Sandra Justice, P.D.,FACA
Today millions of men and women concerned about aging and maintaining a quality of life are undergoing hormone replacement therapy (HRT). Hormone-related problems- such as mood swings, PMS, infertility, endometriosis, fibrocystic breasts, weight gain, low libido, vaginal dryness, frequent bladder infection, heart disease and osteoporosis – can be relieved by achieving a proper hormone balance. In considering the benefit risk ratio, it is important to take into account alternatives to traditional therapy.
Why Natural Hormone Replacement Therapy?
Alternatives to traditional HRT include the use of natural plant-derived bio-identical hormones which have the same chemical makeup as those produced by the human body. Synthetic hormones and hormones from animal sources do not allow the body to produce the full range of other hormones which are needed to function at full potential, and therefore are more likely to produce side effects.
If you haven’t heard much about natural hormone replacement, you’re not alone. It’s even possible your doctor hasn’t either. Because natural hormones cannot be patented for the same reason you cannot patent natural air, water, or vitamins, there’s little or no incentive for the pharmaceutical industry to spend millions of dollars to develop, test, submit to the FDA for approval, and market these hormones.
What hormones are we talking about?
Natural hormone replacement isn’t just estrogens and progesterone. Natural estrogens and progesterone are just part of a complex and closely interlinked hormonal system that includes many other hormones such as testosterone, DHEA, pregnenolone, and melatonin, to name just a few. Many of these hormones have been found to decline with age. Restoring them to normal levels with natural replacement versions can have a remarkably revitalizing effect on our hearts and immune systems to our moods, energy, and libido.
Estrogen is not one hormone, but a group of similar hormones with varying degrees of activity. The three most important estrogens are estrone, estradiol, and estriol. Estradiol is the primary estrogen produced by the ovary, and estrone is formed by conversion of estradiol. The most popular form of estrogen replacement remains conjugated estrogens (containing many estrogens that are natural to horses, but few that are natural to humans). In the intestinal tract, these are converted mostly to estrone. Synthetic ethinyl estradiol is also commonly used in estrogen supplements. Estrone and estradiol are the estrogens primarily linked to breast and endometrial cancer.
New regimens have been developed that use natural estriol in the greatest concentration along with other naturally occurring estrogens in a properly balanced ratio. Estriol produces very little endometrial proliferation and rarely causes postmenopausal vaginal bleeding. Estriol may also be effective at lowering the risk of blood clots in the veins or lungs. Estriol is produced in very large amounts during pregnancy and is thought to be protective against breast cancer. High levels of estriol are found in vegetarians and Asian women, who have a much lower risk of breast cancer.
The hormone progesterone participates in practically every physiological process, in both men and women. The stabilizing action of progesterone is especially visible in muscle tissue, such as uterus, blood vessel walls, the heart, the intestine, the bladder, and bone cells. Less visibly, progesterone stabilizes and normalizes nervous, secretory, immune and growth processes.
Natural progesterone comes from yams and soybean. It matches exactly the chemical composition of the body’s progesterone. Synthetic progesterone, or progestins, are chemically formulated from progesterone and react differently in the body causing the unwanted side effects such as salt build up, fluid retention, low blood sugar, breast tenderness, weight gain, and depression. The role of natural progesterone in preventing and treating osteoporosis, helping to clear endometriosis and fibrocystic breast, and treating vaginal dryness, infertility, and menstrual irregularities is receiving considerable attention in the medical and lay communities. In men over 55 natural progesterone is being used to increase libido, as well to treat osteoporosis.
In some cases, it is necessary to consider the addition of the androgens, testosterone or the synthetic methyltestosterone, to a woman’s hormone replacement regimen. Typically thought of as a male hormone, testosterone is also produced by the female 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, muscle and bone, lowering cholesterol levels, and improving cardiovascular circulation in both men and women.
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 androgen production decreases by as much as 50%. It is possible to supplement a woman’s testosterone deficiency with the same natural testosterone she has produced most of her life. Synthetic hormones with even the slightest alterations can produce side effects not found with the natural hormone.
DHEA, Pregnenolone, and Melatonin
Not just estrogen, progesterone, and testosterone, but many other hormones, including growth hormone, melatonin, DHEA, and pregnenolone, reach peak levels before or during the third decade of life and then begin a gradual decline of about 2% per year. Research clearly indicates that replacing inadequate levels of these important hormones can, among other positive effects, help protect the heart, improve mental alertness, make bones stronger, and revive a lagging sex life. We are just beginning to understand the health benefits that can be achieved by restoring levels of these important hormones to their youthful peak.
Because steroid hormones play such a vital role in maintenance of health, knowledge of an imbalance in any one or more hormones can help illuminate the cause of health problems and provide a rational basis for correcting the imbalance through diet, exercise, or hormone supplementation.
Steroid hormone levels can be determined through blood and saliva testing. When the various glands manufacture the steroids they are released into the bloodstream bound to carrier proteins. Only a small fraction (1-5%) of a given amount of steroid hormone breaks loose from the carrier protein in the bloodstream and is free to enter target tissues. Blood testing measures both the bound and unbound steroid hormones. Studies show that there is a strong correlation between the levels of steroid hormones in the saliva and the bioavailable (unbound) levels of steroids in the bloodstream.
Levels of all steroid hormones can be measured individually by both blood and saliva testing. Blood testing requires a prescription from your physician. Saliva testing kits can be obtained through compounding pharmacies involved with natural hormone replacement.
Customize, Don’t compromise
As many as two-thirds of women who start HRT stop within two years. One main reason they stop is because of side effects, particularly the irregular bleeding that can last anywhere from a few months to a few years.
So how do you reap the benefits of HRT and bypass the side effects? Customize. HRT needs to be carefully initiated by your physician after a personal history, family history, and current medical situation are reviewed. Everyone is unique and will respond to therapy in their own way: therefore the selection of hormone(s), dose and dosage form should be specific to each patient. Close monitoring is important to ensure proper dosage adjustments and avoid unnecessary side effects. Compounding pharmacists can make natural hormones in a variety of doses, regimens, and preparations designed to make you more comfortable with your therapy while gaining long-term benefits.
Quality of life until the end of life
Many options are now available for women and men who want to achieve and maintain optimal health. Proper nutrition, appropriate supplementation and exercise are all-important components of wellness. The advantages of natural hormone replacement for perimenopausal and menopausal women are now quite clear. They include all the well-known benefits of HRT and more, with very few of the unwanted effects and risks associated with the man-made variety.