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Menopause
and Natural Hormone Replacement Therapy
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| NHRT
- Natural Hormone Replacement - The Estrogens |
Overview
There are three major estrogens that your body produces: estrone
(E1), estradiol (E2), and estriol (E3). Of the three estrogens,
estradiol (E2) and estrone (E1) are the most potent forms of estrogen,
while estriol (E3) is the weakest form. All three of these estrogens
are available, alone and in combination, in natural (bio-identical)
form for HRT.
What are the differences between the estrogens?
Estrogen circulates throughout the premenopausal female body in
approximately the following concentrations: Estrone @ 10-20%, Estradiol
@ 10-20%, and Estriol @ 60-80% (the increased concentrations of
estriol are due to its natural "weakness" as an estrogen).
Estradiol is considered the "primary" estrogen - it is
produced by the ovaries and is the most potent and active estrogen
pre-menopause. Estrone is the primary estrogen of post-menopausal
women, because it is stored and retrieved from fatty tissues (this
process continues even after the ovaries cease producing). Estradiol
and estrone have been associated with increased cancer risk, specifically
of the endometrium and the breast. Estriol is the weakest of the
major estrogens and its production increases significantly during
pregnancy (causing nausea). It appears to have low risks compared
to estradiol and estrone, and may actually work as an anti-carcinogenic
agent in the body, helping prevent breast and endometrial cancer.
Estradiol is the most potent form of
estrogen found in pre-menopausal women, and is the form of estrogen
most often prescribed by physicians in the US (both natural and
synthetic). Studies suggest that perhaps the natural form, 17b estradiol,
offers long-term advantages over synthetic versions in the management
of menopausal symptoms. The following table shows the results of
a small 12-month pilot study that compares symptom relief between
10 women on a natural, and 6 women on a synthetic, HRT regimen:2
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.
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Natural
Vs. Synthetic Hormone Replacement
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Natural
HRT 17b Estradiol + progesterone
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Synthetic
HRT Conjugated Estrogens + Medroxyprogesterone
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Symptoms
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Baseline
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12
Months
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Hot
Flashes
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9
|
0
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Night
Sweats
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6
|
0
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Insomnia
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4
|
1
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Decreased
Libido
|
6
|
0
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Dyspareunia
or Vaginal Dryness
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5
|
0
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Anxiety
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5
|
0
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Depression
|
1
|
1
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|
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Symptoms
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Baseline
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12
Months
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Hot
Flashes
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5
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3
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Night
Sweats
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4
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3
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Insomnia
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3
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1
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Decreased
Libido
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2
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0
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Dyspareunia
or Vaginal Dryness
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3
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2
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Anxiety
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3
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1
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Depression
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3
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0
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Additionally,
this study demonstrated that the adverse effects of synthetic progestins
on cholesterol were eliminated by using natural progesterone. All
of the women on the natural HRT regimen continued their HRT after
the study, but there was a 40% dropout rate in the synthetic group
during the year following the study, due primarily to side effects.
This reported absence of side effects with natural HRT vs. synthetic
HRT is fairly well documented and appears to make it easier for many
women to stick with their HRT programs.
Natural 17b estradiol is available in a variety of forms, from both
major pharmaceutical companies and compounding pharmacies.
Estrone is the major naturally occurring
estrogen of postmenopause, at which time it is produced and released
by fatty tissues. In premenopausal women, the ovaries produce approximately
50% of circulating estrone. It is not normally given alone as a treatment
for menopausal symptoms, but is available in combination with the
other estrogens in formulary estrogen preparations and in Ortho-Est,
a type of estrone that is considered "natural."
Estriol was until very recently considered
"the forgotten estrogen" because of its weakness in comparison
to estradiol and estrone. A variety of alternative health advocates
are now speaking out in its favor as a "safer" form of estrogen
for use in HRT because of its possible anti-carcinogenic effects on
breast and endometrial tissues, as well as its ability to relieve
a variety of menopausal symptoms, including hot flashes, urinary tract
infections, vaginal dryness, and memory loss. 3, 4 However, estriol
alone does not provide the cardiovascular benefits of estradiol, and
very large doses (which can cause nausea) are necessary to effect
a positive change in bone density.
Natural
Estrogen Replacement Therapy
As discussed in the Overview section, hormones are called natural
only when they have an identical molecular structure as the hormones
your body produces, which means they are "bio-identical."
All the major hormones - estradiol, estrone, and estriol - are now
available in bio-identical form from either major pharmaceutical companies
or from compounding pharmacies.
Compounding pharmacies take the "raw" natural hormones and
put them into delivery systems (pills, lozenges, creams, etc. . )
in the ratios prescribed by your doctor. Custom compounding is also
the only way to get any hormone combination that includes estriol
in the US, since this hormone is not offered in pre-packaged form
from major pharmaceutical companies.
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.
Note that for 30+ years, many women have successfully treated their
short- and long-term menopausal symptoms with non-bio-identical HRT.
This list is provided to help facilitate discussion between you and
your physician and is not meant to advocate either synthetic or natural
HRT.
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ESTROGEN
ONLY
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| Product
Name |
Bio-Identical |
Description |
| Alora
Proctor & Gamble |
Yes |
Estradiol 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 |
| Natural
Hormone Replacement - Progesterone |
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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
©2002, All Rights Reserved, Center For Clinical Age Management,
Inc.
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