f.a.q.'s > Other Information > What are the Roles of Natural Hormones in Managing Menopause?

As women age and approach their 40’s, subtle and in some cases more obvious changes in hormone levels can result in noticeable changes in how they feel. In some cases, symptoms develop at ages as early as the 30’s. Birth control pill users may notice symptoms that indicate hormone imbalance that require medical attention. Premature menopause can develop from surgery to the ovaries, uterus, tubal ligation, radiation or chemotherapy. Surgery induced menopause requires immediate hormone replacement. Chemotherapy and radiation can be damaging to the ovaries and interfere with hormone production. While we usually think of estrogen lacking around this time, in some cases women can be helped with progesterone replacement only. Progesterone can be especially helpful for those who aren’t ovulating monthly (major source of progesterone). Maybe you have noticed changes like you’re not sleeping as well at night, or you seem more irritable and anxious lately. Perhaps you’re having more frequent headaches, or you are experiencing urination problems. Sometime a visit to your health provider is helpful. Other times you leave the office frustrated and feel that you haven’t accomplished your goals. I’ve found that some practitioners aren’t interested in working closely with their patients who are experiencing annoying hormone imbalance problems. Assessing and managing women with a hormone imbalance requires considerable time and expertise. Objective data (hormone testing levels), along with a complete physical and a detailed history are important in evaluating possible hormone problems. Let’s assume that your medical provider makes a diagnosis of hormone imbalance and with your permission decides to start hormone replacement. What are your choices? What hormones are available? Should you take the traditional hormone replacement, which is most often an estrogen that is either horse derived or synthetic, and a progestin (prevent uterine overgrowth) that is also synthetic? If you’re not offered alternatives (herbs, nutritional supplements, stress reduction, bio-identical hormones), then you will most likely follow the path of most women today, traditional hormone replacement. However, it’s not too late to educate yourself about healthier alternatives. In this newsletter we will investigate why many health professionals feel that menopausal women are being underserved by using commercially available formulations for their symptom management, bone density benefits, and heart disease.

Currently, conventional medicine uses strong synthetic hormones and birth control pills for most hormone related problems (PMS, infertility, post-hysterectomy, menstrual irregularities, menopause). These synthetic chemicals don’t fit perfectly into the hormone receptors that are found in our brain, bone, uterus, and other tissues in the body. I often use the analogy of a lock and key. If you use the wrong key to unlock your car door, you may find that the key enters the lock, however there isn’t a perfect fit and therefore, the lock doesn’t unlock and the door doesn’t open. Hormones that we produce in our body are made to fit exactly into the receptors that are located on the cells through-out our body. A hormone produced in the testes or ovary will always make a perfect match with the cell receptor. A synthetic hormone will never make a perfect match. It may bind to the receptor, however, it will produce a different action then the intended natural hormone. This different action accounts for the high likelihood of side effects that we see with traditional hormone replacement. We don’t see these side effects (if dosed appropriately) when we use hormones that are chemically identical to the ovarian hormone that we are replacing. In addition, the synthetic and horse obtained hormones are metabolized by the liver and excreted out of the body in a much slower and less complete fashion then a natural hormone would be. It makes sense that the body is set up to produce and excrete sex hormones in a safe and efficient method. Our body isn’t equipped with special cells and enzymes to breakdown and excrete man made hormones as efficiently as our own hormones. So what happens to these unnatural hormones? They may accumulate in the body and produce even more toxic effects. This helps to explain why so many women complain of unbearable side effects with traditional hormones. So far we have identified two differences between synthetic hormones and the hormones produced by our body. One difference being the binding ability and subsequent physiologic response that separates synthetic hormones from our natural hormones. The second difference being the metabolism and excretion by the body. There is a third difference. Synthetic hormones are more potent then natural hormones. Therefore, they suppress your own natural hormone production. We know that bio-identical hormones, when dosed appropriately, do not inhibit normal ovarian hormone production. We do not want to suppress the natural hormone production, we only want to supplement it.

So what can we do if we require hormone replacement (based on blood levels, medical history and physical exam), but we don’t want to take what’s usually offered? If you’re already using bio-identical hormones (chemically identical to human hormones) then you’ve already researched and made your decision. For those of you that are undecided, or are presently taking the synthetics, I would like to explain what your options are for hormone replacement. Before we do that I want to explain why the marketplace allows only synthetic hormone replacement.

I first need to explain why drug companies manufacture synthetic hormones and why doctors prescribe them. In the United States drug manufacturers research and eventually apply for a patent on hormones that appear promising in their studies. They spend millions of dollars proving that their hormone is safe and effective. Therefore, they expect and receive the right to be the exclusive distributor of that hormone. Through advertisements and continuing education programs, doctors learn about these hormones and eventually prescribe them for their patients. Natural hormones (those that are identical to ovarian hormone) are not patentable.

This means that anyone who manufactures and sells them won’t have exclusive distribution rights. Therefore, there is much less profit and very little incentive to manufacture them. This is where compounding pharmacists enter the hormone distribution process. Compounding pharmacies buy bulk hormones powders from chemical suppliers, and formulate the hormones into capsules, creams, lozenges, etc. We don’t have salespeople that market our products to prescribers. Our formulations become known primarily via word of mouth. We don’t have expensive studies to compare our compounded formulations to manufactured hormones, however we know that we are quite simply, replacing ovarian hormone with a hormone that is identical to the ovarian hormone. Some practitioners are annoyed at our lack of studies and will dismiss natural hormones. None the less, consumers interest in the natural alternatives continues to grow, and we find ourselves frequently explaining what natural hormones are to the public and to health practitioners. This continued interest has resulted in several community talks each year that I give on natural hormone replacement.

What are the bio-identical hormones that women require for proper hormone balance? The bio-identical hormones are as follows; estrone, estradiol, estriol, progesterone, DHEA, testosterone, and pregnenolone. All are available to compounding pharmacists in powder form from chemical suppliers. There are three estrogens produced by the ovary; estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the most potent of the three and is an important hormone from puberty to menopause. Estrone is less potent then estradiol, and becomes an important hormone after menopause. Estriol is the least potent of the three, and is especially important for vaginal dryness and urinary problems. It is also the major estrogen during pregnancy. Estriol is touted to be the “safe” estrogen, and may compete with estradiol for receptor binding sites on the cell. The theory being that estriol is the least proliferative (less stimulating to breast and uterine cell growth) of the three estrogens, and therefore the safest.

By using the “right” balance of hormones, we might gain the benefits of hormone replacement without increasing the risk of cancer. Traditional estrogen replacement replaces only one of the three estrogens (only estradiol or estrone), and omits the “safe” estrogen, estriol. As reported in our last newsletter, women have a natural balance of weak and strong estrogens. For best health, there should be more weak estrogen (estriol) then strong (estradiol and estrone). The strong estrogens can cause breast cells to multiply and increase the risk of cancer.

In 1966, the Journal of the American Medical Association (JAMA) published the article “Reduced Estriol Excretion in Patients with Breast Cancer.” Their conclusion was that breast cancer patients had more strong estrogens and less weak estrogens then women who don’t get breast cancer. We know that the body fat produces strong estrogens, which might explain why heavier women get more breast cancer.

Another JAMA article in 1978 titled “Estriol, the Forgotten Estrogen,” supported the theory of supplementing with estriol in patients who have had breast cancer. If estriol can block the strong estrogens form binding to the hormone receptors, it should, therefore, theoretically decrease the risk of cancer. I have included the references for these two articles at the bottom of this page.

For more information on bio-identical hormone replacement, visit your local book store. In addition, natural menopause talks will be given regularly at the Essex Learning Center in Essex Junction, Vermont. In the next newsletter we will talk about progesterone replacement.

Lemon HM et al. Reduced estriol excretion in patients with breast cancer prior to endocrine therapy.

JAMA 1966; 196(13): 112-120.

Folllingstad AH. Estriol, the forgotten estrogen?

JAMA 1978; 239 (1): 29-30.

Natural Hormone Class Schedule at the Essex Learning Center-call 878-5656 to register

July 16th, 2002 7:00-9:00 PM                           August 14th, 2002 7:00-9:00 PM

Last updated on November 12, 2007 by Dr Wayne Johnson