Many women approach menopause with the desire to take only “natural” hormones to help alleviate their symptoms. This causes quite a bit of confusion and miscommunication between doctors and their patients. That’s because all hormones can be marketed as “natural” or “plant-based,” and many pharmaceutical companies are capitalizing on women’s quest for “natural” hormone replacement therapy by marketing proprietary hormone products in this manner.
The problem is, while many of these hormonal molecules may have been derived from plant sources, most are not even close to being anything like human female hormones, nor do they perform as such in the body. Many proprietary HRT options marketed as “plant-based” and “natural,” as well as purely yam-based creams fall into this category. Moreover, they are often not effectively converted or used in the body, and sometimes have actions that are more deleterious than the symptoms they purport to quell or stave off.
What’s the Difference Between Natural and Bioidentical Hormones?
All hormones are “natural.” But, what most women mean when they say they want natural hormones, is that they are interested in using bioidentical hormones. The distinction is that bioidentical hormones are identical in their molecular shape, make-up, and structure to hormones made in the human body. This is what makes bioidentical hormones the perfect “keys” to unlock the body’s receptor sites. In other words, it’s the shape of the molecule, not the source.
Today, most women know that, while natural, the hormones Premarin, Prempro, and Provera, are not bioidentical. My colleague Dr. Joel Hargrove (who recently passed) used to say, “Premarin is a natural hormone—if your native food is hay!” That’s because it’s made from conjugated mare urine. Provera was developed as a substitute for bioidentical progesterone. Pharmaceutical companies do this because they cannot patent a naturally-occurring hormone!
Prempro is a combination of Premarin and Provera.
If you are in doubt as to whether a particular product offered to you by prescription is natural, check the label. If it lists “esterified estrogens,” “progestins,” or “progestogens,” the product is not bioidentical. You can also look up the product in your internet favorite search engine as many have their own websites.
Why Bioidentical Hormones Work Better
Our hormones are comprised of a solid steroid base (cholesterol), decorated with “arms,” “legs,” and “tails” pinned on here and there. These attachments are what turn hormones into specialized molecules, allowing them to plug into receptor molecules throughout the body, turning on and off much of the cellular behavior that makes us tick.
When we take hormonal replacement therapy that doesn’t fit the original design that our cells have evolved to recognize, the end result simply may not feel or act quite right. Hence all those side effects, ranging from annoying and uncomfortable to downright dangerous can occur.
Bioidentical hormones duplicate the structure of our hormones exactly as they are found in our bodies. This is why they work better in our bodies.
What Bioidentical Hormones Should You Take?
The molecules naturally produced in the human female body for which we most often seek replacement include:
- Estrone (E1), estradiol (E2), and estriol (E3)
- DHEA, an adrenal precursor to testosterone.
These truly “natural” hormones are available by prescription. Estradiol is available as Estrace pills, Estrace vaginal cream, or transdermals as the Vivelle Dot, and Climera. (Pharmaceutical companies have been able to patent the delivery system on these hormones, though the hormone itself is still bioidentical. Estriol is available only through formulary pharmacies. Most women do fine with just estradiol plus or minus some progesterone. And sometimes a bit of testosterone—which is available in by prescription as AndroGel.
What is the Best Natural Progesterone Cream?
Many women are confused about the use of progesterone creams, particularly regarding the efficacy of yam-based or other plant-based creams. Unlike soy and flax, which contain plant-based estrogens (phytoestrogens) that are adaptogenic and converted into utilizable forms in the body, wild yam (Dioscorea barbasco) cannot be converted into progesterone in the body.
The conversion can occur in a laboratory setting, however, and therefore, wild yam is sometimes used to synthesize the progesterone found in progesterone creams. Some progesterone creams are yam-based, but the active ingredient is not the wild yam itself, but the USP progesterone that has been added.
For this reason, while the body may absorb wild yam extract through the skin, which may then confer mild effects on menopausal symptoms, results of research on oral and topical applications of wild yam extract have not detected a significant change in progesterone levels in the blood.
If you want the beneficial effects of bioidentical progesterone, make sure the ingredients on the label include United States Pharmacopoeia (USP) progesterone. USP progesterone is available in over-the-counter 2% creams as well as by prescription. Choices for prescription-based bioidentical progesterone include Crinone Vaginal Gel in 4% or 8% concentration, or in an oral micronized form such as Prometrium capsules.
How To Talk To Your Doctor
I receive letters almost daily from women who have taken the initiative to offer their health care providers information on bioidentical hormones. If you want to use bioidentical hormones as replacement therapy, here are the salient points to know and share with your doctor about bioidentical hormones:
- They have been prescribed by doctors for many years
- They are readily available through formulary pharmacies
- They are easily titrated to suit a woman’s individual needs
- They are readily absorbed and utilized
- They are safe and effective
Many formulary pharmacists work in partnership with physicians to provide individualized hormone-replacement solutions. You may want to call a local formulary pharmacy to consult with a knowledgeable pharmacist to develop you customized plan.
What Other Resources Do You Recommend?
For information about compounded hormones, or to locate a pharmacy that provides individualized prescriptions, visit the International Academy of Compounding Pharmacists website.
American Hormones, Inc. is a compounding pharmacy founded by Erika T. Schwartz, M.D., renowned expert in the field of natural hormones. The company offers high-quality pharmaceutical-grade hormones shipped nationwide and internationally. The website has extensive information on bioidentical hormones.
There are also many books that you can consult. My books, The Wisdom of Menopause, (Chapter 5, “Hormone Replacement: An Individual Choice”) and Women’s Bodies, Women’s Wisdom, (Chapter 14, “Menopause”) provide in depth information.
One more thing, just because an estrogen or testosterone is bioidentical does not make it completely safe. All estrogens that bind to the alpha estrogen receptor (and testosterone too when converted,) can act as growth promoters in estrogen sensitive tissue, including breast and uterine tissue. This is why some women prefer herbal approaches instead. So, please keep this in mind. That said, there are many women who have comfortably stayed on low doses of these hormones for years with great results.
I also recommend reading The 30-Day Natural Hormone Plan, by Erika Schwartz, M.D., New Menopausal Years, The Wise Woman Way: Alternative Approaches for Women 30–90, by Susun S. Weed and TCM: A Woman’s Guide to a Trouble-Free Menopause, by Nan Lu, OMD, LAc, with Ellen Schaplowsky
Have you tried bioidentical hormones? What was your experience? Please leave your comments below.