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You may know you have a
hormone related health problem. Or perhaps you suspect some of your health
problems may be hormone related? Did you know that the following range of
problems can be hormone related:
- May help
protect against endometrial and breast cancers,
- Protect
against heart disease,
- Guard against
atherosclerosis,
- Protect
against osteoporosis and promote bone building,
- Improve
concentration and memory,
- Reduce
symptoms of depression,
- Promote fat
burning for energy,
- Prevent
vaginal thinning and dryness,
- Eliminate or
reduce hot flashes,
- Reduce sleep
difficulties,
- Enhance sex
drive and libido,
- Improve blood flow
- Improve skin elasticity and prevent
thinning of skin
- Protect
against fibrocystic breasts.
Whether you have any of the
above problems or have PMS, impotence, osteoporosis, menopause,
perimenopause or hypothyroidism, natural hormone replacement can help
balance you. The key point is that your doctor first has to be
able to recognize that vague, stubborn
health problems may be hormone related. Your hormone system (called the
endocrine system) is intricately involved with the immune and nervous
system, and any imbalances affect you at every level of your being. No
hormone in the body works in isolation — they all work in harmonic
interdependence with the rest of the body. One of the keys to well being
is keeping your hormones in balance.
To evaluate you for hormonal
imbalances, in addition to taking a detailed history and making a thorough
physical exam, we may test your blood, saliva or urine. Most of us are
familiar with blood tests as a way of obtaining information about one’s
particular health status, but saliva sampling can provide very useful
information, especially for female hormones. Research has clearly
established that salivary hormone levels correlate well with blood levels
of hormones such as estrogen, progesterone, testosterone, DHEA and
cortisol. Salivary hormone levels measure the amount of free hormone in
the blood — that is, the part that is biologically active. This gives us
an idea of how much hormone your tissues are truly being exposed to. This
is difficult to tell from blood tests because so much of the hormone is
bound to protein in the blood. Salivary testing is also desirable since it
can be done in the convenience of the patients home, is less expensive
than blood tests, and multiple samples can be easily taken over a period
of time to really see what is happening at the hormonal level.
Once your particular hormone
imbalances are understood, we can then begin to restore you to good health
through individualized dietary adjustments, nutritional supplements, and
natural hormone replacement prescribed for your specific needs. To obtain
the intended benefits without the side effects of synthetic hormones, we
use natural hormones. By natural, we actually mean "identical to natural",
or bio-identical hormones. Although these plant-derived hormones are
synthesized in a lab and are not extracted from humans, they are natural
in the sense that they are biochemically identical to human hormones.
Using nature as the template we attempt to provide your body with what it
needs, in familiar form, so it can "fill in the gaps" according to it’s
own wisdom.
Currently in conventional
medicine, what is most prescribed for women with any gynecological
hormone-related problem, whether it’s PMS, infertility, post-partum
depression, post-hysterectomy, menstrual irregularities, or menopause, are
strong synthetic hormones that only resemble your body’s own. This is
where the problems start. Hormones which are not identical to your own —
like Premarin, Provera, and Birth Control Pills — don’t fit! They don’t
fit into your hormone receptors like the lock and key they are supposed
to, but more like a rectangle trying to fit into a square shape. It’s not
only that these synthetic hormones don’t fit, but they also can’t go down
the normal metabolic pathways of detoxification and excretion as fast as
bio-identical hormones. This means they linger and can accumulate in the
body, making them stronger acting and with so many potential side effects.
Unfortunately, these
unnatural hormones, in the form of Premarin and Provera, are the most
commonly used substances in mainstream American medicine for the
correction of women’s hormonal imbalances. Premarin is an estrogen which
is made from the urine of pregnant mares — yes, as in horses. Only 1/3 of
it’s dose is familiar human estrogens, whereas 2/3 are horse estrogens.
These horse estrogens attach more strongly to the human estrogen hormone
receptor than native hormones and may take 8 to 14 weeks to clear from the
body compared to the one day clearance of native human estrogen. When
post-menopausal women on Premarin began to develop uterine cancer, a
synthetic form of progesterone, a progestin, was created to counterbalance
the strong estrogen. Provera is medroxy-progestrone, a synthetic progestin
with properties similar to progesterone but with a different molecular
structure, which is many times more potent than natural progesterone.
Progestins can produce very different, and often undesirable effects in
the body compared to the natural progesterone. Beyond Provera’s numerous
side effects, it interferes with your body’s own progesterone production.
You might wonder why these
drugs have dominated the medical marketplace versus bio-identical
hormones. It is because natural substances can not be patented, and only
patented unique products allow drug companies to corner a market and make
profits. In the rare cases where the drug companies have produced
bio-identical hormones, such as Estrace (estradiol) and Prometrium
(progesterone), they are counting on the patented delivery mode as their
profit maker.
Fortunately the full range of
bio-identical hormones are available through compounding pharmacists in
any combination or dose required. Depending on your individual needs, a
tailor-made prescription can be created for you. If a female hormonal
imbalance or health problem is being addressed, your prescription may
include any of the hormones found in the human ovary. These include three
estrogens (estradiol, estrone, and estriol) as well as progesterone,
testosterone, and DHEA.
Estradiol (E2) is the
predominate natural human hormone produced prior to menopause. It is the
primary biologically active hormone from puberty to menopause and is
responsible for over 400 functions in the female body. It is the decline
of estradiol after menopause that results in the post-menopausal changes
in skin, bone, heart/blood vessels, brain and other organs.
Estrone (E1) is the
predominate human estrogen found in post-menopausal women. It is made by
the body fat as well as by the ovary and can be converted to and from
estradiol. It seems to serve as the body’s reservoir to make estradiol.
Because estrone continues to be produced in the body fat after menopause
it explains why heavier women seem to have a smoother menopause than very
slender women. Estrone is the estrogen most associated with breast cancer
and for this reason we no longer include it in hormone formulations.
Estriol (E3) is the
weakest of the human estrogens and is predominate during pregnancy. It is
especially good for relieving vaginal dryness and urinary problems. It’s
lower potency does not make it as effective as the more potent estradiol
in providing protective benefits for the bone, heart, brain, nerves, or
for relieving the hot flashes, sweats and insomnia of menopause. However,
at higher doses, its weaker potency seems to hive it breast cancer
protection, as it can block the stronger estrogens which encourage breast
cell proliferation.
Progesterone
predominates in a women’s premenopausal years after each ovulation and
during pregnancy. If you don’t ovulate, and if you’re not pregnant, the
adrenal glands are the bodies only other source of progesterone.
Progesterone is critical for maintaining a pregnancy, for enhancing and
balancing the effects of estradiol, for promoting new bone formation, for
protecting against endometrial and breast cancer, and for a natural
calming agent. As women ovulate less and less before menopause, they often
produce less and less progesterone in proportion to estrogen. This leads
to a situation of relative estrogen dominance, which can look like
worsening PMS, fibrocystic breast disease, uterine fibroids, weight gain,
and depression in women in their late thirties and forties.
Testosterone is
usually thought of as the male hormone but it is also very important to
the well-being of women at physiologic doses. It is produced in women’s
ovaries and adrenal glands at about 1/10 th amount males have. As women
age and their ovarian and adrenal function decline testosterone
supplementation in very low doses can be very important in restoring
energy, enhancing sex drive, maintaining muscle mass, lifting depression,
and even strengthening and building bone.
DHEA is the other
male-like (androgen) hormone which women produce in their ovaries and
adrenal glands. At physiologic levels it has multiple beneficial effects
including: restoring energy levels; protecting against stress, depression,
and even heart disease; building bone; enhancing the immune system; and
helping to relieve menopausal symptoms. Since DHEA can convert to both
estrogen and testosterone, it is best to only supplement when testing
indicates it is low, or if you can measure your levels while on it.
These bio-identical hormones
are delivered to your body by two main routes, either by mouth in a
capsule form or transdermally by cream. Each way has its advantages and
disadvantages. The transdermal creams are applied to parts of the body
where the skin is thin and can be easily absorbed, e.g. inner arms, inner
thighs, abdomen. Applying the hormones by skin takes it directly into the
bloodstream, bypassing the liver and digestive tract, allowing greater
immediate systemic effect. Women with gastrointestinal or liver problems
may be best off using the transdermal creams. However, women who are
having menstrual cycles usually can’t use creams because you can’t turn
off the continuous subcutaneous release of the hormones. The creams build
up in the subcutaneous fat layer, and even if discontinued it may take
weeks or even months for the drug levels to decrease to baseline.
Taking hormones orally by
capsule has the advantage over the creams in
- the ability to stop and
start oral doses of hormones as needed
- the desired dose is
better controlled
- the oral route is much
less likely to accumulate as high hormone levels in the body
- better at controlling
hot flashes
A women’s decision to use
natural hormone replacement will be based on many factors — every women is
different. Your medical history, your family medical history, the degree
to which your symptoms are interfering with your quality of life, and your
values may be most important factors. Individualized, appropriate dietary
adjustments, herbal and nutritional supplementation, exercise, and stress
reduction techniques may be enough support for many women to weather their
hormonal imbalances. But for those other women, it is reassuring to know
that there are hormones available which are identical to your own, which
provide the benefits intended without the side effects of synthetic
hormones, and knowledgeable practitioners to prescribe them.
SUGGESTED READING:
- Natural Women, Natural
Menopause, Marcus Laux, ND and Christine Conrad (New York: Harper
Collins, 1997)
- Screaming to Be Heard,
Elizabeth Lee Vliet, MD (New York: M. Evans and Co., 1995)
- Dr. Susan Love’s
Hormone Book, Susan Love, MD and Karen Lindsey (New York: Random
House, 1997)
- The Super Hormone
Promise, William Regelson, MD and Carol Colman (New York: Simon &
Schuster, 1996)
- Susan Weed
- Christiane Northrup, MD
- John Lee, MD
FREQUENTLY ASKED QUESTIONS
What is Natural Hormone Replacement or Bio-Identical
Hormone Replacement?
Natural Hormone Replacement Therapy (NHRT) is an attempt to 'replace' some
of the normal hormones in your body that have declined as a result of peri-menopause
or surgical menopause. One of the differences between the natural vs.
synthetic hormones is that the natural hormones are "bio-identical", meaning
they are exactly the same as what your body makes. In fact, if you looked
under a microscope at the chemical structure you could not tell the
difference between the bio-identical hormones and the body's hormones.
Where do the Bio-Identical Hormones come from?
Bio-Identical Hormones are just that, they are natural and bio-identical to
a person's body. They are made from plant sources. The source of the
estrogen is soy, and progesterone can be obtained from either soy or yams.
Which hormones are in need of replacement?
That all depends on the individual, most commonly women experiencing a
decline in hormone levels may require some type of estrogen as well as
progesterone. Some patients also take testosterone, DHEA and other hormones.
How do you determine which hormones and how much is
necessary?
Various methods can be used to measure levels of hormones, everything from
blood to saliva to urine tests. The information that these tests provide is
somewhat limited because hormone levels fluctuate normally from day to day
and month to month. When you get lab results from a hormone test it is based
on a single point in time. Also, the range of hormones is based on 'the
average', but many people fall outside what is 'average'. For that reason,
many clinicians rely more on the symptoms that patients may be experiencing.
What is Tri-Est & Bi-Est?
Both Tri-Est and Bi-Est contain the bio-identical (and natural) hormones
that are found in all people. Tri-Est contains 3 of these estrogens (Estriol
80%, Estradiol 10%, and Estrone 10%), while Bi-Est contains 2 of the 3
estrogens (Estriol 80% and Estradiol 20%).
Does my insurance cover Bio-Identical Hormone
Replacement?
Insurance may pay all, part or nothing. It depends on what type of drug
coverage you have. We can try to run your insurance through our computer via
a modem to find out if it will be covered. If we do not participate in your
insurance plan (some plans have limited pharmacy enrollment or specify which
pharmacy you must go to) we can provide a universal claim form for you to
submit to be reimbursed for the cost according to your insurance plan.
Insurance questions can best be answered by your benefits coordinator at
your insurance company as they determine what is covered and what is not.
How should I approach my physician or nurse/How do I
get a prescription for Bio-Identical Hormone Replacement?
Some doctors and nurses are familiar with Bio-Identical Hormone Replacement
while many are not. We suggest that you first educate yourself about natural
hormones before discussing it with your doctor or nurse. After learning more
about Bio-Identical Hormone Replacement, approach your current GYN or
physician first. Often people develop a relationship with their current GYN
or physician. If your current physician is unfamiliar with Bio-Identical
Hormone Replacement, The Natural Pharmacy can help with dosing questions and specific
information. If your physician is unwilling to consider Bio-Identical
Hormones, you may want to seek out another physician that is more receptive.
The Natural Pharmacy can recommend doctors and nurses that are familiar with
Bio-Identical Hormone Replacement, but again, The Natural Pharmacy feels strongly that
you should at least approach your current doctor with the request first.
Why would you consider Hormone Replacement?
Throughout their lifetimes, women experience the ebb and flow of hormones
within their bodies. Drastic changes often are first felt during puberty, a
time when there is a significant increase in estrogens, progesterone,
testosterone, as well as other hormones. Puberty and menarche mark the
beginning of reproductive life and menopause marks the end of it. During the
period between these two phases of a women's life, her hormone levels will
continue to fluctuate, but gradually over time these same hormone levels
will begin to decrease.
As a woman makes the transition from the reproductive to the
non-reproductive stage of her life, her body undergoes important hormonal
changes once again. Estrogen, progesterone, and other hormone levels may
decrease and become imbalanced. This change can occur slowly or rather
rapidly and can be initiated through hysterectomy. Often the signs of
imbalance appear as familiar symptoms such as hot flashes, depression,
anxiety, mood swings, vaginal dryness and sleep disruption to mention a few.
Long-term, these same imbalances may lead to an increased risk of heart
disease and osteoporosis (a decrease in bone density that increases the
likelihood of fractures).
It is not uncommon for women to attribute the onset of the
above-mentioned symptoms to something 'age related'. Or perhaps she may have
a generalized I-just-don't-feel-right feeling, but cannot put a finger on
exactly just what's wrong. Often these problems are directly associated with
an imbalance of hormones. It's very reassuring to discover that the source
of so many problems may have a single cause that's related to hormonal
imbalance. Physicians can determine if this may be the cause of the problems
by measuring a FSH level (follicle stimulating hormone) from a blood sample.
The medical term for this phase in a women's life is known as
perimenopause, or the time prior to complete cessation of her period.
Perimenopause is different for all women, but in general it is a time when
cycles may shorten and become irregular. A woman's period may also be
irregular and sporadic. Skipping a cycle or failing to ovulate are quite
common occurrences during perimenopause. If you imagine a woman's hormones
prior to perimenopause as a rapidly spinning top, the top begins to slow as
hormone levels decrease. Perimenopause brings a marked drop in hormones that
may cause the hormonal 'top' to wobble. This unpredictable wobble is usually
when most women first feel the symptoms of 'the change'. Eventually, the top
will stop completely and a woman has now entered menopause.
Hormone replacement therapy (HRT) is an attempt to rebalance a woman's
hormone levels. There are three primary reasons why a woman may want to
consider HRT. Short-term it is used to help alleviate the unpleasant
symptoms related to 'the change' and help improve quality of life. Long-term
it is used to reduce risk of heart disease and osteoporosis. Hormone
replacement can be accomplished by different means and it is important that
every women considering HRT know and understand treatment options.
Most commonly HRT involves using replacement sources of estrogen and
progesterone, but it may also include other hormones. There are a few
misconceptions concerning estrogen. Estrogen is commonly thought of as a
single hormone, and is often called a "female sex hormone". This is not
true. Estrogen occurs in both females and males and actually consists of
three separate hormones in the human body: estrone, estradiol, and estriol.
All three types of estrogens collectively play an important role in
maintaining hormonal balance.
Currently the most commonly prescribed sources of HRT are from drug
manufacturers. They have created and patented chemicals or combinations of
chemicals that may closely resemble what a human body naturally produces.
These synthetic or conjugated estrogens are derived from a variety of
sources including plant and animals, however they do not match what is
natural to the body. These small differences at the molecular level may
cause some of the side effects related to synthetic estrogens such as
bloating and weight gain. Conjugated estrogens contain non-human estrogens.
Other products may contain only one of the three types of estrogens. In
addition, conventional therapy has a limited variety of strengths and
sometimes the "one size fits all" does not work. There are alternatives
however.
Bio-identical hormone replacement consists of hormones that are derived
from plant sources and synthesized in a laboratory. These hormones are
considered bio-identical because they match exactly what the human body
produces at the molecular level. They are used by compounding pharmacists to
custom prepare a balance of hormones that are unique to each individual
woman. Since these hormones are identical to what the body makes naturally,
they tend not to have the side effects associated with the synthetic
hormones. Compounded formulations are custom made to meet the specific needs
of each woman based on her individual needs. Most formulations contain the
estrogens in approximately the same concentrations as that of pre-menopausal
women.
An often-asked question about bio-identical HRT is: why doesn't a drug
manufacturer make a product using these same estrogens? The answer is that
these natural hormones cannot be patented anymore than one could patent air.
Therefore, there is little incentive to manufacture bio-identical hormones.
Bio-identical hormone therapy has been around for years in Europe and the
United States. It offers an alternative to patients seeking a 'natural'
approach to HRT and to those patients who have tried conventional therapy
and failed. As with traditional therapy, bio-identical HRT is available by
prescription only and needs to be discussed with your healthcare provider.
By educating yourself about the options regarding HRT you can make an
informed decision to maximize your health for the immediate future and in
the long term. |
