The average person hears the word “hormone” and their mind goes to “women” and estrogen. In actuality, we ALL have numerous hormones running through our body, such as: insulin, oxytocin, thyroxin, serotonin and epinephrine. A recently identified class of hormones are referred to as the “hunger hormones” and satiety hormones. There are also steroid hormones that derive from cholesterol like testosterone and cortisol. You can see that hormones are much more than the probable cause of hot flashes and mood swings during menopause.
For the sake of this article, I am only focusing on two of the hormones, estrogen and progesterone. Keep in mind that there are three subsets of estrogen: estradiol, estrone and estriol. Estrogen is an anabolic hormone that “increases cell proliferation,” while progesterone has an anti-proliferative and “anti-estrogenic” effect.
Conventional hormone therapy (CHT) consists of hormones either obtained from animal sources, or originating from actual hormones that are then molecularly modified. These hormones are different from our natural hormones in their molecular structure, hormone receptor site affinity, metabolism and physiological traits. The most commonly used estrogen is Premarin, which is derived (and not in a kind way I might add) from the urine of pregnant horses (a “mare” being a female horse). There are some “natural” estrogens being prescribed currently, but this doesn’t necessarily mean that they are bioidentical.
The most common progesterone prescribed is Provera. However, it and the other synthetic progesterones are actually medroxyprogesterone acetate, more commonly known as “progestin.” This structure is nothing like progesterone, therefore it does not interact in the same way in our bodies. Most of the side effects from taking synthetic hormones, which includes oral contraceptives, come from the progestin.
In contrast, bioidentical hormones can be extracted and derived from a variety of sources. They go through several laboratory processes, after which they have the same molecular structure as the ones made in the body. As a result these hormones will also have the same physiologic responses and interactions as our own hormones do. In other words, the two hormones are indistinguishable from each other.
It is important to remember that “natural” and “bioidentical” are not necessarily the same thing. Premarin is advertised as “natural” because it comes from the urine of a pregnant mare, but it is not at all bioidentical to human estrogen. The manufacturing of natural products is not well regulated, and the significance of the word “natural” appears to have different meanings for the consumer and the manufacturer. Phytoestrogens are advertised as a natural hormone treatment because they are derived from plants, but again, they are not bioidentical to human hormones. Natural hormone replacement therapy (NHRT) is a misnomer. The correct term is “bioidentical hormone replacement therapy” (BHRT).
So if my hormones stop my hot flashes, help me sleep and make me easier to get along with, why should I care if they are synthetic, natural or bioidentical? Well first let me say that whatever form you are using, you should be using both estrogen and progesterone. Just because you don’t have a uterus doesn’t mean you don’t need progesterone anymore. And if you haven’t had a hysterectomy then you definitely need to be using both. They work together to keep your body healthy.
If you are considering hormone replacement therapy, it’s important to have a lengthy conversation with your doctor before you make a decision. There are many factors to consider, such as family history, current health issues, your age when starting therapy, and – most important – the reasons you want to start hormone therapy to begin with. Many health issues can cause fatigue, moodiness, weight gain, insomnia and a decreased libido, not just menopause. Get a thorough checkup with appropriate lab work to rule out other causes first.
We’ve all heard talk about estrogen and breast or uterine cancer, blood clots and stroke, and wonder: should we be concerned? Of course you should, but you should also educate yourself on the details behind the statistics. The resulting clarity will calm your fears and to help you make a more informed decision. While it is true there is a higher risk of stroke in the first three years of hormone therapy, that’s only if a woman has never been on hormones, and is starting after the age of 60.
The reason for this is that after menopause we lose the cardio-protective benefits of estrogen, causing a buildup of plaque in our arteries. So when ten years after menopause we decide we want hormones, the addition of estrogen starts cleaning up the cardiovascular system. Plaque is sloughed off, a possible emboli is formed, and a stroke could ensue. This is not a certain outcome, but it is more likely with synthetic hormone use. There still are no studies that have shown the same outcome occurring with BHRT.
Also important to note is that in all the studies for the risk of breast cancer, using estrogen alone showed the highest risk. When it was used in conjunction with “progestin” it appeared to somewhat protect the uterus, but did nothing to protect the breast tissue. The most favorable results were achieved when BHRT was used, in a combination of estrogen and progesterone. Studies showed this actually protected the breast tissue.
In conclusion, a thorough review of the medical literature supports the claim that bioidentical hormones have some distinctly different, and often opposite, physiological effects compared to those of their synthetic counterparts. With respect to the risk for breast cancer, heart disease, heart attack and stroke, scientific and medical evidence shows that BHRT is a safer and more efficacious form of hormone replacement therapy.
If you have any further questions on this topic, please by all means call me – I am happy to spend some time helping you make sense of it all and decide how to approach making these important choices.