Take the Bioidentical Hormones in a Bioidentical Manner

  • As explained in the previous article titled, “Treat the Problem Not Just the Symptoms With Bioidentical Hormones,” I explained that:
  • Menopause is not just a collection of bothersome, temporary symptoms – it is a permanent hormone deficiency state that over time will cause all of your hormone systems to become imbalanced.
  • There are no natural, healthy, physiological adjustments the body can make to correct this hormone imbalance.
  • The hormone system imbalance caused by menopause accelerates aging and contributes to the onset of the degenerative diseases of aging, such as heart disease, cancer, type 2 diabetes, Alzheimer’s dementia, osteoporosis, and stroke.
  • The only way to correct this hormone system imbalance is to restore the missing sex hormones that caused it, namely, estradiol and progesterone.
  • The only safe and effective way to restore the missing estradiol and progesterone is with bioidentical hormones, NOT with hormone drugs.

I finished the article by pointing out that just because you are using bioidentical hormones doesn’t mean that what you are doing is either effective or safe. In order to effectively and safely restore hormone system balance, the bioidentical estradiol and progesterone must be administered (taken) in what is called a bioequivalent manner.


What Does Bioequivalent Manner Mean?

In the context of menopause, bioequivalent manner means, in the manner that mimics, as closely as possible, the way in which your body produced estradiol and progesterone prior to menopause. In other words, we are trying to mirror hormone production during the time you were still menstruating.

Why is this so important? It is because all hormones interact and communicate with each other. There is a delicate balance that must be maintained. You cannot just “fill the hormone tank.” It is critically important that hormones are restored in amounts and in a manner that does not interfere with the way the sex hormones communicate with each other and with all of the other hormones of the body as well.

Therefore, among other factors, we have to consider both when and how the sex hormones were produced and secreted into your bloodstream. These considerations give us guidance for how to administer supplemental estradiol and progesterone, in part, by giving us very clear parameters for how not to. For instance:

  • When you were menstruating, your body produced estradiol continuously, throughout your entire cycle. But you produced progesterone in only the last half of each cycle – not continuously. Therefore, taking estradiol and progesterone on a daily basis is not bioequivalent. In fact, this method, called “continuous combined” is actually harmful. You should never take progesterone every day.
  • Another example of administering hormones in a manner that is not bioequivalent is taking hormones orally. When you naturally produced estradiol and progesterone, they were secreted directly to your bloodstream. They didn’t first pass through your liver. Taking hormones orally requires that, prior to reaching your bloodstream for delivery to your cells, the hormones must first pass through your liver. Doing so poses several problems. Because the liver will filter out a substantial portion of the hormones you swallow, getting an adequate amount of estradiol and progesterone into your bloodstream requires that you take excessive dosages of these hormones. Doing so is problematic both in terms of its effect on the other hormone systems of the body (remember, all of your hormones interact), and because it unnecessarily taxes the liver. And, since the degree of filtration by the liver is variable – it’s not the same for all women at all times – then the actual amounts of the estradiol and progesterone that reach your bloodstream will also be variable; there is no way to regulate or calculate this amount with oral administration.

There are a number of other examples of methods that are frequently used for administering hormones, whether bioidentical or drugs, that are not bioequivalent, such as using creams or pellets, or taking progesterone alone (without estradiol). You should absolutely avoid all of these methods. Remember, our objective is to restore hormone balance, that is the balance, the harmony of all of your hormone systems. And it’s a delicate balance. So, what hormones you take, and when and how you take them, are all critically important factors.


Administering Bioidentical Hormones in a Bioequivalent Manner

How can bioidentical hormones be administered in a manner that exactly mimics the way in which estradiol and progesterone were produced prior to menopause? Well, pre-menopausal hormone production cannot be mimicked exactly. It’s not possible because hormone levels constantly fluctuate. But, the good news is, it is not necessary to replicate estradiol and progesterone production, exactly, just very closely. Doing so still restores hormone system balance.

Throughout my twenty years of treating menopausal women, I developed a very specific method and set of rules for restoring hormone system balance. I call this protocol Hormone Balancing Therapy or HBTx™ (“Tx” is medical shorthand for “therapy”). The essence of HBTx is to restore the missing estradiol and progesterone to approximate pre-menopause levels and to address all other causes of metabolic imbalance, whether due to another hormone system deficiency or to poor nutrition and lifestyle habits.

By the way, HBTx is not a product or something I sell. It is simply the name I gave to my protocol in order to distinguish it from all others. Don’t expect your physicians or others to know this term. Most likely, your physician will use the term hormone replacement therapy or HRT. To me, the distinction between HBTx and HRT is critically important because HRT does not necessarily mean the use of bioidentical hormones given in a bioequivalent manner. Neither, does it recognize the importance of improving nutrition and lifestyle habits in the restoration of hormone balance and, thus, metabolic balance.

The HBTx Protocol is presented in the Menopause Power Course and explained in greater detail in the Menopause Power Take Charge Guide. Here are the four foundational elements of the HBTx Protocol:

  • Take both estradiol and progesterone in a cycling manner to mimic the menstrual cycle (assuming you still have your uterus).
  • Take the lowest dosages of supplemental sex hormones required to achieve hormone system balance.
  • Bypass the liver.
  • Monitor and adjust dosages based on various factors.

These four elements are the basis for what I call The Five Rules for Hormone Balancing Therapy (HBTx):

  • Restore only the hormones that are missing.
  • Restore the missing hormones with bioidentical hormones.
  • Use the bioidentical hormones in a bioequivalent manner
  • Improve nutrition and lifestyle habits
  • Continuously monitor results


A Final Note

The concept of bioequivalent administration is neither new nor unique to treating menopause. Perhaps the best example I can give you is the treatment of type 1 diabetes. Like menopause, type 1 diabetes is a permanent hormone deficiency state – the body is no longer able to produce adequate amounts of insulin. How is diabetes correctly treated? First of all by using bioidentical insulin, not a drug that has some of the characteristics of insulin, but synthetic insulin that has the same molecular structure as naturally produced insulin. Second, the supplemental insulin is administered “in a bioequivilent manner” – in this case, in the manner that mimics, as closely as possible, the way in which the pancreas formerly produced insulin.

There is no disagreement or great debate about whether to use drugs versus bioidentical insulin. Neither is there any divergence of opinion about administering the bioidentical insulin in a manner that mimics the way it was naturally produced.

So why is menopause treated differently? As I alluded to in the previous article “Treat the Problem Not Just the Symptoms With Bioidentical Hormones,”it’s a long and convoluted story. Suffice to say, it’s because the medical profession has not yet come to recognize that menopause is a permanent hormone deficiency state that must be treated. Because estradiol and progesterone are minor hormones, whose absence is not immediately acute (typically), and because physicians are not yet trained to associate with menopause the many medical problems that women face after the onset of menopause, there is not yet a recognition of the need to restore the missing hormones over the long term. I could go on and on about this issue, but I’ll stop here. The good news is, that because women are becoming more aware and more educated, so are physicians. We are making progress!


To your health and happiness,

Diana Schwarzbein, MD