From celebrity Oprah Winfrey who claimed that menopause caught her “off guard” and that bioidentical hormone therapy “helped tremendously”; to an average woman suffering from common symptoms associated with hormone decline (bloating, mood swings, brain fog, loss of libido and more), these imbalances common during peri/menopause can be rectified effectively.


Synthetic / Conventional Hormones 

Often controversial and confusing even to medical professionals…

There are two main differences between natural or bioidentical hormones and synthetic, or conventional hormones. Pharmaceutical companies can patent them; with dosage differing by mere milligrams from those prescribed by your doctor. Nevertheless, the molecular structure of the prescribed hormone is unchanged for everyone taking that drug. Synthetic hormones are not created structurally equal to human endogenous hormones, often yielding undesirable side effects. While synthetic hormones can mimic the effects of endogenous hormones on certain biological pathways, they rarely offer the same effectiveness at a deeper, molecular level.


Natural / Bioidentical Hormones 

Increasingly popular with both patients and medical professionals…

These mimic the affinity of human endogenous hormones; therefore they are effective on more biological pathways, at all levels. Because bioidentical hormones precisely replicate endogenous hormones, side effects are rare. Additionally, bioidentical hormones doses are tailored specifically for individual requirements, not the prescribed doses pharmaceutical companies offer.


“I see great benefit in using hormones, always bio-identical, for women going through menopause. Although we cannot recreate the ovarian function of a healthy 25-year-old, we can do far more than giving nothing. Women in menopause, without oestrogen, must live the remainder of their lives in a perpetual state of oestrogen deficiency. I can’t think of any reason why we should not prescribe oestrogen and progesterone to the bulk of menopausal women. This is why I strongly advocate for quality human studies using physiological hormone regimens.” – Dr. Felice Gersh

Hormones For Healthy Longevity 

In the UAE, by 2020, the number of people, especially women aged 60 years and older, will be greater than children younger than five years old. Due to improved standards of living, the rate of population aging is much faster compared to before. Our society nowadays is mostly composed of adults. In the UAE as of 2018, the median age of the population was 33-34 years old, which means more and more women are now entering pre-menopausal stages wherein their body’s natural hormones are steadily decline.

During the reproductive period of women in the twenties and thirties, females tend to enjoy optimal hormone levels. During this time, women are less likely to develop diseases. Beginning in the late thirties, however, all hormones levels decrease.

The bodies’ biochemical and physiological functions must be calibrated to ensure the harmony of these functions.

The degree of decline however is influenced by the genetic build-up of individual and lifestyle choices. The decline in the level of hormones as we grow older has negative health consequences, putting us at a higher risk to develop age-related diseases such as heart diseases, dementia, cancer as well as arthritis.


“The good news is that oestrogen bio-identical hormones have been around in the market for 20 years now. Micronized progesterone as well. Nowadays, we also have vegan-based BHRT supplements which are made from yam. Oestrogen bio-identical cream has been available in Germany for almost 30 years now. In 2017, FDA approved the first oestrogen progesterone pill. This means that BHRT has been around for a while now but why is the compounding of these supplements not more common? This is a question that one must ask the big corporate pharma lobbies all over the world.” – Dr. Leila Soudah

The Hormone Symphony 

Hormones interact in a delicate and predicted manner with each other, such that a change in the level of one hormone influences the other hormones. For example, elevated cortisol as a result of stress blocks the thyroid production and activity; low thyroid blunts sex hormones and causes a sluggish hormone metabolism. So it is unwise to supplement oestrogen deficiency without paying attention to the cortisol and thyroid status. Another example is the influence of hormones on body fat distribution. It is known that cortisol and insulin facilitate lipid accumulation while growth hormone and testosterone stimulate lipolysis. In females, oestrogen seems to have a similar function to testosterone in this particular situation. Considering the interaction between hormones is critical to adjust imbalances and deficiencies as well.

BHRT For Women 

Oestrogens impact the entire body as they have a protective value against plaque formation in premenopausal women. The risk for plaque formation starts to increase as oestrogen starts to drop after menopause. The value of bio-identical hormonal therapy is excellent when used to prevent plaque formation. Therefore, it has a great preventive influence if started in the early peri-menopausal period before the onset of the plaque. Once the plaque has already developed (e.g. in late stage of menopause) BHRT has no effect in reversing the plaque and may have negative effects through destabilisation of the plaque and through thrombus formation.

So it is advisable to use topical natural oestrogen therapy after evaluating the risks and benefits based on clinical evaluation, family history and after assessing the pathways of detoxification.

The fate of oestrogen 

It is recognised that individual variation exists in oestrogen metabolism as genetics, type of consumed food and lifestyle influence the risk to develop breast cancer. For example, detoxification by the 2-hydroxylation pathway is associated with minimal risk to develop breast cancer and the less efficient methylation of the potentially genotoxic 4-hydroxylation pathway is associated with higher risk. So, it is necessary to assess the pathway of oestrogen metabolism before embarking on oestrogen supplement. However it is possible to manipulate the detoxification pathway of oestrogen by food and nutrient supplement to the extent that oestrogen can be supplemented safely.

Benefits of BHRT

The ultimate aim of hormone therapy is to maintain vitality, prevent disease and rejuvenate flagging energy levels. Integrative Medicine advocates the use of bioidentical hormones and supplemented in a physiologic dose. The timing of the bio-identical hormonal therapy is equally important. Benefits of BHRT outweigh the risks if treatment is begun in younger patients with deficiency before menopause.

Therefore, it is imperative you as a physician to be accredited and qualified in the intricacies of BHRT before starting prescribing natural hormones.


“Today, women in early menopause can benefit from bio-identical hormone therapy without fear of increasing their risk of breast cancer. The treatment will have a positive effect on the psychic (depression, fatigue, libido, nervousness, irritability, sleep) and the physical (hot flush, osteoporosis, headache, fatigue, aging of the skin, dryness of the mucous membranes, risky cardiovascular, arthralgia, hair quality) aspects of the patient.”

– Dr. Thierry Hertoghe

Are you a Physician looking to expand your knowledge base on BHRT?

ima_dubai offers gold standard workshops on BHRT. Check out these links to learn more:

 THE FEMALE BHRT WORKSHOP with Dr. Felice Gersh and Dr. Leila Soudah and BHRT Masterclass by Dr. Thierry Hertoghe–regenerative-medicine