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Menopause and Natural Hormone Replacement Therapy

NHRT -What are Natural Hormones or Bio-Identical Hormones?

Natural hormones are derived from chemical precursors found in plants. Soybeans and wild yams are the most common sources of these chemicals. For a soy or yam precursor to be converted into a hormone, it must be done in a laboratory. Therefore, natural hormones, like their synthetic and animal-derived counterparts, can be pharmaceutical compounds. The major difference being Natural hormones are identical in molecular structure to the hormones the body makes, thus they are called bio-identical. When a bio-identical hormone circulates through your system and binds with a receptor, the fit is the same as if your body had produced that hormone.

Animal-derived and synthetic hormones are similar to human hormones, but they do not have the same molecular structure. When one of these binds with its receptor, the fit is not exact, sometimes resulting in side effects. These side effects include weight gain; increased blood pressure; swollen, tender breasts; bloating; and feelings of anger, irritability, or depression. When women have their prescriptions changed to bio-identical hormones, they get almost immediate relief. Bio-identical hormones fit with your hormone receptors like they are supposed to."1 This "fit" can be compared to the difference between a "master" key and a "duplicate" key - a master key (bio-identical hormone) fits into the lock (receptor) perfectly and provides smooth operation, while sometimes a duplicate key (animal/synthetic hormones) doesn't fit quite right and requires some finessing in order to work the lock.

Not only do bio-identical hormones provide a perfect "fit" with hormone receptors, they also provide advantages when metabolized. Metabolization is performed by enzymes whose work it is to break down (metabolize) hormones -- these enzymes can be quite picky in that they won't metabolize hormones that they don't recognize, which can cause non-bio-identical hormones to sit on the hormone receptors longer than they should, which in turn can cause over-stimulation of the receptors and possible side effects, such as prevention of a women's own biologically produced hormones binding with the receptors and over-stimulation of hormone-sensitive tissues.

Natural hormones have been growing in popularity because they are very effective and often without the same degree of side effects that can come with the use of synthetic or animal-derived hormones.

It is important to note that while natural hormone replacement may offer significant advantages over "traditional" hormone replacement, years of clinical studies and research have been performed by the medical and pharmaceutical communities that strongly suggest that women taking conventional HRT reap significant health benefits. Clinical research regarding bio-identical hormone replacement therapy is sparse in comparison but growing. The most comprehensive and significant study on bio-identical hormones is the Postmenopausal Estrogen and Progestin Interventions (PEPI Study), which suggests that bio-identical progesterone with estrogen offers more cardiovascular benefits than synthetic progestin, in additional to providing protection against endometrial cancer. This is reviewed in detail in the natural progesterone section below.

In addition, some women simply are more comfortable committing to HRT when they know that the hormones they are taking are identical (NHRT) to those their bodies produce which to me is just plain common sense.

Abstracts:

Human identical hormones, real people, real problems, real solutions Nurs Pract Forum 1998 Dec;9(4)227-34

The following table lists some of the natural estrogen preparations that are currently available from pharmaceutical companies and from compounding pharmacies, along with some of the synthetic (non-bio-identical) hormones that are commonly prescribed in "traditional" HRT.


ESTROGEN ONLY
Product Name Bio-Identical Description
Alora Proctor & Gamble Yes skin patch
BiEst Compounding Pharmacies Yes Combination of estradiol (20%) and estriol (80%). Ratios can be modified to address individual patient response. This combination is advocated by some health professionals for women who would be pre-menopausal under normal circumstances (under 52 yrs. old)
Climara Berlex Labs Yes Estradiol - skin patch
E2 III Cygnus Yes 17b estradiol - skin patch
Estrace Bristol-Myers Squibb Yes Estradiol
Estradiol or Estriol Gel (Natural) Yes Available through compounding pharmacies in any dosage prescribed by your physician
Estraderm Novartis Yes Estradiol - skin patch
Estratab No Plant-based, 75%-85% sodium estrone sulfate and 6-15% equilin sulfate
Estinyl No Ethinyl estradiol
Ogen No Not Available
Ortho-Est No Not Available
Premarin Wyteth-Ayerst No Conjugated equine (horse) estrogens
TriEst Yes Combination of estradiol (10%), estrone (10%), and estriol (80%). Ratios can be modified to address individual patient response. This combination is advocated by some health professionals for women who would be post-menopausal under normal circumstances (over 52 yrs. old)
Vivelle Novartis Yes Estradiol - skin patch
ESTRASORB™ Yes Estradiol lotion using a patented micellar nanoparticle technology for the systemic application , currently in phase 3 clinical trials
ESTROGEN AND PROGESTERONE
BiEst + Natural Progesterone Compounding Pharmacies Yes Combination of estradiol (20%) and estriol (80%) plus progesterone. Ratios can be modified to address individual patient response. This combination is advocated by some health professionals for women who would be pre-menopausal under normal circumstances (under 52 yrs. old)
Combi Patch Rhone-Poulenc Yes - Estrogen

No- Progestin
Estradiol plus norethindrone - skin patch
Estradiol or Estriol (Natural) with natural progesterone Yes Available through compounding pharmacies in any dosage prescribed by your physician.
FemHRT Parke Davis No Combination of ethinyl estradiol, and a progestin hormone, norethindrone acetate.
Premphase Wyeth-Ayerst No Combination of conjugated estrogen (Premarin) and medroxyprogesterone acetate.
Activella Yes estrogen No progestin Estradiol plus norethindrone oral tablets
TriEst + Natural Progesterone Yes Combination of estradiol (10%), estrone (10%), and estriol (80%) plus natural progesterone. Ratios can be modified to address individual patient response. This combination is advocated by some health professionals for women who would be post-menopausal under normal circumstances (over 52 yrs. old)
PROGESTERONE-ONLY
Aygestin ESI Lederle No Norethindrone acetate
Cycrin ESI Lederle No Medroxyprogesterone acetate
Micronor Ortho-McNeil No Norethindrone
Natural micronized progesterone Compounding pharmacies Yes Available in custom dosages Yes Available in custom dosages
Nor-QD Watson No Norethindrone No Norethindrone
Prometrium Solvay Yes Natural micronized progesterone in peanut oil
Provera/Upjohn No medroxyprogesterone acetate

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Disclaimer: The information contained on this website has not been evaluated by the FDA. This information is not intended to treat, diagnose, cure or prevent any disease. All material provided in the Dr. Brizel's web site is provided for educational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health program


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