Interview with Katharina Maria Burkhardt
Hormone expert Katharina Burkhardt has been working as a coach, supervisor, hormone researcher, educator, and author for over 20 years. She is fascinated by hormones and the connections between lifestyle and biochemistry. According to her colleague, she is the brains and heart of the network for bioidentical hormones, which she founded jointly with a pharmacist, a gynecologist, and a general practitioner in October 2021. The platform is very popular and builds bridges between therapists, patients, and experts to share all their valuable knowledge about hormones. It provides guidance for physicians on bioidentical hormone therapy in practice, as well as information for interested parties and patients to help them better navigate the jungle of different offerings and therapies. Demand is immense, and the trend is growing. On the one hand, more and more publications have been published in recent years, and on the other, there is now a real trend that is making waves, including in the USA.
Difference between synthetic hormones and bioidentical hormones
The term "bioidentical" is somewhat misleading for some. Many think of "organic," for example, soy or yams. In reality, however, only the basic building blocks are extracted from plants, and hormones are then produced from these molecular structures. Diosgenin, which is also present in yams, is the basic structure for the production of all hormones.
Bioidentical, bioidentical, nature-identical or human-identical means that the structural formula of the respective hormone (gel, cream, suppository) is exactly identical to the structure of the hormones in the human body.
A synthetic hormone, on the other hand, is not exactly identical to the body's hormones. It has "feet" or appendages attached to its chemical structure, which can partially block a different effect on the corresponding receptors to which the hormones bind. This is, of course, sometimes desired, for example, in hormonal contraception with the birth control pill. Bioidentical hormones are intended precisely not to block or occupy receptors. Bioidentical hormones are intended to exert their natural effect on the receptor. "We generally do not work with synthetic hormones in our network unless gynecologists use them for contraception. Bioidentical hormone therapy excludes synthetic hormones."
For which indications is bioidentical hormone therapy suitable?
According to Katharina Burkhardt, there is no condition for which hormones cannot be used. The use of hormones in therapy is by no means limited to the climacteric, menopause , or even PMS. Bioidentical hormone therapy has immense potential in numerous areas of application. Logically, this makes sense. Hormones affect mood, have psychological and emotional effects, and influence mental well-being. Hormones can be used for physical complaints such as osteoporosis, migraines, joint pain, and even depressive moods. The treatment can be broader than the classic hot flashes of menopause. " There is nothing we cannot support with hormones."
What dosage form is available?
Creams, gels, suppositories, capsules, and tablets for progesterone and estradiol are available. It's important to find out in advance which form is best for your individual needs. Pharmacists are best placed to know, as this involves galenics. This means that certain active ingredients work better or worse in a particular form.
Transdermal:
- Through the skin: In transdermal hormone therapy, the hormones are applied as a gel or cream to the skin, for example, the forearm. They are absorbed into the bloodstream via transporters in the skin.
- Vaginal or rectal: These are suppositories containing the respective hormone. If, for example, a woman has heavy bleeding or vaginal discharge, a vaginal dosage form is disadvantageous compared to a rectal form.
- Sublingual: The active ingredient is placed under the tongue and absorbed through the oral mucosa.
- Bucal : A lozenge that is placed in the cheek pouch, where the active ingredient is released into the cheek skin.
Orally:
Intake of the active ingredient as a capsule or tablet.
Is there a preferred dosage form?
It depends on the intended purpose. Transdermal application has the advantage of bypassing the first-pass effect and thus the route via the liver. Transdermally absorbed hormones are therefore gentle on the liver. The active ingredients then usually reach the site of action exactly as needed. A disadvantage of oral administration, in addition to the route via the liver, is a loss of active ingredients of up to 90%. However, progesterone capsules, which are taken orally, have also had sensational success in treating sleep disorders when taken in the evening before going to bed. A progesterone cream cannot compete with this. "On the one hand, there is a best form for the symptoms, and on the other hand, this form must also be practical and pleasant. Not everyone likes creams, for example, because they are usually slowly absorbed." It is therefore always important to consider compliance. How can the patient implement the administration in everyday life and what do they prefer? Creams, for example, are only slowly absorbed, which is why many prefer a gel. Hormone therapy is very individual and complex. “The great thing is that we can also address this because we have an incredible number of options,” says the hormone expert.
Myomas - Is bioidentical hormone therapy the right option?
In many cases – but not always – the use of progesterone has proven effective, according to the hormone expert. Often, the fibroid grows a little and then shrinks. Naturally, the initial growth scares many women. It's important to do this with a knowledgeable gynecologist. This must be accompanied by imaging techniques. Progesterone isn't always the right treatment for fibroids. There are other options. "For example, we're also observing a very positive effect with the use of certain plant extracts, which have been extensively studied," says Katharina Burkhardt. "Bioidentical hormone therapy isn't just therapy with hormones."
Bioidentical hormone therapy does not only consist of hormones
The hormone specialist emphasizes that in addition to the hormones themselves, it is essential to supply the important cofactors and micronutrients. Plants are also needed for this, as it is a holistic approach. "It may sound extreme, but if we treat exclusively with hormones, we are only treating the symptoms." This simply replaces a substance that isn't there, replenishing it. However, the question of why it isn't there remains unanswered.
Cofactors, micronutrients, plant substances
There can be many reasons for hormone deficiency. It may be a lack of cofactors needed to produce hormones. It may be an enzyme deficiency, the body may be trying to detoxify, an imbalanced gut microbiome may be the underlying cause, or plant substances may be needed to restore the body's overall balance.
50% personal responsibility & health literacy
Our 20 years of experience have shown that lifestyle actually accounts for 50% of the whole thing. Above all, it's about the patient's personal responsibility and health literacy. We want to convince and motivate women to embrace these fundamental issues in their lives. A few basics should be clear. Eating red meat five times a week, along with sugar, nicotine, and caffeine, are known to have detrimental effects on general health, including hormones. A healthy routine, exercise, and sport are also important.
Drawing strength from cyclical life
Embracing the rhythm of your cycle in your life is an important part of hormone therapy. Not every day is the same. The days around ovulation or during menstruation require a different level of attention to your body. Many people find that they experience fewer PMS symptoms or low moods when they embrace their tiredness and don't push themselves too hard.
Increase adaptation to stress & reduce inflammation
Inflammation reduction is important in all aspects of life. Any plant that can do this is welcome. On the website of the Bioidentical Hormones Network, experts have compiled an overview in the download section that lists all suitable plant substances and foods. So, if there is a mild estradiol deficiency, you can see which foods promote estradiol production through their phytoestrogen content. This way, women can already take a big step through a conscious diet.
The most important thing: Integrate and live your own rhythm
Of course, plenty of sleep, good nutrition, and stress reduction help. According to Katharina Burkhardt, one of the most important things is rhythm. In today's society, we have lost our rhythm. Reintegrating it is very difficult. Many people lack the necessary knowledge. For women, it may be somewhat easier, as they can orient themselves according to their cycle, if it is regular. If it isn't, they can orient themselves according to the rhythms of the moon. Some women menstruate at full moons, others at new moons. It's about observing that the fertile phase comes after menstruation. What energies are associated with this, what do I need in terms of nutrition, energy intake, and exercise? This is followed by the climax with ovulation, which then either leads to pregnancy and progesterone continues to rise, or it falls again and the cycle begins anew with bleeding. The day-night rhythm is also to be taken seriously and is hormonally controlled. Cortisol levels peak in the morning, and melatonin kicks in in the evening so we can sleep well.
Shift work, going to bed late, eating a lot, eating late, sometimes not eating at all – especially eating habits – have extreme effects on hormone levels, according to the expert. She offers another piece of well-intentioned advice. "Of course, we can't always eat at 12 p.m. and 6 p.m. sharp, or even avoid stress completely. It's a lot about living your own rhythm and consciously taking time out, giving yourself breaks, and seeing what truly nourishes your system. Pausing and noticing what's good for me – that's what really matters! Whether that's yoga or meditation is ultimately not important," she advises. "Just do nothing."
Chronobiology of hormones
Like everything in nature, hormones are subject to daily fluctuations as well as a monthly rhythm. " It is therefore important that we do not go full throttle all day or lie on the sofa all day. Balance and rhythm are the be-all and end-all - as nature teaches us." Therapies should therefore refrain from the classic "take xy once a day". It is much more important to recognise an individual rhythm and how your body and mind are doing today. Questions such as: Is the sun shining today? Am I on holiday? Am I stressed? Have I done any competitive sport? What will my next week look like - can I do anything preventatively can help? Of course, this does not apply to people with acute problems, in which case it is of course sensible and important.
Integrative, individual, holistic
Even if women don't want to deal with hormones, experts can achieve great success by administering specific micronutrients. Vitamin D3 naturally plays a major role as a prohormone, and measuring vitamin D levels is always included in therapy. For example, a research group at the University of Graz discovered that vitamin D3 stimulates testosterone production. Therefore, if there is a testosterone deficiency, it is not necessary to administer the hormone immediately; it may be sufficient to initially measure vitamin D levels and correct the deficiency by administering vitamin D3.
Who is the Bioidentical Hormones Network intended for?
It's for everyone: laypeople, doctors, therapists, companies, scientists, anyone who's interested. The information on our website is available for free download. " We want to increase knowledge and enrich each other. I don't benefit from sitting alone on my treasure."
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