Hormones: Bio-Identical or Pharmaceutical?

© 2014 Dr. Sharon Norling

Are natural therapies better for treating menopausal symptoms? Should you believe popular celebrity spokeswomen and use a more natural approach with bio-identical hormones (BHRT) or follow conventional medicine’s recommendations based on available research? Who’s right? Where is the balance? Do women need any hormones or natural remedies for this biological aging process? The literature is vast and the messages are confusing. So, how do you decide what is best for you during this transition in life?

One of the most complicated and difficult health care decisions menopausal and pre-menopausal women face today is whether or not they should use hormone replacement therapy (HRT). Many health care practitioners have a limited understanding of all the therapeutic options for menopause symptoms and for the more global issues of menopause. Each woman wants to know if hormone replacement therapy is right for her, how she may benefit, how long she will have to undergo therapy to receive benefits, and if there are side effects or potential long-term risks.

The average age of menopause is 51, ranging from 40 to 58 years. Menopause can create dramatic physical and emotional changes, which create memories that remain with a woman throughout her life-time. Therefore, it is important to note that menopausal therapies include not only hormones, but mind body support, exercise, good nutrition, appropriate supplements, self care and laughter. The primary purpose is to manage the transitions, prolong life and preserve a healthy, active lifestyle. The approach to achieving these important goals is to normalize as many hormones as possible by using natural approaches or conventional pharmacology.

Getting Started

I highly recommend women obtain 2-OHE1 and 16-OHE1 estrogen levels before and after taking estrogen. This test determines how you are metabolizing estrogen and may help you and your doctor identify if you are at a higher risk for developing breast or other cancers. Estrogen is metabolized by two pathways; the 16-OHE1 may increase your risk of cancer and the 2-OHE1 is protective. The good news is that it is possible to change the pathway in favor of the protective 2-OHE1 by eating cruciferous vegetables (e.g., broccoli, brussel sprouts, cabbage and cauliflower), soy and omega-3. Nutritional supplements containing Indole-3-carbinol (I-3-C) or diindolylmethane (DIM) also support the 2-OHE1 metabolism.

Benefits and Risks

No other pharmacologic agent has been as thoroughly studied as estrogen. However, most studies have used conjugated estrogens and synthetic progestins. The benefits of pharmacologic hormones are well documented and include the relief of symptoms, decreasing osteoporosis by 30 to 50 percent and decreasing colon cancer by 30 percent. Recent studies have also shown a decrease in short-term memory loss and a reduction in diabetes risk by 12 to 21 percent. Unopposed estrogen (estrogen without progesterone added to balance it) is associated with an increase in the risk of uterine cancer. In addition, the use of hormonal replacement therapy has been shown to increase the risk of blood clotting, coronary heart disease, stroke and gallstones.

In addition, the Women’s Health Initiative (WHI) stunned the nation and the medical community with the results that synthetic hormonal replacement therapy (HRT) posed more health risks than benefits. In the HRT group there were eight more strokes in 10,000 women. There were eight more cases of breast cancer in 10,000 women. There were no deaths in the breast cancer group. According to the Mayo Clinic, the data analysis revealed that participants aged 50 to 59 who took estrogen only experienced fewer heart attacks and deaths from coronary heart disease and fewer cases of breast cancer than the participants who took the placebo!

A scientific advisory panel to the American Menopausal Society issued a position statement on hormones in Menopause, March 2007. Panel chair Wulf Utian, MD., PhD, of Case Western Reserve University states, “For woman with severe menopausal symptoms, within a few years of their last period, hormone therapy shouldn’t be as scary as it has been made out to be.”

Bio-Identical Hormone Therapy

Compounded bio-identical hormones may be your best option. In this approach the physician may use specialized testing to measure your existing hormone levels. Based on the results, your physician can then prescribe a hormone supplement for you that may include several hormones matched to your individual needs.

BHRT compounded estrogens are generally used in lower doses owing to the combined effect of the weaker estriol along with estradiol. These natural estrogens are thought to be metabolized significantly differently by the body, have a shorter half life, can be used in customized dosing regimens and potencies to fit each individual woman and clinical situation. They can be adjusted to be stronger or weaker in small amounts to taper someone on to or off of hormones.

Customization through a compounding pharmacy can maximize the therapeutic effects while minimizing the potential for adverse effects. However, according to the Mayo Clinic, “there is no evidence that bio-identical hormones are safer or more effective than standard hormonal replacement therapy.” We do not have large clinical trials that document safety or show the effects of BHRT on breast cancer. The quality of a finished compounded drug product can be affected by many factors, including the quality of the active pharmaceutical ingredient and the compounding practices of the pharmacy.

Estradiol, progesterone and testosterone are FDA approved. Progesterone is the only bio-identical hormone available over the counter (OTC) but there is a wide range of quality in this low dose progesterone and OTC products are not recommended. The FDA requires manufacturers of FDA-approved products that contain estrogen and progesterone to include a black box warning about the risks. However, compounded products are exempt from providing patient package inserts that contain warnings and contraindications for estrogen and progesterone.

Important Considerations

Interestingly, after menopause the ovaries can continue to produce small amounts of estradiol, as do the secondary hormone-producing sites, such as the adrenal gland and fat cells. Consequently, it is biologically possible for a woman to produce enough of her own estrogen to support her health throughout the second half of her life.

Balanced hormones are the key to health and every person is unique. As hormones decline, health declines and aging accelerates. Decisions about whether to start, stop or change your hormones should be made on an individual basis only after consulting your physician and a knowledgeable pharmacist. Whatever choices you make when deciding your course of action should be taken seriously.

Feeling your best usually takes more than just the right prescription. Consider trying the most natural, least invasive steps first to create a foundation of health and hormonal balance, gradually adding remedies if and when they are needed. That foundation usually includes good dietary habits: avoid processed foods and sugar and eat six, small, healthy meals per day with lots of fresh fruits and vegetables. Add to this time for yourself, multivitamins and minerals, essential fatty acids, relaxation and an overall healthy lifestyle.

Keep these tips in mind:

  • Choose a knowledgeable physician that listens to your story.
  • Choose a reputable compounding pharmacy that specializes in compounding products rather than using a general pharmacy.
  • Be your own advocate and participate in the decision making process.
  • Use the lowest dose of hormones and only what you need in high quality supplements.

Be informed. The choice is yours. But remember laughter is the best medicine.

Written By: Dr. Sharon Norling, MBA