standing up for yourself.
Evaluating Bioidentical Hormone Replacement Therapy Doctors
Here are some guidelines and tips on evaluating bioidentical hormone replacement therapy doctors. When it comes to your final choice, you will need to evaluate the following:
- Do they have experience in bioidentical hormone replacement therapy? Not all physicians do. In fact, limited time is spent in medical school on hormones and hormone therapy. Find one who has several years of experience in this treatment area.
- Are they knowledgeable in osteoporosis? The medical specialties most often familiar with hormones and osteoporosis are endocrinologists and gynaecologists. My experience has been that gynaecologists are the most comfortable with hormone replacement therapy; probably because they deal with women’s health issues on a regular basis.
- Are they willing to perform repeated tests to determine your optimal hormone level? I found it took several test cycles before the physician achieved the optimal balance for me.
- Are they comfortable with bioidentical hormone replacement therapy? Hormones can be quite complex and hard to understand. You want to be with someone who understands the chemistry and potentials interactions with your body. It takes some skill and knowledge to know the types of hormones and the proper levels to prescribe to arrive at the optimal level for you.
My advice is to invest the time to find a physician who has experience with bioidentical hormone replacement therapy and I caution you to avoid a general physician not skilled in this area of therapy.
Bioidentical Hormone Replacement Therapy Cost
Before I started down this path, I did not realize the cost of bioidentical hormone replacement therapy. The costs include the hormone treatments, the testing (and retesting), and the cost of the bioidentical hormone replacement therapy doctor.
I have been prescribed six different hormone treatments:
I found it a frustrating experience to deal with one of the compounding pharmacies because I did not like they way that they were dispensing the medication. It was frustrating for me to try to figure out exactly how much I was supposed to take. I explored another compounding pharmacy and the experience and results were so much better.
Depending on where you live, some of the pharmacies will deliver at your doorstep. Some require that you to show up in person.
The lab test costs were modest; perhaps less than a $100 (Canadian) in the first year. The cost of the bioidentical hormone replacement therapy doctor was also manageable: around $300 (Canadian) per year.
I am really pleased with having pursued bioidentical hormone replacement therapy. The benefits have been improved strength, better sex and richer, deeper sleep.
It was frustrating to find a doctor who worked for me, I had some troubles dealing with compounding pharmacies, and the out-of-pocket costs for bioidentical hormone replacement therapy are high for many people.
Ultimately, the decision is yours and it has be right for you. I hope that this helps you with your decision.
- Levin VA, Jiang X, Kagan R. Estrogen therapy for osteoporosis in the modern era. Osteoporos Int. 2018 Mar 8. [Epub ahead of print]
- Bailey, DA et al. A six year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: The University of Saskatchewan Bone Mineral Accrual Study. J Bone Miner Res 1999: 14(10):1672-1679
- Saggese G, Baroncelli GI, Bertelloni S, Puberty and bone development. Best PractRes Clin Endocrinol Metab. 2002 Mar;16(1):53-64
- Carson JA, Manolagas SC, Effect of sex steroids on bones and muscles: similarities, parallels, and putitive interactions in health and disease. Bone. 2015 Nov;80: 67-78
- Unger CA, Hormone therapy for transgender patients. Trans Androl Urol. 2016 Dec;5(6):877-884.
- The Benefit of Menopausal Hormone Therapy on Bone Density and Microarchitecture Persists After its Withdrawal. Papadakis G., et al. J Clin Endocrinol Metab, 2016 Dec;101(12): Epub 2016 Nov 17
For more information, check out my Osteoporosis Guidelines.