There is a lot of confusion in the minds of intelligent people due to misinformation about hormonal replacement therapy (HRT). One week we are told that hormone replacement is safe and the next week we are told it will cause cancer. An article published in the January 26, 2000 Journal of the American Medical Association (JAMA) has caused unnecessary alarm for both physicians and their patients when it states that estrogen and progesterone increase the risk of breast cancer. The reason for this confusion is simple: they fail to delineate between natural and synthetic hormones. In the JAMA study, Premarin®, a synthetic estrogen made from horse urine, and Provera®, a synthetic progestin, were used. Both are prescription drugs commonly prescribed by most physicians. Most physicians won’t tell you about natural HRT.
Women in Asia do not have the problems with menopause that women in this country have. The reason for this is very simple: diet. Soy is a legume high in protein, fiber, essential fatty acids, vitamins (especially B complex) and minerals including calcium, zinc, iron and potassium. One cup of soy beans or a soy product such as tofu or soy milk has as much natural estrogen as a 0.45mg Premarin tablet. Studies show that eating 60 grams of soy protein a day will reduce menopausal symptoms by almost 50% in 12 weeks. Phytochemicals are now being intensively studied, but the health benefits have been known for centuries. Phytoestrogens fill receptor sites, including those in the breasts, and prevent stronger, potentially harmful estrogens from occupying those receptor sites.
If you travel a lot or don’t like tofu, we have a high quality, soy-based food bar available from Standard Process™ that is a balanced source of nutrition.
Another dietary deficiency commonly noted is that of essential fatty acids – omega-6 fatty acids found in grains and vegetables, and omega-3 fatty acids found in fish and flaxseed oil. I encourage you to take flaxseed oil. Increasing these oils can improve such conditions as dry skin, hair loss, vision difficulties, mood disturbances and behavioral changes, infertility, slow wound healing, and circulatory problems.
Several herbs have mild estrogenic activity and mimic estrogen’s effects on the body. Dong quai is a traditional Chinese remedy. It is known as a uterine tonic. Siberian ginseng enhances mental and physical stamina and helps relieve stress and anxiety. It balances the adrenal-pituitary complex where your hormones are concentrated. Black cohosh is a native American remedy and comes from the root of an herb. It is widely used in Europe to ease women through menopause. It works by helping normalize hormonal fluctuations that affect mood and energy levels.
Estrogen and Progesterone
Estrogen is actually a group of hormones – estrone, estradiol, and estriol. Estradiol is much stronger than the others, and estriol is the weakest, but also the most benign. Levels of estriol rise in pregnancy. Dr. Erickson prescribes Bi-Estrogen, which contains a combination of natural estriol and natural estradiol. Estrone, which is converted in the intestinal tract from estradiol, is implicated in hormone-mediated cancers, and is not used.
Are natural hormones really natural? The key here is “bio-identical.” It does not indicate the source of the hormone, but it does indicate that the chemical structure of the replacement hormone is identical to that of the hormone naturally found in the human body. These hormones follow the normal metabolic pathways so that the active metabolites do not cause problems or side effects found in the synthetic hormones. The synthetic hormones form different metabolites, and it is these metabolites that have been implicated as possibly causing cancer by causing oxidative stress and altering the DNA structure of cells.
Testosterone is an anabolic steroid (protein sparing) and women make about 1/10 the testosterone that a man makes. If a women’s testosterone is low (menopause or due to hysterectomy), she can have symptoms of fatigue and is at greater risk for osteoporosis.
The Choice is Yours
I believe for most women, HRT is very beneficial. Not only does it alleviate hot flashes, vaginal dryness, and mood swings, but it also protects the cardiovascular system and reduces the risk of atherosclerosis and heart attack. It also stops, and in some cases, reverses, osteoporosis, which is epidemic in this country. Calcium by itself is not enough.
Bi-Estrogen is prepared by a compounding pharmacist in a convenient liquid, capsule, or trouche form that is taken daily. We also use natural progesterone in a micronized oral form, or in a cream that is applied to the skin. Some progesterone creams can be purchased without a prescription at health food stores. They are made from wild yams rich in phytoestrogens, and are safe and effective. Most patients use bi-estrogen and natural progesterone together, although some women use progesterone cream by itself (I don’t think this is as effective in preventing osteoporosis). Natural testosterone in physiologic doses may also be used to help improve energy, mood, and build up bone mass. And remember, these forms are identical to the hormones your body was making before menopause.
If you are already on Premarin or another synthetic estrogen, consider switching to natural HRT. If you are on no HRT, but are having hormone deficiency symptoms, or are at risk for osteoporosis, ask Dr. Erickson what would be right for you. For detailed information on this topic we suggest reading Natural Hormone Replacement by Jonathan V. Wright, M.D.