As each person’s wellness is unique to them, it is important that we understand your whole health first. All Patients start with a Naturopathic Initial Visit. One of our highly skilled Integrative Doctors will meet with you for your initial consultation to review your general health, lifestyle, hormones, nutrition, labs to date and determine the proper new lab tests to run.  This helps us determine the type of hormone support that is the right fit for you. The appointment is an hour long and includes a Metabolic Urine Test (MUT) which is a screening test for your adrenal gland (that produces stress hormones and is the backup organ for sex hormone production), digestion and pH.  You can choose to be supported in your hormone health with natural remedies that your Naturopathic Doctor can recommend OR you can be referred to one of our Bio-identical (BHRT) prescribing practitioners for BHRT care.

The next step is to have a Doctor’s Report to summarize all the clinical findings, get you started on the initial recommendations which may include nutritional suggestions, as detox or other therapies to help prepare you for optimal hormone absorption and care. If it is determined that the specialized bio-identical hormone support (BHRT) is the right path for you, then you will be referred to one of our BHRT providers.

Hormones such as thyroid, pregnenolone, cortisol, DHEA, estrogen, progesterone, testosterone, are powerful regulators of weight, mood, vitality, libido and overall health.  Common signs and symptoms of hormone imbalance include:

When properly prescribed, the risk of side effects is minimal. With any hormone replacement therapy, there can be side effects, including:

• Headaches
• Irritability
• Mood Swings
• Increased Acne
• Difficulty Sleeping
• Breast Tenderness
• Itching at the application site

Hormone testing is typically done through a blood draw. Individuals can ask their doctors to test their hormones, or the team at Revivelife can test for them. Men should test cortisol, DHEA-S, TSH, free T3, free T4, estradiol, free and total testosterone. They can also test DHT and pregnenolone for a more complete sex hormone profile. Women should test cortisol, DHEA-S, TSH, free T3, free T4, estradiol, free and total testosterone. Pregnenolone and total estrogens could be added for a more complete profile. Advanced hormone testing is also available, through urine and saliva.

Your prescription will be sent to a compounding pharmacy of your choice, that will send your prescription right to your doorstep. Once you have your visit, your prescription will be sent to the pharmacy. Once your prescription is received at the pharmacy they will contact you to arrange billing and shipping. If this call is missed it is your responsibility to follow up. It’s as easy as that!

All BHRT prescription refills require a pre-lab hormone visit, blood work, and a post-lab hormone visit. WE CANNOT REFILL PRESCRIPTIONS BY EMAIL OR PHONE REQUEST ONLY. Every alternative visit may be done by phone if needed. Although we do live in a world of information technology (IT), it is important for your hormone team to assess your health completely, which includes being able to see you. We are happy to answer simple questions by phone or email, however our experience has lead us to suggest an office visit if there are more questions or concerns, as there is a more complete understanding of the total picture. NOTE: Please allow up to 3 WEEKS to receive your refill after your visit. After each visit, you will be given a recommended date to schedule your next Pre-Lab Consult with Revivelife. Please ensure that this visit is booked so that you do not run out of your prescription.

Your hormone team will review your general health as well as your hormones. The program is designed to address your hormone needs. If you have other health goals, specific separate visits or care may be suggested that is outside of the hormone program Many have found the combined use of hormone therapy and other services like nutritional counselling, acupuncture or our weight program have been very helpful to total approach to health. We look forward to assisting you on you path to wellness! 

Hormone services may be covered by your extended health care insurance provider under the designated practitioner that you receive your treatment by i.e. Naturopathic Doctor, Nurse Practitioner or Medical Doctor.  Please check with your insurance company for details. A receipt will be provided for your care to submit to your insurance provider.

The number of visits required and reassessment visits vary depending on the severity and duration of your concerns. Generally, hormone visits are monthly for naturopathic care or every 2.5 months for BHRT care until you improve and then in wellness every 6 months to maintain your health.

Although we do live in a world of Information Technology ( IT). It is important for your hormone doctor to be able to assess your health completely, which includes being able to see you. It is recommended to have office visits for refills or change of prescriptions. We are happy to answer simple questions by phone or email, However our experience has lead us to suggest an office visit if there are more questions or concern, as there is a more complete understanding of the total picture.

• What is BHRT?
• BHRT Safety
• How is it different than synthetic HRT?

Hormone therapy has gone through an evolution of approaches, which has left many confused, including doctors. For decades, hormones were prescribed to women for menopausal symptoms. The hormones initially used were synthetic versions. 

• Women’s Health Initiative 2002: In 2002, The Women’s Health Initiative (WHI) study was published, showing that when the synthetic hormones Premarin (synthetic estrogen) and Provera (synthetic progesterone) were used there was an unacceptably high risk of breast cancer, cardiovascular disease including blood clots and stroke. Thus, the study was halted 3 years early and everyone was told that hormones were dangerous.  However, when we re-analyze the data in detail, what the results of the WHI indicate is that synthetic oral forms (vs transdermal) forms of hormone replacement therapy (HRT) did seem to pose a risk. However, the limitations of the study were that the women were older i.e. average age 63 and 10+ years post-menopausal where there would already be a significant increase risk of breast cancer, cardiovascular disease and stroke, and only synthetic versions were used. Thus, the results of the WHI are not transferable to bio-identical hormone replacement therapies (BHRT) or to younger healthier women.
• Mayo Clinic Cohort Study of Oophorectomy and Aging (MCSO) 2007: In 2007, The Mayo Clinic Cohort Study of Oophorectomy and Aging (MCSO) was run and the results showed that estrogen protects brain function and the earlier you begin estrogen support the greater the reduced risk of dementia is in women who have lower levels of estrogen, in this case due to the removal of ovaries.¹ This was supported by other studies and called the timing hypothesis.^2,3
• The Kronos Early Estrogen Prevention Study (KEEPS) 2012: The Kronos Early Estrogen Prevention Study (KEEPS) was published in 2012.⁴ It was a 4 year randomized trial that used low dose oral Premarin (synthetic estrogen), transdermal estradiol and Prometrium ( bio-identical progesterone) . This study was significant because it was run with lower doses of estrogen, younger (i.e. average age 52) and healthier women vs the WHI.⁴ The results showed a neutral blood pressure and favorable impact on cardiovascular health markers HDL, decreased LDL and increased TG.⁴  In addition, when a transdermal (topical form) estradiol was used, there was the benefit of improved blood sugar levels.⁴  Thus, the KEEPS showed many favourable effects of hormone therapy (improved hot flashes, night sweats, depression, libido, and bone density) in newly menopausal women and did not show any adverse effects such as breast cancer, endometrial cancer, myocardial infarction, or stroke.⁴ It is important to keep in mind that this study was only run over 4 years and included younger women.
• The BMJ – Danish Study: The BMJ- Danish study was a 16-year study run with 1006 healthy women with an average age of 50. In the 10 years of randomized treatment women who received hormone therapy (bio-identical estrogen and synthetic progesterone) there was a significant reduction in mortality, heart failure, myocardial infarction, and there was no increased risk of cancer, blood clots or stroke.

Conclusion: More research is needed to assess bio-identical hormones, the method of use, it’s benefits or risks and the impact of its use on different age categories. Now, what we know is that synthetic hormones do pose a risk of breast cancer, cardiovascular disease and stroke when introduced to an older age population. When bio-identical hormones are used on a younger population we see that there is not an increased risk of breast cancer, blood clots or heart disease over a 10-16 year’s treatment with BHRT. Hormone therapy when used earlier after menopause can significantly reduce the risk of mortality, heart failure, and myocardial infarction.  In addition, hormone therapy can help hot flashes, night sweats, libido, memory, cognition, bone density and overall wellness.

Each person is unique and only you and your hormone practitioner can help you make the decision that is right for you. At Revivelife we work with you to find an optimal level of hormone balance, especially if the symptoms of menopause or andropause are making you feel “not yourself” and turning your life upside down.

+References

1. Holtorf, K,, The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?, Postgrad Med. 2009 Jan;121(1):73-85. doi: 10.3810/pgm.2009.01.1949., PMID:19179815
2. Rocca et al., Molecular and Cellular Endocrinology, 2014
3. 2007 The Mayo Clinic Cohort Study of Oophorectomy and Aging (MCSO)
4. Harman SM, Brinton EA, Cedars M, Lobo R, Manson JE, Merriam GR, Miller VM, Naftolin F, Santoro N., KEEPS: The Kronos Early Estrogen Prevention Study, Climacteric, 2005 Mar,8(1):3-12,PMID:15804727

When properly prescribed, and monitored BHRT therapy may reduce cancer risk and improve overall health.  If you have had cancer, have cancer or a family history, time will be taken to review the benefits and risks in your individual case.

Breast Cancer & Hormone Therapy: Multiple factors affect breast cancer risk, including high estrogen levels with increased exposure over a lifetime¹, and synthetic progesterone (primarily medroxyprogesterone acetate)² while synthetic estrogens (conjugated equine estrogens (CEE) appear not to increase breast cancer risk^3-6.  When proper evaluation, prescription and monitoring are put in place, there are ways to use hormone support to be cancer protective.^7,8 Research shows that bio-identical progesterone (vs synthetic progesterone i.e. progestins) has a cancer protective effect.⁸ In addition, present research suggests testosterone has a breast protective effect, countering the cancer-promoting effect of estrogen.⁹

• The Danish study which reviewed 1006 healthy women over a 10- year period with women aged 45-58 (average 50) showed that women receiving hormone therapy (bio-identical estrogen and synthetic progesterone) early after menopause had no increased risk of cancer (including breast cancer) or cardiovascular disease and had a significantly reduced risk of mortality.¹⁰

Prostate Cancer & Testosterone: Over the 20 years and 430,000 men studied there has not been one study that has shown a direct correlation between serum total testosterone levels and prostate cancer.^11-15 If prostate cancer were truly fueled by testosterone, we would see more prostate cancer in younger men with higher testosterone levels instead of the reverse. Recent research indicates that low levels of testosterone may present a greater risk for prostate cancer than higher levels.^16-18 Testosterone therapy is contraindicated in men with prostate cancer.

• A collaborative review of 18 prospective studies compared serum concentrations of androgen and estrogen in 3,886 men with prostate cancer with those in 6,438 healthy controls. The results showed no significant associations between the risk of prostate cancer and sex hormone levels.¹⁹

+References

1. 1. Dall GV, Britt KL. Estrogen Effects on the Mammary Gland in Early and Late Life and Breast Cancer Risk. Frontiers in oncology. 2017;7:110.
   2. L’Hermite M. Bioidentical menopausal hormone therapy: registered hormones (non-oral estradiol +/- progesterone) are optimal. Climacteric: the journal of the International Menopause Society. Aug 2017;20(4):331-338.
   3. Chlebowski RT, Anderson GL, Gass M, et al. WHI Investigators. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010 Oct 20;304(15):1684-92.
   4. Zhao S, Chlebowski RT, Anderson GL, Kuller LH, Manson JE, Gass M, . . . Prentice RL. Sex hormone associations with breast cancer risk and the mediation of randomized trial postmenopausal hormone therapy effects. Breast cancer research: BCR. Mar 26 2014;16(2):R30.
   5. Shah NR, Wong T. Current breast cancer risks of hormone replacement therapy in postmenopausal women. Expert opinion on pharmacotherapy. Dec 2006;7(18):2455-2463.
   6. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. Jan 2008;107(1):103-111.
   7. Holtorf, K,, The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?, Postgrad Med. 2009 Jan;121(1):73-85.
   8. Mohammed H, Russell IA, Stark R, Rueda OM, Hickey TE, Tarulli GA, . . . Carroll JS. Progesterone receptor modulates ERalpha action in breast cancer. Nature. Jul 16 2015;523(7560):313-317.
   9. Glaser R, Dimitrakakis C. Testosterone and breast cancer prevention. Maturitas. Nov 2015;82(3):291-295.
   10. Mørch LS, Ph.D, Skovund CW, MSc, Hannaford PC, MD et al, Contemporary Hormonal Contraception and the Risk of Breast Cancer, N Engl J Med 2017; 377:2228-2239
   11. Huggins C, Stevens RE, Hodges CV. Studies on prostatic cancer II: the effects of castration on advanced carcinoma of the prostate gland. , Arch. Surg. 1941; 43: 209-23.
   12. Morgentaler, A. Testosterone Replacement Therapy and Prostate Cancer Urologic Clinics of North America Volume 34, Issue 4, November 2007, Pages 555-563.
   13. Stattin, P. Lumme L., Tenkanen L. High levels of circulating testosterone are not associated with increased prostate cancer risk; a pooled prospective study, Int. Cancer 108 (2004), pp. 418-424.
   14. Barrett-Connor, C. Garlan and J.B. McPhillips et al., A prospective, population-based study of androsteneione, estrogens and prostatic cancer, Cancer Res. 50 (1990), pp. 169-173.
   15. Parsons, H. B. Carter and E. A. Platz et al., Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy, Cancer Epidemiol Biomarkers Prev 14 (2005), pp. 2257-2260.
   16. Morgentaler A. Testosterone replacement therapy and prostate risks: where’s the beef? Can J Urol. Feb 2006;13 Suppl 1:40-3.
   17. Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. Feb 6 2008;100(3):170-83.
   18. Morgentaler A. Testosterone for Life. New York: McGraw Hill; 2009.
   19. Parlapiano C et al. he relationship between glycated hemoglobin and polymorphonuclear leukocyte leukotriene B4 release in people with diabetes mellitus. Diabetes Res Clin Pract. 1999 Oct;46(1):43-5

Hormones are like stop-lights. When they are balanced, the light is green and you will get the optimum results from your nutrition and fitness programs. When they are imbalanced the light is red making it, in many cases, difficult to lose and easy to gain weight. Key hormones in metabolism include insulin, thyroid hormones, cortisol, estrogen, progesterone, and testosterone.

If you opt for hormone replacement, you have a choice: standard hormone replacement therapy (HRT) or bioidentical hormone replacement therapy (BHRT), which differ in significant ways. Synthetic hormones may lead to uncomfortable side effects, may come from non-natural sources and come in standard one-size-fits-all doses. Synthetic progestins although developed to target the uterus, their use affects every major organ system including the brain, the cardiovascular system, the immune system and the generation of blood cells which may contribute to its side effects.  Since bioidentical hormones are an exact structural replica of your body’s hormones, side effects occur less frequently, are more effective, are created from natural sources, and are customized doses to suit your body’s exact needs in comparison to synthetic hormones.

• Several studies show that menopausal women have reported similar or greater improvements (30% better sleep, 50% lower anxiety, 60% less depression, 40% less cognitive difficulties, 30% better sexual function, and 80% overall satisfaction) and fewer estrogen therapy-related side effects with the use of BHRT progesterone compared to synthetic progesterone or progestins (medroxyprogesterone acetate).^1-5 BHRT progesterone has also been found to be safer than synthetic progestins for cardiovascular health.^6-9

References:

1. Hargrove JT, Maxson WS, et al. Menopausal hormone replacement therapy with continuous daily oral micronized estradiol and progesterone. Obstet Gynecol. 1989;73(4): 606-612.
2. Montplaisir J, Lorrain J, et al. Sleep in menopause: differential effects of two forms of hormone replacement therapy. Menopause. 2001;8(1): 10-16.
3. Ryan N, Rosner A. Quality of life and costs associated with micronized progesterone and medroxyprogesterone acetate in hormone replacement therapy for nonhysterectomized, postmenopausal women. Clin Ther. 2001;23(7): 1099-1115.
4. Lindenfeld EA, Langer RD. Bleeding patterns of the hormone replacement therapies in the postmenopausal estrogen and progestin interventions trial. Obstet Gynecol. 2002;100(5 Pt 1): 853-863.
5. Fitzpatrick LA, Pace C, et al. Comparison of regimens containing oral micronized progesterone or medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J Womens Health Gend Based Med. 2000;9(4): 381-387.
6. Binkowska M. Menopausal hormone therapy and venous thromboembolism. Przeglad menopauzalny = Menopause review. Oct 2014;13(5):267-272.
7. Scarabin PY. Hormone therapy and venous thromboembolism among postmenopausal women. Frontiers of hormone research. 2014;43:21-32.
8. Prior JC. Progesterone or progestin as menopausal ovarian hormone therapy: recent physiology-based clinical evidence. Current opinion in endocrinology, diabetes, and obesity. Dec 2015;22(6):495-501.

Both bioidentical hormones and synthetic hormones are created in labs, but synthetic hormones are not identical to natural hormones. In contrast, bioidentical hormones match human hormones, molecule by molecule and are exact structural replicas of the natural hormones produced by your body.

• Hormone Replacement Therapy (HRT): is the first type of hormones that were used historically for hormone support. HRT hormones are synthetic and are not human-identical. Examples of HRT include: Estrogens (Premarin, Cenestin, Menest, OrthoEst, EstraTab); Progesterones (progestins, medroxyprogesterone) (Provera, Aygestin, DepoProvera, certain birth control pills); Combinations ( EstraTest, Activella, PremPRo, PremPhase, CombiPatch, ClimaraPro, FemHRT, many hormonal birth control methods); and Testosterone ( MethylTestosterone).
• Bioidentical Hormone Therapy (BHRT): is the popular next label for the generation of hormone support. BHRT hormones are human identical. Examples of BHRT include: Estrogens (17 beta-estradiols (Estrace, Estradil, Estring); estradiol acetate (Femring); estradiol hemihydrate (Vagifem); Micronized Progesterone USP (Prometrium and Prochieve).

Both Bio-identical and Human Identical Hormones are available in standardized (FDA or government approved) or custom compounded formulas.

According to the FDA, for some women, synthetic hormone therapy may increase the chances of blood clots, heart attacks, strokes, breast cancer and gall bladder disease. For women who have not had their uterus removed, estrogen increases their chance of getting endometrial cancer. Adding progestin, however, lowers this risk.

There are many ways we can support hormone balance. Certain herbs and nutrients can promote hormone production and metabolism. For example, the vitamin B5 and cholesterol form all sex hormones, and the mineral zinc can support healthy testosterone and estrogen balance in men by inhibiting the conversion of testosterone to estrogen. Bioidentical hormones are also available where indicated.