Unique solutions for your unique symptoms

Many women experience Menopause, PMS, Endometriosis, and Osteoporosis along with the accompanying symptoms of:

– Insomnia
– Irritability
– Low Sex Drive
– Hot Flashes
– Weight Gain
– Breast Tenderness

Maintaining your natural hormone balance is essential to the resolution of these symptoms.

WHAT IS IT?

Natural Hormone Replacement — By Anne Walch, M.H.S., P.A.

You may know or suspect that you have a hormone related health problem. The following problems can be hormone related:

• Fatigue
• Muscle Aches
• Anxiety
• Urinary Troubles
• Depressions
• Insomnia
• Loss of Sex Drive
• Weight Gain
• Joint Pain
• Irritability
• Headaches
• Mood Swings
• Menstrual Irregularities
• Dry Hair and Skin
• Infections
• Bloating

Whether you have any of the above problems or have PMS, impotence, osteoporosis, menopause, perimenopause, or hypothyroidism, natural hormone replacement can help balance you. Your doctor first must recognize that these vague, stubborn health problems may be hormone related. Your hormone system (called the endocrine system) is intricately involved with the immune and nervous systems, and any imbalance affects you at every level of your being. No hormone in the body works in isolation; it works in harmonic interdependence with the rest of the body. One of the keys to well being is keeping your hormones in balance.

To evaluate you for hormonal imbalance, we may test your blood, saliva or urine, in addition to taking a detailed history and making a thorough physical exam. Most of us are familiar with blood tests as a way of obtaining information about one's particular health status, but saliva sampling can provide very useful information, especially for female hormones. Research has clearly established that salivary hormone levels of estrogen, progesterone, testosterone, DHEA and cortisol correlate well with those in the blood. Salivary hormone levels measure the amount of free hormone in the blood, the part that is biologically active. This gives us an idea of how much each hormone your tissues are exposed to. This is difficult to tell from blood tests because so much of the hormone is bound to proteins in the blood. Salivary testing is also desirable since it can be done in the convenience of the patient's home, is less expensive than blood tests, and multiple samples can easily be taken over a period of time to see what is happening at the hormonal level.

Once your particular hormone imbalances are understood, we can then begin to restore you to good health through individualized dietary adjustments, nutritional supplements, and natural hormone replacement prescribed for your specific needs. To obtain the intended benefits without the side effects of synthetic hormones, we use natural hormones. By natural, we actually man identical to human hormones. Using nature as the template, we attempt to provide your body with what it needs in familiar form so it can fill in the gaps according to it's own wisdom.

Currently in conventional medicine, any gynecological hormone-related problem, whether it's PMS, menstrual irregularities, or menopause, is treated with strong synthetic hormones that cause serious side effects. This is where the problems start. Hormones that are not identical to your own, like Premarin, Provera, and Birth Control Pills, don't fit! They don't fit into your hormone receptors like a lock and key, but more like a rectangle trying to fit into a square shape. It's not only that these synthetic hormones don't fit, but they also can't go through the normal metabolic pathways of detoxification and excretion as fast as bio-identical hormones. This means they can linger and accumulate in the body, making them stronger acting with many potential side effects.

Unfortunately, these unnatural hormones, in the form of Premarin and Provera, are the most commonly used substances in mainstream American medicine for the correction of women's hormonal imbalances. Premarin is an estrogen, which is made from the urine of pregnant mares, yes, as in horses. Only one-third consists of familiar human estrogens, whereas, two-thirds are horse estrogens. These horse estrogens attach more strongly to the human estrogen hormone receptor than native hormones and may take 8-14 weeks to clear from the body compared to the one-day clearance of native human estrogen. When postmenopausal women on Premarin began to develop uterine cancer, a synthetic form of progesterone, a progestin, was created to counterbalance the strong estrogen. Provera is medroxy-progesterone, a synthetic progestin with proteins similar to progesterone but with a different molecular structure, which is many times more potent than natural progesterone. Progestins can produce very different, and often undesirable, effects in the body compared to the natural progesterone. Beyond Provera's numerous side effects, it interferes with your body's own progesterone production.

You might wonder why these drugs versus bio-identical hormones have dominated the medical marketplace. It is because natural substances cannot be patented, and only patented unique products allow drug companies to corner the market and make profits. In the rare cases where the drug companies have produced bio-identical hormones, such as Estrace (estradiol) and Prometrium (progesterone), they are counting on the patented delivery mode as their profit maker.

Fortunately, the full range of bio-identical hormones is available through compounding pharmacies in any combination or dose required. Depending on your individual needs, a tailor-made prescription can be created for you. If a female hormonal imbalance or health problem is being addressed, your prescription may include any of the hormones found in the human ovary. These include three estrogens (estradiol, estrone, and estriol), as well as progesterone, testosterone and DHEA.

Estradiol (E2) is the predominant natural human hormone produced prior to menopause. It is the primary biologically active hormone from puberty to menopause and is responsible for over 400 functions in the female body. It is the decline of estradiol after menopause that results in the postmenopausal changes in skin, bone, heart/blood vessels, brain and other organs.

Estrone (EI) is the predominant human estrogen found in postmenopausal women. It is made by the body fat as well as the ovary and can be converted to and from estradiol. It seems to serve as the body's reservoir to make estradiol. Because estrone continues to be produced in the body fat after menopause, it explains why heavier women seem to have a smoother menopause than very slender women. Estrone is the estrogen most associated with breast cancer and for this reason, we no longer include it in hormone formulations.

Estriol (E3) is the weakest of the human estrogens and is predominant during pregnancy. It is especially good for relieving vaginal dryness and urinary problems. Its lower potency does not make it as effective as the more potent estradiol in providing protective benefits for the bone, heart, brain, nerves, or relieving the hot flashes, sweats and insomnia of menopause. However, at higher doses, its weaker potency seems to give breast cancer protection, as it can block the stronger estrogens, which encourage breast cell proliferation.

Progesterone predominates in a woman's premenopausal years after each ovulation and during pregnancy. If you don't ovulate, and if you're not pregnant, the adrenal glands are the body's only other source of progesterone. Progesterone is critical for maintaining a pregnancy, for enhancing and balancing the effects of estradiol, for promoting new bone formation, for protecting against endometrial and breast cancer, and for a natural calming agent. As women ovulate less and less before menopause, they often produce less and less progesterone in proportion to estrogen. This leads to a situation of relative estrogen dominance, which can look like worsening PMS, fibrocystic breast disease, uterine fibroids, weight gain and depression in women in their late thirties and forties.

Testosterone is usually thought of as the male hormone, but it is also very important to the well being of women at physiologic doses. It is produced in women's ovaries and adrenal glands at about 1/10th the amount males have. As women age and their ovarian and adrenal function decline, testosterone supplementation in very low doses can be very important in restoring energy, enhancing sex drive, maintaining muscle mass, lifting depression and even strengthening and building bone.

DHEA is the other male-like (androgen) hormone which women produce in their ovaries and adrenal glands. At physiologic levels it has multiple beneficial effects including: restoring energy levels; protecting against stress, depression, and even heart disease; building bone; enhancing the immune system; and helping relieve menopausal symptoms. Since DHEA can convert to both estrogen and testosterone, it is best to only supplement when testing indicates it is low, or if you can measure your levels while on it.

Delivery Systems

These bio-identical hormones are delivered to your body by two main routes, either by mouth in capsule form or transdermally by cream. Each way has its advantages and disadvantages. The transdermal creams are applied to parts of the body where the skin is thin and can be easily absorbed, e.g. inner arms, inner thighs, and abdomen. Applying the hormones by skin takes it directly into the bloodstream, bypassing the liver and digestive tracks, allowing greater immediate systemic effect. Women with gastrointestinal or liver problems may be best off using transdermal creams. However, women who are having menstrual cycles usually can't use creams because you can't turn off the continuous subcutaneous fat layer, and even if discontinued, it may take weeks or even months for the drug levels to decrease to baseline.

Taking hormones orally by capsule has the advantage over the creams in the ability to stop and start oral doses of hormones as needed, the desired dose is better controlled, the oral route is much less likely to accumulate as high hormone levels in the body, and hot flashes are better controlled.

A woman's decision to use natural hormone replacement will be based on many factors: medical history, family medical history, the degree to which symptoms are interfering with quality of life, and values. Individualized, appropriate dietary adjustment, herbal and nutritional supplementation, exercise, and stress reduction techniques may be enough support for many women to weather their hormonal imbalances. But for those other women, it is reassuring to know that there are hormones available which are identical to your own, which provide the benefits intended without the side effects of synthetic hormones. Consult knowledgeable practitioners to prescribe them.

Anne Walch, M.H.S., P.A.-C. graduated from Duke University's Physician Assistant Program. She worked for seven years on faculty at Duke's Family Medicine Department, including the Women's Health, Sports Medicine and the Travel Medicine Clinics. Anne then worked in Nepal for three years, gaining more experience in adventure medicine, tropical diseases and pediatrics. She came to Integrative Medicine via her long-standing interests in health and nutrition, meditation, the experience of healing and her own illness. She has special interest in nutrition, endocrine disorders, natural hormone therapies and environmental toxins.

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