The findings of numerous studies on hormone replacement therapy (HRT) conflict and, as a result, have raised serious questions regarding the appropriateness of HRT. Does HRT improve women’s health by decreasing the risk of heart disease, stroke, osteoporosis, and Alzheimer’s disease? Reputable sources provide conflicting answers.
Click on the articles below to learn more about HRT.
The Bio-identical Hormone Debate: Are Bio-identical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?
Hormones in Wellness and Disease Prevention: Common Practices, Current State of the Evidence, and Questions for the Future
Why use Bio-identical (Natural) vs Synthetic Hormone Replacement Therapy?
Researchers believe that significant differences exist between hormones which are natural to human bodies (bio-identical) and those which are synthetic (including animal). They also believe that it is the chemical structure of the synthetic hormones which may be responsible for side effects when used in replacement therapy.
- According to a study by the Mayo Clinic, women reported an overall 34% increase in satisfaction when used micronized progesterone as apposed to their previously used synthetic progesterone.
- They also reported a 50% improvement in hot flushes, 47% in anxiety and 42% in depression levels.
- Immediate-release dosage forms might cause unwanted side effects due to producing a higher peak blood level of hormones. Slow-release capsules could be prepared to dampen high peaks and low valleys to prolong absorption over several hours to enable less-dosing and improve results.
- A 1999 study showed women who have had PMS to have a higher chance of developing postpartum depression and those who have had postpartum depression once have over 60% chance of developing it again after another pregnancy.
- Preventive progesterone treatments can reduce the recurrence to less than 10%.
What Are Bio-Identical Hormones?
Bio-identical hormones have the same chemical structure as hormones produced by the human body. Only hormones whose chemical structure exactly matches the body, will reproduce the same effects. These hormones are able to follow normal metabolic pathways so that essential active metabolites (breakdown products) are formed. “Bio-identical” does not refer to the source of the hormone, but rather indicates that the chemical structure of the replacement hormone is identical to that of the hormone it is replacing. Natural hormones are transformed to the human bio-identical hormones from sterile analogies (precursors) found in many plants, primarily wild yams and soy products.
Why Bio-Identical Hormones Are Not Available Commercially
Natural substances can not be patented. Therefore, side chains are added to a natural substance (i.e. chemically altered) to create a synthetic product that can be patented by a manufacturer, which in turn would be profitable for mass productions!
ANDROGENS, THEIR ROLE IN HORMONE REPLACEMENT THERAPY
RESTORING THE “BALANCE”
In keeping with the intent to restore hormones in a bio-identical manner one must assess the androgen levels and if found to be deficient they should also be replace. Not to do so is to leave the woman’s therapy incomplete. We cannot improve upon human physiology. Estrogen, progesterone, DHEA and testosterone are involved in a complex symphony and to leave out one or more “instruments” could change the beauty of the final arrangement. Which “instruments” are needed and which “notes” they will play must be individually determined with and for each woman. Hence, the “art” and “science” of medicine.
WHAT ARE ANDROGENS?
Testosterone and dehydroepiandrosterone (DHEA) which is actually an androgen precursor hormone. Androgens are metabolically active in skin, muscle, and are thought to have an important role in maintaining libido. (3) Androgens help maintain muscle mass and strength. In the skin, they support collagen and help maintain oil production. Estrogens and androgens are necessary to maintain the optimum integrity of the musculoskeletal system.
WHAT HAPPENS TO ANDROGEN AFTER MENOPAUSE?
After “natural” menopause a woman’s ovaries continue to produce androgens. However, the majority of the androgens produced in the body even before menopause, some from peripheral conversion of DHEA. As the body ages, production of DHEA declines so that by the time a woman goes through her transition into menopause, and is in need of support from her adrenal glands, the production of DHEA is often inadequate. Symptoms provoked by this potential deficiency vary substantially, again, this is unique to each individual. Replacement must be provided to maintain physiologic levels. (Normal in this instance is defined as comparable to the replacement levels of estrogen and progesterone used) 3, 25
ARE “NATURAL” HORMONES PROTECTIVE?
“Customized” prescriptions provide assurance of most appropriate dosing for each individual…attempting to establish reasonable hormone replacement based solely on management of symptoms defies logic.” (19) Estradiol levels can be kept at levels that are currently known to be protective against osteoporosis and cardiovascular disease. (3, 19)
- Natural Progesterone is superior to synthetic progestins in preventing cardiovascular disease. Natural progesterone does not adversely affect lipid levels. (22)
- Certain progestogens, such as micronized progesterone, can be administered concurrently with estrogen replacement therapy, providing protection against endometrial hyperplasia without significantly affecting the beneficial effects of estrogen on lipid profiles, atherosclerosis and vascular reactivity.
WHAT ARE THE COMPOUNDED NATURAL HORMONES?
After physical examinations, personal and family medical history analysis, and laboratory testings are considered, your physician will prescribe a precise compound to meet your exact needs. Hormones typically prescribed for BHRT are:
* Estrone (E1)
* Estradiol (E2)
* Estriol (E3)
* Dehydroepiandrosterone (DHEA)
Often prescribed combinations to re-establish body’s normal physiological balance include:
Tri-estrogen(Tri-Est) = 80% Estriol + 10% Estradiol + 10% Estrone
Bi-estrogen = 80% Estriol + 20% Estradiol
It’s been found that estradiol, when prescribed by itself (as sometimes happens in conventional HRT) can raise the risk of cancer after several years. Estriol, on the other hand, is anti-carcinogenic. Healthy women naturally excrete much more estriol than estradiol and estrone. But when hormone production slows down during menopause, it’s important to replace all three estrogens in the same proportions your body would produce on its own if it could.
Another substance used in hormone replacement therapy is progesterone. Pharmaceutical progesterone (medroxyprogesterone) isn’t necessarily bad for you in one way—it can lower the risk of developing cancer from taking horse estrogen or estradiol by itself. But it raises the risk of heart problems, so why bother with “fake” progesterone when the natural kind has the same benefits and virtually no risk? The natural form also helps rebuild bone mass, which gives it a major advantage over synthetic.
The next step in natural hormone replacement therapy involves getting in touch with your masculine side. When testosterone levels go down during menopause, it can negatively affect your sex drive. DHEA works along with testosterone in controlling your libido, as well as keeping your body’s tissues healthy. Please have your levels of these hormones tested and if your levels are low, ask your doctor to prescribe identical-to-natural replacements. This is especially important for testosterone replacement, since the major synthetic version (methyltestosterone) is a known carcinogen. Fortunately there is no synthetic form of DHEA (yet), so you can only take the natural form.
- <href=”/bio-identical-hormone-replacement/what-you-should-know-about-synthetic-hormone-replacement-therapy-hrt/”>What You Should Know about Synthetic Hormone Replacement Therapy (HRT)
- What Can Bioidentical Hormone Replacement Therapy (BHRT) Do for Me?
1 JAMA, Jan. 18, 1995, 273(3):199-208.
2 Effects of estrogen replacement therapy on response to tacrine in patients with Alzheimer’s disease. Neurology 1996;46:1580-4
3 Risks and benefits of estrogen plus progestin in healthy postmenopausal women. J Am Med Assoc 2002;288:321-33
4 Nature Medicine, 3(3):324-7
5 Satisfaction of patients using bioidentical hormones for HRT. Int J of Pharm Comp, Sep-Oct 2002, 6(5):377-8
6 Custom-compounded micronized hormones in a slow-release capsule matrix. Sep-Oct 2002, 6(5):378-9
7 Once A Month, Kathe
3. Hargrove, Joel T., Osteen, Kevin G. “An Alternative Method of Hormone Replacement Therapy Using the Natural Sex Steroids.” Infertility and Reproductive Medicine Clinics of North America. 6.4 (1995).
19. Vliet, Elizabeth Lee. Screaming To Be Heard. New York: M. Evans Co., 1995.
20. Sperol T. Leon, Robert H. Glass, and Nathan G. Kase. Clinical Gynecologic Endocrinology and Infertility. 4th ed. Maryland: Williams & Wilkins, 1989.
21. Sperol T. Leon, Robert H. Glass, and Nathan G. Kase. Clinical Gynecologic Endocrinology and Infertility. 4th ed. Maryland: Williams & Wilkins, 1989.
22. Pepi Trial Group. “Effects of Estrogen or Estrogne/Progesslin Regimens on Heart Disease Risk Factors in Postmenopausal women.” Jama 773.3 (1995): 199-209.
25. Young, Ronald L. “Androgens in Postmenopausal Therapy?” Menopause Management. May 1993: 21-24.
26. Hickok, L.R., C. toomey, L. Sperott. “A Comparison of Esterfied Estrogens With and Without Mithyltestosterone: Effects of Endometrial Histology and Serum Lipoprotiens in Postmenopausal Women.” Obstet Gynecol. 82.919 (1993).
27. Mayop, Mary Ann, and Joseph L. Mayo. The Menopause Manager. Grand Rapids: Baker Books, 1998.
28. Hargrove, Joel T., et al. “Menopausal Hormone Replacement Therapy With Continuous Daily Oral Micronized Estradiol and Progesterone.” Obstetrics and Gynocology. 73.4 (1989): 606-612.
29. Vliet, Elizabeth Lee, “New Insights on Hormones and Mood.” Menopause Management. Jun/July 1993: 14-16.
J Reprod Med 2000 Mar;45(3 Suppl):245-58
Rationale for hormone replacement therapy in atherosclerosis prevention.
Comparative Medicine Clinical Research Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1040
The abstract of this article can be viewed online. Go to PubMed. In the search box, enter the following PMID:10756506