Natural Hormones and Menopause
A natural hormone is a hormone that is biochemically and molecularly identical to the human hormone and is derived from a plant (i.e., defined by their chemical structure not by their source). Natural hormones are converted in a laboratory from diosgenin extracted from wild yam and beta-sitosterol extracted from soybeans. Hormones that can be converted from wild yam and soybeans are estrone, estriol, estradiol, progesterone, testosterone, and DHEA (dehydroepiandrosterone).
Estrogen is not a single hormone but a family of hormones. To date, there are over two dozen identified estrogens. The three principal estrogens are as follows:
- Estrone - Comprises 10-20% of circulating estrogens in the body.
- Estradiol - Comprises 10-20% of circulating estrogens in the body; is considered the most potent estrogen. This estrogen is contained in most conventional estrogen products.
- Estriol - Comprises 60-80% of circulating estrogens in the body; has the weakest estrogenic activity. All estrogens are considered to be somewhat carcinogenic, but estriol may be protective against some reproductive cancers, such as breast cancer. Estriol is not used in U.S. conventional estrogen products but is used in U.S. natural estrogen products and European products. Naturopathic physicians use estriol vaginal cream to treat menopause-related urinary incontinence, urgency, thinning vaginal tissue, and persistent urinary tract infections.
Conventional (may also be referred to as synthetic or patentable) estrogen replacement products contain estradiol or estrone synthesized from soybeans or wild yam and/or horse estrogens either as esterified estrogens or as conjugated equine estrogens (CEE). The estradiol and estrone used in the conventional products are the same as those used in the natural products. The difference is that those used in conventional products also contain binders, fillers, preservatives, and additives. Estrogens obtained from a horse are designed for a horse's physiology and are a foreign estrogen in a woman's body. Foreign estrogens, which are not identical to human estrogen, interact differently in the body, which can lead to one or more of the following unwanted side effects:
- Blood clots
- Breast tenderness
- Fluid retention
- High blood pressure
- Impaired glucose tolerance
- Increased risk of endometrial cancer and breast cancer
- Leg cramps
- Nausea and vomiting
- Vaginal bleeding
- Worsened uterine fibroids and endometriosis
Practitioners and women choose natural estrogen products over conventional products because they believe a natural product is unadulterated or pure, estriol has characteristics that make it a more suitable estrogen for supplementation, and there is greater control over dosage and formulation. Natural estrogen formulations are usually tri-estrogens (80% estriol, 10% estradiol, and 10% estrone) and provide 2.5 mg total estrogens. Bi-estrogens (80% estriol and 20% estradiol) are becoming more popular due to concerns estrone may increase cancer risk. It is important for any woman with an intact uterus who is taking estrogen to also take progesterone to protect the uterus from hyperplasia (cell proliferation) and uterine cancer.
When female hormones are mentioned, most women immediately think of estrogen. However, progesterone is as important during the menstruation years and as beneficial during the menopausal years. Levels of progesterone actually decline faster than estrogen levels in the perimenopausal years, which results in irregular menses, mood swings, vaginal dryness, and hot flashes. For this reason, progesterone is often preferred over estrogen as the initial hormone replacement treatment for menopausal symptoms.
Progesterone performs the following functions:
- Acts as a natural diuretic and natural antidepressant
- Assists thyroid hormone function
- Body uses progesterone to make other hormones, such as estrogen, testosterone, and cortisol
- Maintains the lining of the uterus
- Normalizes blood clotting, blood sugar levels, and zinc and copper levels
- Promotes bone building and fat burning for energy
- Protects against fibrocystic breasts, endometrial cancer, breast cancer, and osteoporosis
All conventional progesterone replacement products contain synthetic progesterone known as progestin. People often refer to progestin as progesterone, but this is incorrect. Progestin is a synthetic compound that does not have the same chemical structure as the progesterone found in the female body. As with estrogen, this difference in chemical structure causes sides effects. There are different progestins on the market. Natural progesterone converted from plants in a laboratory is considered progesterone because it is identical in structure to human progesterone. It is tolerated very well by most women.
Possible side effects of progestins include the following:
- Breast cancer, breast tenderness, milk production
- Blood clots
- Fluid retention
- Hair loss or unwanted facial hair
- Impaired glucose tolerance
- Menstrual irregularities
- Skin rash
- Weight gain
Progesterone can be applied topically as a cream (available over the counter or by prescription) or taken (available by prescription) as an oral micronized progesterone (OMP) capsule. A minimum of 40 mg 2 times daily is required to oppose estrogen adequately and to protect the uterus. Note: 10 mg of a synthetic progestin is equivalent to approximately 200 mg OMP.
Perimenopausal women can also use natural progesterone cream to manage menopausal symptoms. The amount of progesterone used closely approximates the normal progesterone balance in a menstruating woman. The cream is applied to the palms, inner arms, chest, or inner thighs. Progesterone cream should be used only to treat menopausal symptoms and not to oppose estrogen or to prevent heart disease, osteoporosis, or reproductive cancers. For those functions, higher doses of progesterone are required that can be obtained from oral micronized progesterone.
Natural estrogen and progesterone formulations are made from a physician-s prescription in a compounding pharmacy (a pharmacy that prepare drugs from separate ingredients) in the form that is best suited for the patient. Different proportions of estrogens and progesterone can be compounded by the pharmacist, which allows the physician to individualize hormone supplementation treatments.