So you are looking for Natural Hormone Replacement Therapy because you think that it must be safer than the traditional hormones, right? And because it's natural and not synthetic, it must be better. Well, this may or may not be true as you will see. Just because something is natural does not necessarily mean it is automatically safer. There are numerous substances that are natural but certainly neither safe nor effective.
Traditional hormone therapy gained a bad reputation several years ago when the Women's Health Initiative found that hormone treatment increases the risk of breast cancer and heart disease. This has led to a number of follow up studies that not only increased our options of hormone treatments but also changed the recommendation about what is considered safe. The development of the bioidentical hormone therapy is one example.
What are Natural Hormones?
Natural Hormone Replacement Therapy is often used synonymous with Bio-identical Hormone Therapy. The terms "natural" or "bioidentical" are often used interchangeably to distinguish them from the traditional therapy that uses synthetic hormones.
So let's define what we are talking about: A hormone is bioidentical (natural) if their molecular structure is identical to the hormone our body produces naturally. Natural hormones are typically compared to "synthetic hormones" which are developed to have a similar (not an identical) molecular structure.
Natural hormones are plant derived, mostly from soy or wild yam, but are modified in the lab to add the required molecules to make it into a human hormone. Some synthetic hormones are also derived from plants but other natural substances can be used as well, such as the urine from pregnant mares (hence the name for Premarin). The ultimate difference between natural and synthetic hormones is the final molecular structure, regardless of the original substance.
Several natural hormones are now available in standardized dosages approved by the FDA from pharmaceutical companies. They can be filled by a pharmacist and most health insurance companies will pay for them. So a natural hormone replacement therapy for the treatment of menopause symptoms is available through conventional or traditional medicine. (There are two exceptions: Testosterone replacement for women and estriol. Estriol is available from compound pharmacies but it is not available in standard form in the US only in Canada and Europe ).
Bioidentical Hormone Therapy and Hormone Testing
Some people say that the true bioidenticals are produced in individual doses at compound pharmacies. Using this method of bio-identical hormone treatment can be a gamble, and an expensive one at that. Individually prepared doses of hormones typically cost more than the standardized natural hormones and are not reimbursed by most insurance companies.
Additionally, the bioidentical doctors use controversial hormone testing to determine the dosage that is needed for the individual patient. This increases the cost even more. Testing can be done by saliva or blood test. Because hormones fluctuate a lot even during the day, most conventional practitioners deny that frequent hormone testing is useful or reliable.
There is very little regulation and oversight over compound pharmacies because of the individual nature of the hormone products. Depending on the doctor and the compound pharmacy, you may or may not get good results and safe products.
Boosted by celebrity advertising, this method of bioidentical hormone replacement claims that hormones can be used for anti-aging and can be balanced to reflect the levels of much younger women. These claims imply that women can feel (and look) young again, which is a very powerful and successful (lucrative) marketing strategy but unfortunately neither possible nor proven to be safe.
Also, endocrinology (Hormone Science) gives normal hormone levels as a range between two extremes, and no agreement exists what the healthy hormone balance for a menopausal women should be. So we are back to the treatment of symptoms anyway – which is what conventional medicine is doing.
Having said that, we have numerous friends and acquaintances who are absolutely thrilled with the results of their bioidentical hormone treatment, regardless of the higher cost.
How Do You Find the Best Hormone Therapy?
Until there are better data from the long term use of these individualized bioidenticals, especially regarding their safety, be aware that current guidelines suggest using hormones:
only for the treatment of symptoms
for the shortest possible time
in the lowest possible dose
– not for long-term, anti-aging purposes.
The distinction between "bioidentical" and "conventional" is getting rather blurry since so many of the bioidenticals now exist as FDA approved medications. There is a list of common Hormone Therapies for Menopause Symptoms, including Bioidenticals in the Journal of Women's Health, from 2007. It is rather scientific but well worth reading if you want to understand the pros and cons between your options a little better.
Independent of the use of natural or synthetic hormones, the issue is made more complex by risks resulting from how a specific hormone is taken. Oral hormones (pills) react differently in the body than creams or patches. Creams can have different effects depending on where they are applied. Effects differ with the various hormones.
Today women have so many more options for hormone replacement than previous generations. Finding the right method for you should be based on a frank discussion with a trusted health care provider that is aware and open to the different options - and up to date on the latest research. If you know more about menopause and hormones than your family doctor, it may be time to find a specialist. The American Menopause Society's website lists menopause specialist in your area.
Hormone replacement is a very complicated issue. After all we are messing with very powerful chemicals in our body. The effects of women's hormones go way beyond the treatment of the specific menopause symptoms and influence all systems in the body - from blood vessels to hair growth to cell and brain functions.
Women need to be aware of the various options, as well as the risks and side-effects of ANY hormone replacement. Just because something has the label "natural" or "bioidentical", be aware of the pros and cons – and the costs for your valet and your health.
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