This document discusses regenerative and integrative medicine, which aims to optimize the body's self-repair mechanisms through hormones, lifestyle changes, and supplements. It focuses on hormone optimization for women, explaining how hormone systems can fail and symptoms of menopause. Different hormone replacement options are described, including bioidentical hormones that have the same chemical structure as what the body produces, reducing risks. Safety studies on bioidentical progesterone are summarized, finding no increased breast cancer risk unlike synthetic progestins.

1. P A U L E . C O X M D , M S
O C U L U S S K I N C A R E , L A S E R A N D L O N G E V I T Y
Bio-identical Hormone
Optimization for Women

2. What is Regenerative or Integrative Medicine?
 the field of scientific research aimed at the early
detection, prevention, treatment and reversal of age
related decline.
 the optimization of the body’s mechanisms of self
repair with hormones, lifestyle and neutraceuticals (
vitamins and herbal supplements).

3. Why Regenerative Medicine
 Current medical model is broken
 Short office visits with long wait times
 Impersonal service with a prescription to cover up
symptoms but not address the real problem

4. Why Regenerative Medicine
 No education provided to patients to explain the
difference between disease and optimal health
 Stressed and overworked doctors are unaware of the
latest medical evidence
 The current medical model is dedicated to preserving
compromised health rather than improving health.

5. Steroid Hormone Pathway

6. Why do hormone systems fail?
 Stress
 Decline with age
 Chronic disease (Diabetes)
 Medications ( pain, cholesterol, blood pressure )
 Genetic factors
 Environmental factors (pesticides, plastics,
pollution)
 Poor nutrition
 Surgical intervention

7. Thyroid hormone function
 Lights the furnace of the body
 The main hormone responsible for metabolism
 Symptoms of deficiency may resemble other
hormone deficiencies.
 Often “normal” but not optimal

8. Peri-menopause
 A period of gradual ovarian dysfunction
 Irregular periods
 Increased irritability, mild hot flashes
 Anxiety
 Low libido
 Skin and hair drying and thinning
 Mild weight gain

9. Menopause
 The absence of menstrual periods for at least one
year.
 The actual problem is the failure of the ovaries.
 Ovarian failure means sudden loss of the female
hormones estrogen and progesterone and a decrease
in testosterone.
 Loss of these hormones leads to the typical
symptoms of menopause.

10. Symptoms of Menopause
 Tired
 Moody
 Tense/Anxious
 Sleepless
 Forgetful
• Uninterested in
sex
• Depressed
• Hot flash(y)
• Sweaty
•Fat

11. Could HRT be right for me?
 Documented deficiency on labs.
 Symptoms of deficiency on surveys or
questionnaires.
 No contraindications to treatment.

12. Bio-identical or Human identical Hormones
 What does it mean?
 The exact same chemical structure that your body would
produce.
 Why is that important?
 Allows the body to
 Recognize
 Utilize
 Metabolize

13. Non Bio-identical Hormones
 Examples of non bio-identical hormones include
Conjugated Equine Estrogens (CEE) which is known
as Premarin. This compound has a higher risk of
blood clots and is not easily metabolized by the body
 Progestins are progesterone like compounds
invented for the use in oral contraceptive pills. These
compounds do not protect breast tissue and may
lead to an increased risk of heart disease and breast
cancer.

14. HRT Safety
 Randomized controlled and observational studies
indicate that the addition of synthetic
progestins to estrogen increases the risk of
BC much more than estrogen alone.
 A study on a French cohort suggests that when
natural progesterone is used instead of
synthetic progestins in HRT the risk of BC is
not increased.

15. HRT Safety
 The findings come from 2 large cohort studies
carried out in France, where oral micronized
progesterone has been used by large numbers of
menopausal women over 2 decades.
 One study followed over 3000 women for 8.9 years
found that women receiving estrogen plus
progesterone or a non MPA progestin had no
increased risk for BC.

16. HRT Safety
 The E3N0EPIC cohort study on over 54,000 HRT
naïve women followed these women for 5.8+/- 2.4
years found that oral micronized progesterone did
not increase risk of breast cancer in women treated
with micronized progesterone.

17. HRT Safety
 What is the consequence of non-bio-identical use?
(Prempro or equillin and progestin) WHI study of
2002
 Breast cancer- 26% increase
 Stroke -41% increase
 Blood clots (doubled)
 Heart disease -22% increase

18. Estrogen Patches
 Might have an adhesive problem, especially
with athletic activity or sweating/hot flashes.
 Need to be changed 1-2 times weekly.
 Absorption varies individually.
 Available commercially (Vivelle, Alora).
 Low risk of blood clots and low testosterone
levels.

19. Estrogen Gels
 Must be applied to skin daily at specific
sites.
 Will have peak/valley effect.
 Not everyone absorbs creams or gels well.
 Available commercially or compounded.
 Must be careful about transference to
loved ones and friends (not ideal if small
children are often present).

20. Estrogen Implants
 Proven technology for over 60 years
 Steady state of hormone release closely
mimics the body’s
 Less roller coaster effect
 Easy dosing, most people need them 2-3
times yearly

21. Testosterone for Women
 Maintains lean muscle mass
 Necessary for Libido (sex drive)
 Prevents osteoporosis
 Not FDA approved for women in US (used widely in
Europe and Australia)
 Available as compounded gels or implants

22. Progesterone for Women
 Available as a pill commercially (Prometrium) or
compounded
 Available as a gel from compounding pharmacies.

23. Hormone Considerations:
• Not all hormone therapies are created
equal
• Hormone replacement therapy is not a
“one-size-fits-all” approach.
• You deserve a program created just for
you based on your medical history, family
history and lifestyle

24. references
 J Steroid boichem mol Biol 2005 July: 96 (2) 95-108