I see a lot of women suffering from menopause symptoms. Hot flushes, frequent awakenings at night, exhausted, short fused, and no sex drive are many of the primary symptoms that bring women into my office.
We discuss types of bio-identical hormones, different hormone tests and a better understanding on what is actually happening to their bodies (physically, mentally and emotionally) during this natural transition of life.
The subject of bio-identical hormones has been nothing but confusing and frustrating to women who desperately want to feel better but hear conflicting opinions from celebrities and their physicians. Here are some facts and opinions of what I see clinically surrounding the subject of menopause.
1. Women make 3 types of estrogens: 17-beta estradiol, estrone and estriol. Seventeen-beta estradiol (estradiol) is the primary hormone made in the ovaries during the reproductive years. Estrone is the main hormone in menopausal women which is not sufficient to relieve the symptoms women have or preserve bone. Estrone is produced by peripheral conversion of an adrenal hormone similar to testosterone, named androstenedione in fat tissue. Estriol is primarily produced during pregnancy by the placenta. The most potent of these human estrogens is estradiol. Estrone is 50%-70% less active than estradiol, and estriol is the weakest with only 10% of the activity of estradiol. This is just good stuff to know.
2. “Natural” is a marketing term. It is misunderstood to mean active hormone ingredients from plant sources, such as yams and soybeans. It literally means coming from nature which would include 17-beta estradiol, estrone and conjugated equine estrogen. Yes, the hormone derived from horse urine. I don’t use the term “natural” with my patients.
3. All hormonal agents, including those made at compounding pharmacies, must undergo some type of chemical change or process before it can be ingested by humans. Most hormones come from soy or yams. The only truly synthetic hormones are esterified estrogens (Estratab, Menest, Ogen) and synthetic conjugated estrogens (Enjuvia- which contains 10 different estrogen substances!!) I must say..I also consider Premarin in this category because it contains so many different estrogen metabolites (and other substances) from horse urine that are foreign to the human body. These estrogens may bind to estrogen receptors, but they certainly do not have the same chemical structure as a woman’s own hormones, which is the definition of bio-identical.
4. There are many bio-identical hormones that are FDA approved. The only hormones not FDA approved are the formulations made by compounded pharmacists such as “Bi-est” or Tri-est”. These products are made by FDA approved ingredients. Women have many choices outside of these customized formulas.
5. Women do not have as many choices with bio-identical Progesterones. The only FDA approved progesterone is “Prometrium”. There are only 2 doses and many women do not tolerate it. This is where I will prescribe compounded Progesterone for women because they tolerate it better with fewer side effects.
It is important to know these facts before meeting with your doctor or practitioner so you can have an open discussion, and make the best informed decisions during this important transition in your life.