The Benefits of Natural Hormone Replacement Therapy

"Natural hormone" is a term reserved for those hormones that are derived from plant sources and have the same chemical structure as the human body naturally produces - one could call them "human-identical". Natural hormones differ from synthetic hormones that have been chemically altered so that they can be patented by drug companies. Synthetic hormones cannot be used by our bodies to produce other hormones that are needed to function at full potential.

Dr. Christiane Northrup, MD, former Clinical Professor of OB/GYN at the Univ. of Vermont College of Medicine and respected author, states in her book Women's Bodies, Women's Wisdom: "Synthetic progestins are made by taking natural progesterone from soybeans or yams and changing it chemically to make a chemical, with progesterone-like activity, which is not found naturally in your body. This was done in the past so that progesterone could be taken orally. Until 20 years ago, natural progesterone could only be taken as an intramuscular shot or as a suppository. Then Joel Hargrove, MD of Vanderbilt University, developed a way to micronize natural progesterone. This process allows natural progesterone in capsule form to be absorbed from the gastrointestinal system. Another reason why natural hormones are chemically altered to produce a synthetic hormone is to allow this synthetic (progestin) to be patented by a drug company. If a drug company cannot patent a drug, then it cannot make enough profit to warrant manufacture of the drug...But, hormones that occur naturally in the body cannot be patented. Natural hormones have been prescribed in Europe for over 50 years. Women in the U.S. deserve the same..."

For years, women have been given the hard sell to believe that synthetic hormones, especially estrogen, are required after menopause. What women are not told is that synthetic estrogen may have serious side effects, including breast cancer. Joel Hargrove, MD and other physicians have found that there are many disadvantages to using synthetic hormone derivatives, in comparison with natural estrogen and progesterone. A 1993 study showed that users of these synthetic conjugated estrogens (which are derived from pregnant mares' urine) had a 40% greater risk of breast cancer. Synthetic estrogens are also known to suppress the disease fighting function of the immune system. But, women do have a choice. New regimens have been developed that use naturally occurring estrogens, which are not one hormone, but a group of similar hormones with different degrees of activity.

Despite all the evidence that indicates this is not optimal and appropriate therapy, the most popular form of estrogen replacement in menopausal women remains conjugated equine estrogens (from pregnant mares). In the intestinal tract, these are converted mostly to estrone, the hormone that has been implicated in breast cancer. Synthetic ethinyl estradiol, commonly used in contraceptives and estrogen supplements, also presents a significant risk due to its high oral absorption and slow metabolism and elimination from the body. John Lee, MD stated: "Since this factor of slow metabolism and excretion is true of all synthetic estrogens, one would think that, in all cases of estrogen supplementation, the natural hormones would be superior"

It is a custom of contemporary medicine to prescribe estrogen for women who have undergone a hysterectomy. This is done to protect against problems such as osteoporosis. Estrogen does decrease the rate of bone breakdown for the first five years or so; but after that time, bone loss continues at the same rate as in women not using estrogen. The more important factor of osteoporosis is that the lack of progesterone can cause a decrease in new bone formation.

There are three categories of naturally-occurring sex hormones:

  1. Estrogens
  2. Progesterone
  3. Testosterone and Dihydroepiandrosterone (DHEA)

Estrogens

The three human estrogens are prescribed for replacement therapy due to menopause, ovarian failure or for women who have had a hysterectomy with removal of their ovaries. The estrogens can be used as a single agent or in combination.

There are benefits to prescribing the natural hormone replacement of estrogen. When prescribed for menopause, estrogens can often alleviate hot flashes, vaginal and urinary tract dryness, sleeplessness and mood swings. There are also cardiovascular benefits to replacement therapy such as increasing "good" HDL and decreasing "bad" LDL cholesterol, and protection against hypertension. Lastly, hormone replacement therapy can help osteoporosis if treatment is begun early enough.

The side effects that women can experience can include nausea, loss of appetite, breast tenderness, headaches and alterations in body chemistry. Although the concern of cancer can be mediated by lowering the dose of estrogens or by adding progesterone, a thorough analysis of the benefit-risk ratio with your physician or health practitioner is wise.

Estrogens can be taken by mouth, under the tongue or dissolved in the cheek pocket, rubbed into the skin, inserted vaginally or transmitted through the skin with a patch. The advantage of the transdermal, vaginal or sublingual routes is that the dose can be lower than the oral dose. The action in the body is more natural when the drugs can go directly into the bloodstream instead of passing through the stomach. Some disadvantages to these systems include inconvenience and messiness of vaginal creams, the extra time it takes to rub in a topical gel, patches that won't stick and the taste or time it takes to dissolve a sublingual lozenge. The therapy's pros and cons should be discussed with your physician, pharmacist or health care provider.

Progesterone

Progesterone is derived from the Mexican yam or the soybean. Progesterone can be prescribed for infertility, luteal phase defect, PMS or in combination with estrogens for menopause. Researchers have conducted studies involving oral capsules filled with lactose (milk sugar) or oil (peanut oil), vaginal or rectal suppositories, sublingual lozenges and topical gels.

The major side effect of progesterone, when taken in a capsule form, is drowsiness. If taken with food, the drowsiness is reduced. Although the older literature discusses serious side effects when progesterone is used during pregnancy, this risk is involved with the use of progestins (i.e., 19-nortestesterone progestagens). The use of natural micronized progesterone has been extensively reported and endorsed by clinicians and researchers. The benefits are clear. All hormones have to be used appropriately and in a responsible way in accordance with the recommendations of your physician, but no serious or adverse side effects have been noted with the use of natural progesterone in appropriate doses.

In his book Natural Progesterone: The Multiple Roles of a Remarkable Hormone, Dr. John Lee discussed the concept of unopposed estrogen. He said that "no matter how valuable estrogen is, when unopposed by progesterone, estrogens undesirable side effects cannot be prevented. To effectively use estrogen, it must be used with natural progesterone to prevent unwanted side effects."

Prior to the development of micronized progesterone, the available oral powder was poorly absorbed. Through micronization, the particle size is reduced to facilitate absorption through the gastrointestinal tract. This formulation is becoming the progesterone replacement of choice among many noted physicians. It is stable, well absorbed, and has been proven to raise the level of progesterone in the bloodstream.

Transdermal creams offer many advantages. Because there is no gastrointestinal involvement, the cream can be used in much weaker strengths. This is why Over-The-Counter progesterone cream is widely used to treat PMS symptoms.

Testosterone and Dihydroepiandrosterone (DHEA)

In some cases, it is necessary to consider the addition of the androgens testosterone or DHEA to a woman's hormone replacement regimen. Typically thought of as a male hormone, testosterone is also produced by the ovaries and is essential to normal sexual development. Testosterone plays an important role in maintaining sexual desire, as well as the strength and integrity of skin, muscles, and bone. As a woman enters the transitions of menopause, circulating androgens begin to decrease as a result of age-related reductions in adrenal and ovarian secretion. After menopause, a woman's total estrogen production decreases by 75% and androgen production by 50%.

Susan Rako, MD states: "Supplementary testosterone can be a substantial help in restoring a woman to her familiar level of energy, libido, and well-being." It is possible to supplement a woman's testosterone deficiency then with some natural testosterone she has produced most of her life. Chemically altered hormones, with even the smallest changes, can produce side-effects not found with the natural hormone.

The use of testosterone in women includes breast carcinoma and low or decreased libido in the aging process. The side effect profile of testosterone should be discussed with your physician. Low dose therapy can be administered by the sublingual route, which would also bypass the liver.

Conclusion

Women should discuss these options and alternatives with their physician and pharmacist to decide which therapy would be most beneficial to meet their unique needs.

These statements have not been evaluated by the FDA. None of the products listed or mentioned should be used as a substitute for medical advice, or to diagnose, treat or cure any illness. Always consult your personal physician before consuming any new supplements and never change any medications without his/her expressed permission.