As women age, the consistency of menstrual cycles become erratic. Bleeding that was once regular, has become heavier, then lighter, then absent, then spotting with no rhyme or reason as to which type of month the next will be. It is these unpredictable cycles that lead to the highs and lows of estrogen and progesterone.
Natural bio-identical hormone replacement (BHRT) has only come into popularity in the last dozen or so years. Prior to that, women were told to use the synthetic hormones to relieve their menopausal symptoms. Because of the gaining popularity of BHRT, several years ago I began studying and learning about this “new” approach to therapy. Coincidently, while investigating these hormones, the frequency of questions from patients about the therapy increased.
In these last dozen or so years; many doctors, with the help of pharmacists, have been prescribing these bio-identical hormones to tens of thousands of women, as well as men. The hormones can enter the body through the skin, oral capsules, implantable pellets, or sublingual delivery systems. The dosages are individualized to meet the needs of the individual patient. Men and women all over the world have taken and continue to take these bio-identical hormones with great success and virtually no drawbacks.
What not to do
In 2002, one arm of the Woman’s Health Initiative, or WHI, study was abruptly stopped because of side effects. The study was testing the efficacy of combining synthetic estrogen and synthetic progesterone (Prempro) versus nothing. The synthetic hormones increased the risk of breast cancer, heart disease, blood clots, and stroke. The study was stopped after just five years, three years early, because the risks of synthetic hormone replacement were too great.
The study looked at 16,000 women and determined that after five years of taking synthetic hormones, there was a 29% increased risk of breast cancer, 26% increased risk of heart disease, and 41% increased chance of stroke. In August 2003, the British medical journal, The Lancet, published a different study involving approximately one million women. The researchers concluded that in the United Kingdom, in ten years time, synthetic hormone use has caused 20,000 extra breast cancers.
Because of this, both patients and physicians have been inundated with conflicting information regarding hormone replacement. Many physicians are avoiding hormone replacement altogether because of the new findings. These findings after years of prescribing these medications, confused even the most experienced of doctors. Patients began looking into alternatives.
The synthetic hormones increase breast cancer risk because of “unchecked” estrogen in the breast tissue. You have to balance estrogen with progesterone. Taking oral synthetic hormones will also give you a better chance of blood clots due to metabolism in the liver. When the liver has to filter out these synthetics, it produces chemical metabolites that cause blood clots. These blood clots can increase your risk of a blood clot in the brain, also known as a stroke.
The goal of most physicians is to optimize their patients’ health while alleviating annoying symptoms that occur with hormonal changes. With the stoppage of the WHI, many physicians were left scratching their heads. They knew the hormones relieved their patients’ symptoms but, in the long term, did not optimize health. Also, there are no long term, large clinical trials to test the effectiveness of bio-identical hormones versus the synthetics.
Looking for clinical trials to show the effectiveness or ineffectiveness of bio-identical hormones proves difficult. Large, clinical studies are generally funded by big drug companies. They are trying to prove that their patented medication out performs other therapy. Since “Big Pharma” cannot profit from the sale of these bio-identical hormones, they are not going to pay for a study.
Or, as I see it, drug companies have plenty of money to study medication. If they are confident that their synthetic product is superior to the naturally occurring bio-identical hormone, why don’t they test them side-by-side in a long term study? The answer is, because they would lose. If you can’t win, don’t fight.
Some government agencies and colleges have performed studies with bio-identical hormones. While many studies are positive, other studies are inconclusive. This is partly due to the expertise required for proper individualized dosing. Getting the proper dose for the patient is critical when balancing the delicate hormone system.
Go natural or don’t go at all
These hormones are the exact chemical structure found inside our bodies. There is a constant on-going long term clinical trial called life. We, as humans, have had these hormones in our body since, well, since we were created. By simply replacing what our body can no longer produce or supplementing our lowered output is certainly a reasonable goal. Don’t we have enough sense to realize that we are not drugging ourselves but simply restoring our natural hormone levels?
Bio-identical hormone replacement has been sometimes regarded as a way to slow down or stop the aging process. This is untrue as the goal of BHRT is not to bring a 60-year old woman’s hormones to that of an 18-year old. The goal is to optimize the function of the body without causing harm in the form of overdosing the patient. How many 60-year old women would like to return to the menstrual cycle and fertility of an 18-year old? I think the number is very low. God does not want us having children at 60 years old.
Statistics show that nearly 50% of woman who begin synthetic hormone replacement stop within one year. They stop because of side effects like weight gain, spotting, moodiness, and breast tenderness. With the bio-identical hormones, the dose is based on the individual woman, not on a widely accepted “normal” range. The one year continuation rate with bio-identical hormones is reported to be over 90%.
This form of therapy works. It has absolutely no side effects, none, never had, never will. The only unwanted effects are from under dosing or over dosing.
Before we go any further, it is important to know the hormones that are currently flowing through your body. Both men and women should have a balanced level of the big three; progesterone, estrogen, and testosterone. These, along with dehydroepiandrosterone (DHEA) make up the majority of the hormones we’ll be discussing here.
In short, progesterone regulates the other hormones and preserves pregnancy. Estrogen makes a woman a woman, giving her wider hips, softer skin, breasts, and a higher-pitched voice. Testosterone makes a man a man, giving him a larger frame, body hair, and deeper voice. DHEA can be converted into these hormones. As we age, DHEA levels drop, therefore, our other hormone levels tend to drop.
Later, we will go into further explanation of each of these essential hormones.
What are bio-identical hormones?
Bio-identical hormones have the same, exact chemical structure as those found inside the human body. Bio-identical hormones will provide for you the exact same physiological response and action as those hormones manufactured in your own body. What the practitioner is attempting to do when administering bio-identical hormones is to bring you up to normal levels. This will achieve the same physiological response that would normally happen if your own body were producing the proper amounts of estrogen, progesterone, and testosterone.
These hormones should be administered in a similar manner in which your body excretes them. This provides a more natural and balanced approach. By doing this, we are attempting to duplicate what your body has done for years by itself. You had been running along on cruise control for 30 or 35 years with your hormones directing the show. Now, your hormones have diminished and your body wants its hormones back where they are supposed to be.
Although theoretically impossible to reproduce exactly how our bodies send out the hormones, we do our best to replicate it. Your body will release a small burst of hormones about every two hours, or 12 times a day. This gives an average level as well as high and low levels. Symptoms of hormone imbalance vary but the most common complaint from the menopausal woman is the hot flash.
The dreaded hot flash
It is reported that up to 75% of women go through the “experience” of hot flashes during menopause. A hot flash occurs when blood vessels in the upper torso area open more widely than normal. These blood vessels are generally located towards the surface of the skin and this opening brings more blood to the area. This increase in blood causes the heat and redness in the upper chest, neck, and face region.
Almost immediately the perspiration arrives and you become a soaking mess. Shortly after the hot flash is over you become a shivering wreck because of the cooling effect of the perspiration. Fortunately, this annoyance only lasts a few minutes but you know the next one is on the way.
Of course, there is never a convenient time for this phenomena. They seem to occur while sleeping, at an important meeting, during a speech, or at a job interview. It would be nice if there was a way of controlling these. Fortunately, we can relieve most of these symptoms.
Hot flashes are caused by a drop in hormones and a rise in another hormone called follicle stimulating hormone. The time before a burst of hormones is when the hot flashes occur. The estrogen level gets to a certain critical threshold causing the unpleasant effects. As soon as the hormones are released again, the hot flash is over. Without any treatment, hot flashes will slowly decrease and eventually go away on their own. This process can take up to three years after your last menses.
Are bio-identical hormones “natural”?
Yes, and no. To the general public, the term “natural” means coming from nature. The base chemical structure to the bio-identical hormones are found in the Mexican yam or soy plants. The base structure, called diosgenin, cannot be readily used by the body in the same form in which it is found in nature. So, yes the basic chemical structure is natural, as in found in nature. This structure must then be brought into a laboratory and altered to create the exact chemical found in our bodies. So, no the exact chemical is not natural, as in found in nature.
Well, then is Premarin natural? Yes, and no. Premarin comes from the urine of pregnant horses. The last time I checked, urine is natural. The urine is then brought into a laboratory where the estrogens are concentrated. This product is then pressed into a tablet. So, yes the basic chemical structure is natural. This estrogen from horses is natural to horses, not to humans. To the human body, they are foreign, and therefore not natural.
The term “natural” is more appropriately referred to the system that is using the natural product, not from where it came. In other words, the body “sees” these chemicals as natural because they are the exact same structure as the ones it has produced since before you were born. They are not synthetic as far as your body is concerned. The base could have originated anywhere. It could have begun in a tomato, a mouse, a tree, in ocean algae, it doesn’t matter where it started, it matters where it ends up.
What are phytoestrogens?
Phytoestrogens are very weak estrogen-like compounds. In fact, they are as much as 10,000 times weaker than your own natural estrogen. They can be found in various substances, over-the-counter products, and herbal supplements. What needs to be clear is that phytoestrogens are not hormones and they are not estrogen. They mimic, and very poorly at that, what estrogen does in the body.
There are three basic types of phytoestrogens; isoflavanoes, lignans, and coumestans. Isoflavones are the most popular and the most potent of the three types. Isoflavones can be found in legumes such as soy, chickpeas, red clover, lentils, and beans. Lignans are found in flaxseed, lentils, whole grains, beans, fruits, and vegetables. Coumestans are found in red clover, sunflower seeds, and sprouts.
It also takes a long time for the phytoestrogens to build up in the body in order to have any effect. The exact time for this action varies from person to person and is dose dependent. There has not been much in the way of clinical research on the subject of phytoestrogens, especially when it comes to long term effects.
Some scientists are discovering that, depending on where the phytoestrogen is located within the body, it can act as either an estrogen or an anti-estrogen. Studies have shown that soy acts as either an estrogen or anti-estrogen, depending upon where it resides in the body. If you have a normal estrogen level and eat soy products, the phytoestrogens can counteract the actions or your own estrogen, causing an anti-estrogen effect. It does this by attaching to the cell and blocking the normal estrogen hormone from attaching. This causes less estrogen affects. If your estrogen level is low and you eat soy foods, the phytoestrogens act like a weak estrogen. It will bind to the cell and have a slight effect on the cell. Crazy huh?
I’ve been asked many times about the subject of cancer with the phytoestrogens. The thinking is that if the synthetic estrogens cause cells to grow uncontrolled, will these weak estrogens cause cancer like the synthetic estrogens are known to cause. We aren’t sure.
We do know that the phytoestrogens in soy cause uncontrolled cell growth in breast tissue. This means that they can cause cancer. But the actual, real life, results show that women who eat a large amount of soy have lower amounts of breast cancer. Another study concluded that soy lowered your risk of breast cancer if you were premenopausal but not if you are postmenopausal. Other studies concerning endometrial cancer have come to similar conflicting results. While some show an increase in cancer, some show a protective effect.
Some women have begun taking the phytoestrogns before any menopausal symptoms have appeared. By doing this, they may prolong the beginning of the symptoms for a short period of time. This, so far, has not been fully proven nor is the therapy very effective. Remember, by taking these phytoestrogens, a woman may block the actions of her own hormones. This is explained by the phytoestrogens blocking the hormones at the receptor site. To put it another way, the doorway is being blocked by something you do not want to come inside.
A word of warning…
If you have a history of breast cancer, or a family history of breast cancer, I would recommend you avoid using phytoestrogens alltogether. If you include some of the phytoestrogen foods in your diet occasionally, there shouldn’t be a problem. But avoid the supplements containing isoflavanoes, lignans, or coumestans.
Is there a difference between commercially available
hormones and bio-identical hormones?
Yes, a big difference. The big drug manufacturers are now using the term “natural” to describe some of their products. This is in response to the large number of patients who are asking their doctors for natural alternatives to the synthetic hormones. Remember, Premarin could be considered natural because it is derived from natural horse urine. The chemical is natural but it is not a natural substance to the human body. The structure is different and therefore our bodies see it as a synthetic, foreign chemical.
The synthetic, commercially available, patented medicines are chemically different from those found in the human body. They are not the same chemical structure, and do not perform the same functions as the hormones produced by the human body. These drugs only mimic some the activity of our hormones. When you take them the response from the body is similar, but not exactly the same.
One of the main issues surrounding the bio-identical hormone movement is money; yes, money. The pharmaceutical drug manufacturers cannot patent a naturally occurring chemical. Therefore, they cannot make any money from the sales. The only way they can profit from hormone therapy is to alter the chemical structure and patent the new structure.
They can patent how a natural chemical is manufactured and a unique drug delivery system. In other words, a company can protect it’s intellectual knowledge in extracting a natural product from its source, but not the actual product. They can place this natural product in a patch or capsule, develop some unique technology for the drug to enter your body, and patent the delivery system. But they cannot make money from something that is not unique and not manufactured in a laboratory.
For example, you can get natural, bio-identical estradiol in the form of a prescription patch. The medication is not patentable, but getting the medication through your skin by way of a matrix delivery system is patentable. So the drug company took a natural product and impregnated a drug delivery system. They are protected by the patch’s drug delivery system.
Many in the medical community use the term HRT, or hormone replacement therapy, without properly defining the meaning. By using a synthetic product, like Premarin, the patient is substituting natural, human estrogen with a synthetic, horse urine product in the form of a drug. This drug simply mimics the action of estrogen, it does not replace it. The patient is not replacing estrogen with estrogen, she is substituting estrogen with a drug. This definition of the term HRT has led to confusion amongst the medical community.
Let’s use a little common sense. A hormone’s job is to get to a cell and fit into it’s unique receptor site. This fitting is like a lock and key, or two pieces of a puzzle. The hormone molecule fits perfectly into a receptor site located on the cell wall.
By studying chemicals that are structurally similar from our own hormones, we learn that the foreign chemicals act differently at the receptor site. Sometimes they act like our own hormones, sometimes they have no effect, sometimes they have a harmful effect, and sometimes they block the receptor so no other hormone can enter. These are not natural to our body.
The pharmaceutical companies know this and try to formulate a chemical that is similar to our own. It doesn’t matter how close they get, the effects at the receptor site on the cellular level are different from the exact chemical structure of our own hormones. Remember, they cannot patent a naturally occurring substance.