PRACTICAL USE OF BIO-IDENTICAL HORMONE REPLACEMENT
by DR S NEDIC
During menopause, the hormonal metabolism undergoes significant changes, leading to some typically unpleasant symptoms such as hot !lushes and anxiety, and leading to an increase in the relative risk of cardiovascular disease, osteoporosis and declined cognition. In order to overcome these symptoms, hormone replacement therapy (HRT) is usually prescribed. As recent data has shown the association between HRT and the risk of breast cancer, the routine prescription of HRT has become a significant concern for both patients and physicians. Despite an ongoing debate between conventional HRT and bioidentical HRT (BHRT) users, the purpose of this article is to show that the risk of breast cancer is a result of patients’ individual oestrogen metabolism, and that personalisation is the key to increased safety when using HRT. Therefore, before prescribing any HRT, including BHRT, an assessment of the patient’s genetic make-up for the production of dangerous oestrogen metabolites, and an identification of her oestrogen load from endogenous oestrogens, environmental oestrogens, and dietary oestrogens should be undertaken. This will allow the physician to estimate the most adapted hormonal dosage, as well as evaluate whether the beneficial effect of HRT will outbalance the potential risk of developing breast cancer. Treatment with BHRT then becomes personalised and safe. In order to increase safety and — in addition to the adapted hormonal dosage — personalised nutritional modulation of oestrogen metabolism is prescribed knowing the specific single nucleotide polymorphism of the genes involved in oestrogen metabolism.