BHRT Vs
Synthetic
A number of methods available for treating
menopausal symptoms are considered 'natural'. They include maintaining a
healthy lifestyle through diet, exercise and stress reduction; the use
of herbal medicines like dong quai, black cohosh and licorice; and the
use of phytoestrogen (plant) products which contain flavones. While many
women find these natural therapies helpful, they are not the same as
natural Hormone Replacement Therapy (HRT).
Even though natural therapies are healthy
choices and sound practices, it is important to remember that diet and
exercise do not raise hormone levels. The only way to truly impact
hormone levels is to take hormones.
For many years
conventional HRT has consisted of a standard prescription of hormones -
most commonly
0.625 mg of Premarin®
(animal-derived) and 2.5 mg of Provera® (synthetic). Premarin is a
combination of estrogens derived from the urine of pregnant mares.
Provera is synthesized in the laboratory from natural progesterone, then
modified for reasons of product patenting.
As women seek education
about options available to them as they enter menopause, and as their
demand for more natural products increases, a ripple effect has been
created throughout the pharmaceutical industry. The result has been a
number of new natural, bio-identical pharmaceutical products
What are Natural
Hormones?
Natural hormones are
derived from chemical precursors found in plants. Soybeans and wild yams
are the most common sources of these chemicals. For a soy or yam
precursor to be converted into a hormone, it must be done in a
laboratory. Therefore, natural hormones, like their synthetic and
animal-derived counterparts, can be pharmaceutical compounds.
Natural hormones are
identical in molecular structure to the hormones the body makes, thus
they are called bio-identical. When a bio-identical hormone circulates
through your system and binds with a receptor, the fit is the same as if
your body had produced that hormone.
Animal-derived and
synthetic hormones are similar to human hormones, but they do not have
the same molecular structure. When one of these binds with its receptor,
the fit is not exact, sometimes resulting in side effects. Natural
hormones have been growing in popularity because they are very effective
and often without the side effects that can come with the use of
synthetic or animal-derived hormones.
The Estrogens
By definition, estrogen
is not a single hormone; it is a category of hormones which includes
estradiol, estrone and estriol. The one most commonly used in the
treatment of menopausal symptoms is estradiol, but estrone and estriol
are also prescribed.
Progesterone
In the natural form,
progesterone is identical to what a woman's body produces every month.
Synthetic progestins such as those found in oral contraceptives, on the
other hand, can suppress ovulation and lower the body's output of the
natural hormone. Synthetic progestins often intensify, rather than
relieve, PMS symptoms. Natural progesterone and synthetic progestins
cannot be used interchangeably." Most often, progesterone is prescribed
to be taken during the second half of the menstrual cycle, from
ovulation until menstruation begins. Some people think "natural"
progesterone is an herbal or organic substance, something you would buy
in a health food store. It isn't. Natural progesterone is a highly
purified, quality pharmaceutical preparation derived from soy that is
regulated by the Food and Drug Administration (FDA). It is a
prescription drug that must be individually compounded by a pharmacist.
Combination Products
The commercial
combination products, Prempro® and Premphase® combine Premarin and
Provera. To date, there are no pharmaceutically manufactured combination
products of estradiol and natural progesterone, however bio-identical
estrogen products can be formulated by a compounding pharmacy to include
progesterone. Tri-Est and Bi-Est are natural estrogen combination
products. Tri-Est is a combination of estradiol, estrone, and estriol.
It comes in a 10-10-80% formulation that is designed to match the body's
ratio of each hormone and can be prepared by a compounding pharmacy in
oral, gel, and cream forms. Bi-Est is a similar product but does not
include estrone and is 20% estradiol and 80% estriol. More and more
women are using Bi-Est because it does not contain estrone (already
plentiful in postmenopausal women) and because there is some research to
indicate that estriol is the weaker and safer form of estrogen. Both Bi-Est
and estriol alone can be formulated into a vaginal cream. Because of the
numerous estradiol receptors in the vagina, these products work well
addressing vaginal atrophy and incontinence.
Testosterone
Until recently, the
only commercial testosterone products available contained
methyltestosterone, a synthetic form of testosterone, in dosages only
appropriate for men. Current studies, however, clearly show that
testosterone is also an important hormone for women. Now, because of its
increased popularity, there has been a rush by both pharmaceutical
companies and compounding pharmacies to meet the demand. The estradiol-testosterone
combination patch Estratest® provides dosages appropriate for women, but
does not contain natural, bio-identical testosterone. Presently,
bio-identical testosterone can only be purchased from compounding
pharmacies, formulated as tablets, capsules, creams, gels, or
sublinguals.