“Being healthy—really healthy—is largely about the choices we make,” observes Dr. Jennifer Burch of Central Compounding Center in Durham, “about giving our bodies what they need to function well, resist disease, and recover from illness. It’s a familiar list: we need good nutrition, water, exercise, sleep. But being healthy is also about our ability to respond to the stresses and health challenges we encounter. Something we cannot do if our hormones are out of balance.

“Hormones affect every cell in the body,” she points out. “They work together to help regulate all the body’s processes. An imbalance—too much or not enough of one or more hormones—can cause a variety of problems. And the high-stress world we inhabit is a huge factor in causing hormonal imbalances. Under stress, our adrenal glands produce chemicals to help our body cope and to produce more energy. The adrenal glands are endocrine glands that produce estrogen, progesterone, DHEA, cortisol, and other hormones—too much stress, and any or all of these hormones are affected.

“If we are to achieve optimal health in this context,” she says, “we have to address hormonal balance.”

Hormone Balance: A Complex Challenge

Dr. Burch takes a special interest in hormone balance issues—a subject about which she has considerable expertise. And she and her staff at Central Compounding Center have developed a comprehensive program to evaluate hormone problems and to provide bioidentical hormone therapy (BHRT).

“Hormonal imbalances are extremely complex conditions,” she says. “I would describe them as ‘hormone symphonies,’ in which a variety of factors contribute to the patient’s symptoms. Teasing out the precise nature of the imbalance—and its cause—is essential.

“For example, when one thinks of hormonal imbalances, conditions such as menopause and its hot flashes, mood swings, and exhaustion can come to mind. But those symptoms can be misleading.

“For example, while you and I might have similar symptoms, the hormones causing them might be entirely different. So, comprehensive hormone testing and monitoring—for each individual—is essential, because it allows for accurate hormone adjustments.”

Dr. Burch prefers to use either a saliva test or a finger-stick test for assessing a variety of hormone levels and balance, because these methods examine the free usable hormone available in the body. “Blood tests are less precise,” she says, “and as a result those patients typically end up being prescribed much higher dosages of hormones than they would be if salivary hormone testing had been used.”

The hormone testing protocol at Central Pharmacy is comprehensive. It includes measuring levels of all hormones—estradiol, estradiol progesterone, testosterone, DHEA—as well as cortisol levels.

“Cortisol,” notes Dr. Burch, “affects aging, depression, chronic fatigue, immune function, heart disease, thyroid function, inflammation and pain, and more. Stress influences cortisol, which normally peaks in the morning and declines throughout the day. So, we measure cortisol levels several times throughout the day to get the most accurate reading.

“Following testing, we set up consultations to work with folks to analyze the results and look at options. And it’s important to note that sometimes hormones are just a piece of the puzzle. When I do a consultation, I won’t be looking only at your hormones.”

She adds that they work closely with physicians, making recommendations about how to balance estrogen, progesterone, and testosterone, as well as providing specialized treatments.

“Some hormones, such as DHEA and cortisol,” she notes, “can be improved with over-the-counter supplements. But many hormonal treatments must be individualized. That’s why compounding is such a powerful tool. It allows us to customize individual dosages so we can give whatever amount of hormone is needed and in a form most suitable to the individual patient.”

The basic message, concludes Dr. Burch, is that “when one hormone is out of sync, it can have cascading effects throughout the body. In that ‘hormonal symphony,’ we need all the players to be playing in the same key, hitting the same notes at the right time.”

Correcting Myths About Hormone Replacement Therapy

“For over 20 years,” says Dr. Burch, “an unfortunate myth has persisted—that hormone replacement therapy (HRT) increases a woman’s risk of heart disease and breast cancer.

“The myth originated with the 2000 Women’s Health Initiative (WHI) study, which appeared to find a correlation between HRT and these risks. The study had a huge effect: Within months, the number of women using HRT dropped by almost half; and even today there is considerable fear about the risks of HRT.

“This is despite the fact that there have been numerous studies since then discrediting those findings and affirming the safety and benefits of hormone replacement therapy.”

Reassessment of a Flawed Study

“There were many problems with the WHI study’s design,” notes Dr. Burch. “It did not use bioidentical hormones, and it did not account for many other factors in the study group that also increase risk of heart disease and cancer—such as age, obesity, hypertension, and smoking. But perhaps most important, it appeared to ignore the important role that estrogen plays in protecting women’s health.

“That’s because multiple other studies have repeatedly found that hormone therapy is protective against breast cancer and supportive of heart health.”

The Truth about HRT

“The benefits of hormone replacement therapy are best understood in the context of women’s life expectancy,” notes Dr. Burch. “Simply put, women are living longer—way past childbearing years. The average age of menopause is around 52, so if they live to be 100, that’s up to 50 years without the hormones that have supported them since puberty.”

And those hormones support health in many important ways, she explains. “They control many different bodily processes—not only reproduction, but metabolism, blood pressure and blood sugar regulation, sleep-wake cycles, and much more.

“Significantly, estrogen plays a key role in preventing cardiovascular disease—which is the number one killer in women. Estrogen decreases LDL and lipoprotein (a); it reduces the accumulation of plaque in your arteries; it dilates small arteries—all factors in heart disease. “And there’s more. Estrogen helps decrease the risk of colon cancer, and aids in maintaining memory and preventing Alzheimer’s. And it helps skin maintain its elasticity—it prevents wrinkles! When you lose your hormones, it accelerates the aging process.”