Women are at risk for excessive bone loss and osteoporosis during menopause. And this is why, for a long time, conventional medicine pushed the idea that since estrogen protects bone, a good way to protect women from menopausal osteoporosis was to “replace” the estrogen they’d lost.

Taking synthetic hormone replacement therapy (HRT) even came with the big bonus of reducing hot flashes and other symptoms.

Sounds great, right?

Well, like almost everything about how our complex and wonderful bodies work, it’s not that simple. Using synthetic estrogen HRT as a way to protect bones comes with a lot of unintended and downright dangerous consequences. So many, in fact, that the FDA no longer recommends it as a first-line solution for menopausal osteoporosis. Still, despite this warning, some doctors still prescribe HRT for osteoporosis.

Is your conventional doctor recommending HRT for menopausal or postmenopausal bone loss? You deserve to know why this advice is outdated, and even worse, why it’s dead wrong.

Estrogen’s pros come with some very big cons

Most of us know estrogen as a reproductive hormone, and there’s no question that it serves an important role in that system — but there are estrogen receptors throughout the body in many tissues, including the skin, the heart and cardiovascular system, and the brain. It’s important in cholesterol production, temperature regulation and skin thickness (which is part of why menopause can mean hot flashes and thinner skin in women). Its impact isn’t just limited to women’s reproductive tracts — it has roles in many different body systems, including the skeleton.

Estrogen has important effects on two bone-related pathways, RANKL and OPG. It directly reduces the expression of RANKL, and by doing so suppresses osteoclasts (thus slowing bone breakdown), while at the same time increasing secretion of OPG (which further reduces RANKL). This means estrogen is fundamentally bone-conserving — it works to limit bone breakdown.

Thus, it’s true that taking HRT for osteoporosis comprised of synthetic estrogens, with or without progestins, during or after menopause is likely to slow or stop bone loss.

But that protection comes at a price many women may not want to pay.

Studies have shown that women who take HRT had a 44% lower risk of vertebral fracture and a 27% lower risk of nonvertebral fractures (excluding fractures of the hip, for which there is no benefit) — but the flip side of that finding is the much higher risk of blood clots, which can predispose women to life-threatening problems like stroke, pulmonary embolism or cardiovascular events, including heart attacks.

The Endocrine Society’s 2010 review of the risks and benefits of menopausal estrogen therapy found a 2-fold increase in thromboembolism risk — but also noted that this risk “is multiplicative with baseline risk factors including age, higher body mass index, thrombophilias, surgery and immobilization.” In plain English, that means that using HRT increases your risk of thromboembolism by 200% or more, with the additional increase depending on what other personal circumstances you already have that put you at risk (for most of us, age and excess body weight are probably the two biggies).

So the end result is that if you take HRT, the risk of vertebral fractures is cut almost in half, and the risk of nonvertebral fractures is reduced by about a quarter — with no benefit whatsoever respecting hip fractures, which are among the most dangerous kind — but you more than double your risk of a deep venous thrombosis, pulmonary embolus or stroke.

Then there’s the concern around HRT and breast cancer, which originated in the Women’s Health Initiative study, in which two hormone therapy trials looked at estrogen therapy by itself versus combined estrogen-progestin therapy (both versus placebo) in approximately 27,000 women who were about a decade past the average age of menopause. This study not only found HRT use to be associated with the cardiovascular risks I’ve already mentioned, but also with an increased risk of breast cancer.

It’s notable that the further away you get from menopause, the higher the risk of both cardiovascular disease and cancer become — so some organizations advocate using HRT only in women who just recently went through menopause. In general, though, when the purpose for using HRT is to protect bones and not to address menopausal symptoms like hot flashes, vaginal dryness and the like, most authorities are backing away from estrogen-centered therapy and advocating other avenues (mostly bone drugs, and that’s an entirely different discussion!)

In a nutshell, giving women estrogen at a time when their bodies are naturally winding down production of this hormone may slightly offset some bone-related losses, but it greatly increases the risk of other very serious health problems.

Menopause is a natural process — so let’s work with it

I’ve long been in awe of how our body systems work in concert to keep us healthy — and how they’ll continue working to restore our health if we support them. And this is the main problem with estrogen therapy for bone health: women in menopause aren’t “losing” estrogen. It’s decreasing because it no longer serves a need in the body’s systems.

When we’re in our reproductive years, estrogen has a key role in enabling our reproductive cycles — but Nature didn’t intend for us to produce offspring the way rabbits do! We have a limited capacity for reproduction, and when it’s over, our bodies no longer waste resources in supporting it — so away goes the estrogen. Menopause is a normal facet of our life cycles, the transition from the role of the nurturing “Mother” to the wise, knowledgeable “Crone,” as some pagan traditions describe it. Throwing more estrogen into the mix just when we’re supposed to be easing back on it works against Nature, so it shouldn’t be surprising that we get a bunch of unintended and pretty serious consequences.

Instead, we might do better to work with Nature and find ways to support our bodies during and after the menopause transition so that we don’t have to rob those ever-gracious givers — our bones — of the nutrients we need to cushion other systems that rely on estrogen, too.

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The Lancet, one of the world’s leading medical journals, published a new study on the long-term risks of synthetic HRT use during menopause. The buzz around the study claims that it shows women taking HRT have “twice the risk of breast cancer” than experts previously thought. Is this true? 

We have read the new meta study carefully and agree that its findings are very important to the whole debate about HRT. But the press coverage is not exactly right. We asked one of our physician experts, Dr. Sharon Stills, NMD, to explain what this study really means for women. Let’s hear from Dr. Stills…

I received a call from one of my patients as soon as the news about this study broke. She was worried — who wouldn’t be after reading about a doubled risk of breast cancer? — and wanted to know if she should stop taking the biodentical progesterone that has been giving her so much relief.

Frankly, I had been expecting this call. Virtually all media coverage on the Lancet study contained a very large and sloppy mistake: it didn’t bother to specify that the study’s findings pertained only to synthetic hormone replacement therapy. In the world of HRT, this distinction means everything.

So before we go any further into the other problematic aspects of the study, you need to understand up front that if you are taking bioidentical hormones, the findings of this study do not apply to you. As I reminded my patient, the difference between bioidentical hormones and synthetic hormones is like comparing apples to elephants!

What the study actually says is that the longer you take synthetic HRT, the more at risk you are for breast cancer. Researchers looked at different groups of women, and among other things compared women who had taken synthetic HRTfor varying numbers of years. According to the results, increased risk for breast cancer was seen during years 1 to 4 of use, and then this risk doubled during years 5 to 14. The risk persisted for a certain number of years following use.

These findings make complete sense to me because the longer you ingest any toxic substance, the more likely it is to harm you. Is that really a surprise to anyone?

We’ve known for a very long time just how bad synthetic HRT is for women. You may remember being shocked back in 2004 when the large-scale Women’s Health Initiative (WHI) revealed that synthetic HRT put women at serious risk of breast cancer, stroke and other life-threatening disorders. The study was a bombshell because, at the time, more than 10 million women were being prescribed some form of synthetic HRT, most commonly during menopause.

The forms of synthetic HRT studied in the WHI included medications such as conjugated equine estrogen (Premarin) and synthetic progestins. These synthetic medications are the same forms of HRT examined in the new Lancet study. If anything, what this shows is that we knew these synthetic hormones were bad in 2004, and now 15 years later, nothing has changed!

If you are suffering from menopause symptoms, I know that you might be feeling pulled in different directions right now. If you see a conventional doctor, you’ve probably gotten the “risk/reward” talk that having this effective form of relief for your symptoms is worth the risk synthetic HRT carries.

Here is what I tell my patients: these synthetic hormones have no place in your body. There are so many other ways to effectively rebalance your hormones — naturally and safely. I am talking about diet and lifestyle interventions, nutritional supplementation, exercise, and bioidentical hormones — which are not at all the same as synthetic hormones. You have so many options! Please note that it’s important to work with a physician with extensive training in the use of bioidentical hormones and who can appropriately monitor you.

In the UK, physician groups have already adjusted their prescription guidelines for HRT in light of this latest study. I wish we were so responsive here in the US. We need to keep talking about the real risks of synthetic HRT and the safer, effective alternatives available to women to deal with symptoms of hormonal imbalance, especially in menopause. That’s exactly what we’re doing at Women’s Health Network, and I am so glad to be part of the conversation.

We’ll be delving deeper into the Lancet study and all the issues surrounding HRT in the months ahead. But let me make one point now about the true value of the Lancet study. Since the WHI revelations in 2004, the pharmaceutical industry has been on a campaign to restore women’s confidence in synthetic HRT. The Lancet study should finally put that campaign to a well-deserved end.

Stay tuned for more!

Hot flashes? Anxiety? Low libido? Learn 5 steps for natural menopause symptom relief.

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If you’ve been keeping up with the news, you’re probably aware of the recent questions about risks and benefits of hormone replacement therapy (HRT). These reports, along with new scientific evidence, are leading some women and their healthcare practitioners to reconsider the 2002 mandate to stay off of HRT. We hear this question again and again: “What’s changed since the negative results of the Women’s Health Initiative?”

We’re happy to say that researchers have been busy over the past few years, and their findings give the medical world new perspective on the use of HRT for menopause symptoms. The answers we now have are similar to what Women’s Health Network has been telling women all along — the decision to go on hormone replacement therapy is individual, and the risks, benefits, and side effects differ depending on the individual.

In the end, you can take comfort in the fact that there are several options for menopause symptoms — and we’re here to help you understand them.

The Women’s Health Initiative results — then and now

Time has given researchers more perspective on the results that came out in 2002, when women were warned that hormone replacement therapy leads to higher risks for breast cancer, cardiovascular events, blood clots, cognitive decline, and more. An extensive collection of data has been scrutinized and published, showing us that timing and individual circumstance are key.

New studies suggest that women under 60 years old and within ten years of menopause can benefit from HRT with much less risk (even with potential benefit) than older women who are more than ten years away from menopause. The majority of the women enrolled in the WHI study were older and much past menopause.

The most recent evidence on the use of hormones for menopause

Here’s an overview of how HRT may affect certain health issues:

Although the new research is promising, one limitation is that much of it still looks only at synthetic progesterones and equine estrogens (estrogens derived from a pregnant horse). These hormone forms are molecularly different from the hormones we make in our bodies, so drug companies can patent them.

Bioidentical hormones, on the other hand — those that have the same molecular structure as those made in our bodies — are becoming more popular. We’ve always supported the use of bioidentical hormones because we feel they are gentler on the system than synthetics, and a significant and growing body of research is now bearing this out.

Above all, hormone therapy, synthetic or bioidentical, is not the right choice for every woman — because we all have our own unique set of circumstances. Each HRT case should be evaluated individually so women can make informed decisions about starting or continuing bio-HRT on her own terms. We generally recommend women stay on hormones for fewer than five to seven years.

Risks and benefits of HRT — individuality is central

Researchers tell us that the risk profile for hormone replacement therapy goes down in women under 60, women less than ten years from menopause, and women who don’t have a history of breast cancer, endometrial cancer, or liver disease.

Taking a look at whether or not your hormones are still fluctuating is also an important consideration. It is safer to introduce HRT when hormones haven’t tapered off yet. This way, your estrogen and progesterone receptors are still active.

Each woman has a different set of circumstances that determine her personal risk, but based on the new evidence, the safety of HRT is enhanced if the following guidelines are met:

• It is given to younger women (under 60), who are close to menopause and whose hormones are still fluctuating.
• The woman does not have a history of breast, ovarian or endometrial cancer, or liver disease.
• The woman uses bioidentical hormones as opposed to synthetic HRT.
• The woman uses transdermal, transvaginal, sublingual, or “melt” forms of HRT instead of pills that need to be swallowed.
• Hormone replacement therapy doesn’t go on for more than five to seven years.

For a broader discussion of risks, read our perspective on the risks of HRT.

Phytotherapy: a safe and effective alternative

Many of the women who were on hormone therapy in the past were instructed by their practitioners to get off of it. Now, as their bodies have gone for some time without replacement hormones, it’s not a great time for these women to start up again — even though their symptoms are still bothering them. A safe and effective option for these women, and for those who just don’t feel comfortable with HRT, is phytotherapy.

Phytotherapy is the use of plants for healing purposes. Herbs like Black Cohosh, Red Clover, Passionflower, and many others are wonderful alternatives for menopause treatment because they work with your endocrine system to ease symptoms instead of the “sledgehammer effect” pharmaceutical drugs often provide.

Herbs offer a gentler approach to menopause symptoms, which means there’s less risk to you than taking a hormone. Though using herbs for menopause may not provide enough relief for some, we’ve found that 85% of women can find relief from a plant-based product like our Herbal Equilibrium.

Your options for menopause symptom relief

The media can often make it seem like we have limited options when it comes to our health, but if we’re willing to adopt a more holistic approach, the options are endless. Here are just some of the treatment options available.

Diet and lifestyle changes. Diet and lifestyle play a large role in exacerbating menopause symptoms. For some women, adding more protein, high-quality fats, and fresh fruits and vegetables, while limiting refined carbohydrates, sugar, gluten, and highly processed foods can make a world of difference. You may also want to consider supplementing with a quality multivitamin like the one we offer in our Health Programs.

Phytotherapy. Soy, Black Cohosh, Red Clover, Ashwagandha, Wild Yam, and other botanicals can offer satisfying relief from menopause symptoms. You can explore our Herbal Equilibrium, which provides a safe and effective combination of herbs for gentle endocrine support and menopause symptom relief.

Bioidentical HRT (bHRT). Bioidentical HRT consists of hormones made in a lab, primarily from Wild Yam and soy, that are identical to the hormones your own body produces. Bioidentical hormones are available through compounding pharmacies by prescription. For more on how to choose the right bioidentical hormones for you, see our guide to bioHRT options.

Synthetic HRT. Hormone replacement therapy drugs like Premarin and Prempro are the drugs studied in the original Women’s Health Initiative. Premarin is made from the urine of a pregnant horse, while Prempro combines Premarin and a synthetic progestogen. There are also synthetic forms of testosterone. We feel most comfortable with bioidentical HRT, but understand that there are cases where synthetic hormones are a viable choice.

Your body, your choice

Only you can decide what is best for your body. Menopause can be a confusing time, a time when it’s difficult to make decisions (especially if you haven’t slept well in weeks!). But know that there is an option out there for you — and it’s okay to take your time in deciding. We have some customers who don’t mind enduring the symptoms as long as they know there will be an end to them in good time. Others simply can’t perform their day-to-day activities without some relief from their symptoms. Look inside to make your decision, and don’t ever be afraid to ask questions!

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There has been nearly non-stop controversy surrounding the health risks of hormone replacement therapy (“HRT”) in the decade following the Women’s Health Initiative (WHI) study. Back then, women by the millions stopped their HRT suddenly — often to find that their symptoms reappeared right away. Many of the big pharmaceutical companies pushed back, criticizing the WHI study and making new claims about the efficacy of HRT.

Understandably, many women feel confused about whether to get off HRT or avoid starting it. But new studies continue to support the unsettling conclusion: synthetic HRT really is risky when compared to the benefits it provides.

If you want to quit HRT, but aren’t sure how, you’ve come to the right place. There are great ways to get off HRT without symptoms or side effects. We’ve helped hundreds of women safely wean off HRT, and we can help you too.

HRT withdrawal — don’t quit “cold turkey.”

Many women are so motivated to stop HRT that they quit overnight, which is very stressful for the body. That’s because it has grown dependent on this external supply of synthetic hormones. Your body had the ability to make its own hormones — right through perimenopause and menopause — but when you began HRT it cut back its production. But here’s a little-known detail about your sex hormones: your body can naturally resume its production of estrogen, testosterone and progesterone, even developing secondary hormone production sites to compensate for the decline in hormones from your ovaries. It’s just that your body needs time and support to develop those sites.

In addition, we believe the stronger estrogen replacement therapy drugs, such as Premarin and Prempro, actually alter the estrogen receptors in your cells so they only recognize the synthetic hormone forms. It takes time for those receptors to resume their original form and accept natural hormones, whether it’s your body’s own hormones, bioidentical HRT supplements, or plant-based hormonal support in the form of phytotherapy.

Keep this rule in mind: the more severe your original symptoms, the stronger your HRT prescription, and the longer you used that therapy, the more likely it is that you will have symptoms of HRT withdrawal when you quit.

Support yourself naturally when getting off HRT

Your body has the power to make and balance its hormones at every stage of your life, but it needs adequate support. That means rich nutrition, a well-functioning digestive system that can really absorb nutrients, a strong metabolism, and a steady routine of exercise and stress reduction. If your symptoms are moderate to severe, you can add phytotherapy, nutrients, and make dietary and lifestyle changes to normalize your hormone levels naturally and more quickly. The more severe your hormonal imbalance, the more support you’ll need. After you’ve weaned off HRT completely, your body will require less support.

Ideally, you will have the opportunity to put this program of support in place before you begin to wean off HRT. We advise everyone to allow 2–4 months for the weaning process overall, if possible (some require a little less, some more). If you do it with care, you can feel better than you ever have in your life.

How to deal with stubborn “rebound” symptoms

After making exciting progress in the first few weeks of weaning off HRT, women may “plateau” and find themselves with stubborn symptoms that won’t go away. They may jump to the conclusion that the lack of hormones and estrogen replacement is to blame and say, “This isn’t working.” But in fact, the natural alternative to HRT is working — it’s gradually healing the issues that created the conditions in the first place. And if you can find relief from common rebound symptoms, you’ll be able to complete the process of tapering down with targeted support.

Natural remedies for the top four HRT rebound symptoms

1. Hot flashes. In addition to herbs like black cohosh, red clover and kudzu, we recommend avoiding caffeine, sugar, and alcohol for two weeks to see if your symptoms subside.

2. Weight gain. Carbohydrate consumption is a key factor with weight gain in menopause. Keep the carb content of each meal to 16 grams or less and snacks to 7.

3. Insomnia. We offer a unique sleep and relaxation product to help reset your circadian rhythm, but you might also try setting a regular bedtime and scheduling at least an hour of downtime (electronics-free) before bed.

4. Anxiety. Deep breathing, yoga, and being outside in nature are all helpful ways to calm your body and mind.

Don’t be surprised if you need help, especially in the beginning

While many women know there are natural alternatives to HRT, lots of them spend months randomly self-prescribing soy, dong quai, black cohosh, and so on without knowing how much to take or what forms work best. Each of these natural therapies can have positive effects, but we recommend a multi-herb formula like our Herbal Equilibrium for best results.

Our Getting off HRT Program takes the guesswork out of natural menopause relief. Our weaning schedule includes directions on how to taper off HRT and identifies the herbs and supplements to take in place of it. We include Herbal Equilibrium (to balance estrogen, testosterone, and progesterone), Serinisol (to regulate sleep patterns), a doctor-formulated multivitamin, Omega 3s, and a diet and lifestyle eGuide. Plus we include personalized phone support from our experienced Nurse–Educators at no extra charge. We’ve helped so many women get off HRT, and we can make it happen for you too.

To get started, take our Menopause & Perimenopause Quiz. If you have questions about whether the Health Program will work for you, call us toll-free at 1-800-448-4919.

The post Getting off HRT safely & symptom-free appeared first on Women's Health Network.

Women were immediately taken off of, or took themselves off of, hormone therapies like Premarin and Prempro, and left to suffer from rebound symptoms, with no true alternatives.

Now, physicians are coming back to prescribing hormone replacement therapy for some women. But what makes HRT safe for some women and not others? We’ve been keeping up with this debate over the years and following the research as well. Ultimately, the decision to take HRT is between a woman and her healthcare provider but the best way to prepare yourself to make that decision is by educating yourself first.

The Women’s Health Initiative — what we know now

The original results of the Women’s Health Initiative showed that women who took estrogen and progestin had increased risks for heart attack, stroke, blood clots, and breast cancer. For those who took estrogen alone, the results showed increased risk of stroke, blood clots, with an uncertain effect on breast cancer. These results made it clear that hormone replacement therapy came with significant risk.

The passage of time has given researchers more perspective on the original results. For instance, most of the women enrolled in the WHI were older and far beyond menopause. Newer studies are suggesting that women less than 60 years old and within ten years of menopause are at considerably less risk than older women, and, in fact, may benefit from hormone replacement therapy. Yet, the US Preventive Services Task Force published a report in 2012 concluding that the risks of hormone therapy still outweigh the benefits.

Do the risks outweigh the benefits for you?

Our stance on hormone replacement therapy is that the decision is personal and the risks and benefits should be discussed with your practitioner. However, based on the recent research, there are some guidelines you should consider as you make your decision. HRT risks go down if:

• You are less than 60 years old.
• You are close to menopause and still having symptoms.
• Your personal and family medical history do NOT include breast cancer, endometrial cancer, ovarian cancer, or liver disease.
• You use transdermal, transvaginal, sublingual, or melt forms of HRT instead of pills that are taken orally.
• You don’t use hormone replacement therapy for more than five to seven years.

Each woman has a unique set of circumstances and should always make decisions about hormone therapy with her healthcare practitioner. If you are experiencing severe symptoms that are significantly impacting your life, HRT may be the best option for you. However, consider our recommendation to always begin with the least invasive approach first and add more support, if needed.

Phytotherapy — an effective alternative to HRT

Phytotherapy, the use of medicinal plants and plant extracts heal and restore balance in the body, is a great way to manage menopause symptoms without the risks of HRT. Several herbs have shown great results for women. We recommend black cohosh, kudzu, and red clover for symptoms of estrogen imbalance like hot flashes and night sweats. Passionflower, chasteberry, and wild yam work well for symptoms related to progesterone imbalance like anxiety, insomnia, and irritability.

We’ve found that the most effective approach to eliminating menopause symptoms includes a multi-botanical like our Herbal Equilibrium (which contains all the herbs above and ashwagandha for its mood stabilization and aphrodisiac properties), plus a high-quality multivitamin/mineral complex and hormone-friendly changes in diet and lifestyle. Our Hormonal Health Program includes all of this, plus phone support from women right here in Maine so you can personalize our approach to fit your needs for menopause relief. There are lots of options for frustrating menopause symptoms — and we are here to help!

The post The real risks of HRT appeared first on Women's Health Network.

We’re now almost 20 years past the Women’s Health Initiative and the fear of health implications with Hormone Replacement Therapy (HRT), and there’s new information, new research, and more attention on Bioidentical hormones. Bioidentical hormones are formulated in a lab with the same molecular structure as the hormones we make in our own bodies. They’ve gained popularity in the past few years, but many women still have questions.

In this article

• Are there natural alternatives to getting off of HRT?
• Getting natural estrogen
• Getting bioidentical progesterone
• Troubleshooting and making adjustments
• Things to avoid — combination patches or products

We hear from women who are frustrated and confused about the process of getting bioidentical hormone therapy (bHRT). Some have no access to specialty providers, and think their provider will only offer up Premarin or Prempro — which raises concerns about the health risks of synthetic hormones. Others began using bioidentical hormones, but their provider retired or relocated, or they just plain can’t afford it anymore. These women feel stuck, thinking they can’t afford the time, effort, or expense of compounded bHRT. Yet they continue to suffer with perimenopause symptoms. And that’s just not necessary, since there are so many wonderful options and alternatives available.

Why is there so much confusion about bHRT?

There’s a lot of misinformation out there about the availability of different bioidentical hormone options. Many ad campaigns imply the only “real” choice for severe menopause symptoms is between synthetic HRT and antidepressants. There are blogs and websites stating bHRT is illegal or banned by the FDA (which aren’t true). There are also concerns about consistency and quality in the products made. No wonder women are confused!

First of all, bioHRT is not banned or illegal. So far the FDA has just wanted compounding pharmacies to refrain from making false claims about bHRT that have not yet been proven in studies. The FDA has approved many bHRT-based products from pharmaceutical companies, such as estradiol products and Prometrium (progesterone).

Second of all, the best way to ensure quality is by finding a trustworthy provider. You can locate a trustworthy compounding pharmacy that’s accredited through the Pharmacy Compounding Accreditation Board. The Pharmacy Compounding Accreditation Board (PCAB) is a nonprofit organization created by eight pharmacy organizations to set standards for compounding pharmacies in the United States. We also recommend you ask your healthcare practitioner about compounding pharmacies that they recommend and feel are trustworthy.

What about avoiding HRT or getting off of HRT?

There is a wealth of natural alternatives to HRT, including a huge variety of herbs, flax seed, exercise, stress reduction, and optimal nutrition that can make a huge impact when weaning off or trying to avoid HRT. In fact, we’ve created one of our Programs specifically for women who want to get off of HRT safely using these natural alternatives. Our herbal products along with diet and lifestyle changes, can help you wean off of HRT with minimal symptoms.

Natural measures work synergistically to help relieve symptoms and balance your hormones yet pose a mere fraction of the potential HRT risk. And when used alongside HRT, they allow for faster, better, and more sustainable results, often using lower hormone doses.

If bioidentical hormones are the next step

We want you to know that if you and your healthcare provider determine you need hormone replacement therapy, there is a bioidentical option that will work well for you. It may take a few tries, but you are worth the effort. Understanding some basics will help you know what to ask for.

If you’re looking for bioidentical hormone replacement therapy but don’t want or cannot access compounded bioidentical hormones, there are some simple ways to cue your practitioner toward alternative forms of hormonal support rather than synthetics. Explain that:

• you don’t want to take estrogen in conventional pill or capsule (oral) form.
• you don’t want Premarin or Prempro — conjugated equine estrogens or synthetic progesterone/progestin products — in any form.
• you’d prefer to stick with estradiol, a natural human estrogen, and Prometrium, which is bioidentical progesterone, at least to start with. (Both are available from ordinary pharmacies, and there are several popular brands of estradiol to choose from). You may also want to ask your healthcare practitioner about Bi-Est in particular, which is a combination of estriol (80%) and estradiol (20%). This combination may be safer than estradiol alone, and can be combined with bioidentical progesterone as well.

Often it is usually best to schedule a special appointment for discussing hormone therapy with your practitioner, so they allot enough time to answer all your questions — rather than try to squeeze the topic in during a physical.

There are many forms of “natural” or bioidentical HRT available. See our table of natural hormone options for bHRT for more information. All of the non-compounded, brand-name hormone preparations listed in our table are FDA-approved, legal, and available by prescription.

Getting natural estrogen

Due to the fact that Premarin is made from horse urine and has been implicated in the increased health risks seen in studies such as the WHI, there are many women looking for alternatives. This is making it easier to get bioidentical estrogen. Estradiol is bioidentical estrogen that is now readily available in many forms (see table). Estradiol is the primary biologically active estrogen that changes in menopause, and it’s the one that usually matters most for estrogen replacement.

We do suggest you avoid estradiol in the pill forms that must be swallowed. We now know that any form of estrogen taken orally, even bioidentical estrogen, can induce the liver to make more blood-clotting factors and can increase the risk of stroke. It also drives up a protein that binds up hormones over time, and can disrupt blood sugar and triglycerides as well. That means that taking oral estrogen pills of any kind can, over time, affect your body in ways that are problematic. This does not include the sublingual (under the tongue) troches (tro’-keez) or “melt” products, which pass directly into the blood stream through the thin membranes of the mouth, bypassing the GI system and liver.

The latest evidence suggests that low-dose estrogen delivered by transdermal (through the skin) methods, such as patches, creams, or sprays, can be superior and lack the negative effects associated with oral formulas. Transdermal delivery should be the first-line approach when using estrogen these days, but some conventional practitioners may not be aware of these options. Often it’s worth bringing the subject up yourself. (One important note: birth control patches such as the one sold under the name Evra are not the same as transdermal estradiol.) You should note that sometimes transdermal application can lead to dermal fatigue, a condition where the hormones can get trapped in the fatty tissue under the skin and therefore not utilized effectively by the body. Remember to talk to your healthcare practitioner about what you should be mindful of when using patches, creams and sprays transdermally.

Another good delivery options for creams and sprays is via transmucousal delivery (through the mucous membranes). I often recommend my patients apply hormone cream directly to the labia majora. This can make a huge difference in absorption and efficacy, and many times enables patients to lower their dose. Again, I recommend working with your healthcare practitioner if you are considering transmucousal delivery to ensure you are getting the right dose of hormones for you.

The FDA has approved many brands of estradiol patches for many years, and they are an option if you cannot afford to pay out of pocket and must rely on your insurance coverage as they are usually well covered by insurance (see table). Patches are not for everyone, as skin sensitivities or hot humid climates can result in irritation, but there are also gels, lotions, and even a topical spray for estradiol (see table). These forms do tend to be more costly as they’re newer, but they all deliver bioidentical estradiol through the skin.

There are also estradiol products that target the genital tissues directly, such as the vaginal or urethral tissues where they are applied or worn, without exposing the rest of your body to the hormones in the products (the exception is the brand-name vaginal ring called Femring, which does deliver a systemic dose of estradiol).

Getting bioidentical progesterone

For most women — though not all — bioidentical progesterone has a calming, mood-stabilizing effect. Synthetic progestins, on the other hand, such as medroxyprogesterone acetate (MPA) and norethindrone acetate, tend to be associated with a set of net unpleasant effects — often the actual symptoms that we are looking for relief from.

When progesterone therapy is called for, we favor the use of bioidentical forms, whether in low-dose over-the-counter creams, compounded prescription-strength preparations, such as creams, “melts” and troches, or in the sole brand-name, FDA-approved prescription-strength called Prometrium. If you are advised to go on estradiol estrogen replacement, ask about a prescription-strength oral progesterone (as in Prometrium).

If you have had a hysterectomy, you may find that a low-dose, over-the-counter progesterone cream is right for you. Other women who are post hysterectomy choose to complement their estrogen replacement therapy with botanical support, such as chasteberry, wild yam, and other herbs that mimic or complement natural progesterone, using it instead of, or in addition to, bioidentical progesterone. (Chasteberry and wild yam are two of the phytotherapeutic ingredients in our Herbal Equilibrium).

Oral progesterone doesn’t have the same risk profile as oral estrogen; it has an entirely different set of molecular actions in the body. The progesterone in Prometrium is derived in a laboratory setting from yams or soybeans, then micronized in (peanut) oil, to allow for better absorption. (If you’re allergic to peanuts, you should avoid Prometrium.) Because of its calming effects, it’s best taken at night, and taking it with a bit of food also enhances absorption.

Troubleshooting and making adjustments

As explained above, you can obtain a prescription for bioidentical hormones by requesting any one of the standard-dose, FDA-approved bHRT products. If you find that one brand of bHRT doesn’t work well for you, you can always ask to try a different one, or even a different combination.

Sometimes a woman does best with a brand-name form of bHRT used in combination with a compounded bioidentical cream, lotion, gel, or lozenge. For example, she might use a trademark estradiol patch each week, together with a compounded prescription-strength progesterone cream during the second half of her cycle, mixed with a small amount of testosterone. She’s unique, and so are you.

But there are situations where a bioidentical version from a compounding pharmacy is more desirable. Among these are the following situations:

• Prometrium can be costly if not covered by insurance, and a bioidentical progesterone from a compounding pharmacy can be a less expensive option. Even those practitioners who don’t normally prescribe compounded hormones may be willing to do so when cost is an issue, so be up-front with your provider if expense is a concern.
• If you are allergic or sensitive to peanuts, avoid Prometrium. A compounded peanut-free version is the only other prescription-strength option for bioidentical progesterone. (Many compounding pharmacies suspend the progesterone in olive oil instead of peanut oil).
• For a small amount of women, Prometrium taken orally is too sedating or has depressive side effects. Cutting the dose, or adjusting the time you take it, can often help. It’s also possible to insert the capsule into the vagina to be more directly absorbed, which can help eliminate these side effects (but talk to your practitioner about that alternative). Or your provider can prescribe a similarly-dosed capsule, troche, melt, or topically-applied cream.

These are all prime examples of why the service that compounding pharmacies provide is essential to our well-being.

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At Women’s Health Network, we talk with many women who are frustrated with their medical care, especially when it comes to discussions of hormonal imbalance and hormone replacement therapy.

Women who are suffering from hot flashes, irritability, sleep disturbances, forgetfulness, anxiety, and more are often told that their hormones are “fine,” or they’re given prescriptions for hormone replacement therapy (HRT) or antidepressants, often without any discussion of drug risks or alternatives. Other women who are interested in HRT are confused about risks and benefits of synthetic hormones versus ‘bioidentical’ hormone therapy, but aren’t always getting their questions answered.

When something is off with our bodies, we want to talk it over with our healthcare practitioners. But if these conversations are discouraging or, worse, nonexistent, we’re left without the critically important information we need to feel better, and we don’t know where to turn for help. Our approach can help you foster a fruitful conversation with your doctor about hormone therapy and your alternatives.

Know where your doctor is coming from

Our goal is to help you find a health provider who will partner with you to create the best possible path through this potentially challenging period in your life, i.e., menopause. Remember that all healthcare providers are human. They have spent many years learning to be experts in their field and even more years practicing their expertise. They went into medicine to help people, but are also overstressed these days by managed care rules, financial considerations, and having to work as quickly as possible. He or she probably also did not get much training in sex hormones (female or male). (Only recently have many hospitals even started women’s health programs.)

We also want to help you understand the complexities of hormone therapy. HRT is still the gold standard for treating menopausal symptoms. However, HRT has been the subject of wide debate since the 1970s, and your doctor may be just as confused as you are. Both media headlines and drug companies have bombarded doctors with conflicting arguments about HRT and alternatives. Many practitioners are still wary of prescribing hormone therapy ever since large studies like the Women’s Health Initiative reported increased risks of breast cancer, coronary heart disease, stroke and venous thromboembolism in menopausal women using conventional HRT. “Bioidentical” hormones are made from plants and match the chemical structure of your own hormones. Although bioidentical HRT is safer in many ways than conventional HRT, most doctors don’t have experience with it, or they simply place more trust in synthetic hormones because they’ve been so thoroughly tested.

Is hormone therapy dangerous or not?

Many different factors determine the risk/benefit ratio in menopausal women using HRT. Some of these factors have to do with the hormones themselves. Various effects of HRT can depend on:

• the form of the hormones (synthetic versus bioidentical)
• the route of administration (oral versus topical, or transdermal)
• the dosage
• the length of treatment

Conventional HRT typically consists of “conjugated equine estrogens,” or CEEs (e.g., Premarin) and – if a woman still has her uterus – medroxyprogesterone acetate, or MPA (e.g., Provera); the combination of the two is called Prempro. CEEs are made from pregnant mares’ urine; hence, they’re natural to horses but not to us! CEEs are also much more likely than bioidentical hormones to break down into an compound that damages DNA in breast tissue. MPA is given along with estrogens to protect a woman’s uterus. However, it’s entirely synthetic and is responsible for much of the disease risk that has been observed in women using conventional HRT. Because CEEs and MPA are taken orally, they must first travel to your liver where they can activate pro-coagulation proteins, increasing the risk of clot formation, ischemic stroke and thromboembolism. This doesn’t happen with transdermal hormones, since they bypass the liver.

Because we’re all unique in terms of our genetic make-up and individual health problems and risks, the typical one-size-fits-all approach to HRT is asking for trouble. Individual factors that can influence the safety of HRT include:

• Your age
• Your weight and body mass index (BMI)
• Family history, e.g., of breast cancer or cardiovascular disease
• Genetic susceptibilities
• Environmental stressors
• Alcohol intake

Are you beginning to see why the question of whether to use HRT or not a simple one? Ideally, your healthcare practitioner will fully evaluate your unique set of risk factors, including genetic make-up, environmental factors, and underlying health problems that might make HRT more risky (e.g., breast cancer risk) or more helpful (e.g., osteoporosis prevention). If you decide to use HRT, the safest forms and doses should be used, and you should be regularly monitored over time for any emerging problems.

Know your body, your menopause symptoms and your medical history

We suggest assessing your symptoms to figure out what’s bothering you most before visiting your doctor. Your worst symptom may be insomnia, moodiness, hormonal weight gain, hot flashes, or something else. Doctors are taught to first ask for a patient’s “chief complaint,” then take a history — when, what, how, where, etc. Unfortunately, with managed care time constraints, a full discussion often fails to take place. So, be prepared and you’ll get more out of the visit.

Here’s some information to gather prior to your appointment:

• A list of your symptoms, with the most bothersome at the top
• Your own past medical history and your family medical history
• A list of your prescriptions and supplements
• Notes about your ideal approach to menopausal symptoms, and what feels realistic for your life (i.e., Do you like to take a more natural approach to your health? Are you willing to make changes in your diet and in your lifestyle? Are you interested in bioidentical hormones?)

When you are ready to call for your appointment, specifically request a “hormone consultation.” Ask for an appointment of at least 15 to 30 minutes. Having a “hormone consultation” should be the sole focus of your visit, and you deserve to stay comfortably dressed in your clothes instead of having to wear a “johnnie” and sit on an exam table. Be sure to schedule your check-up after the consultation, or on another day, if necessary. This type of focused consultation appointment makes it easier to say what you want to say without being rushed or distracted by other topics.

Know what you are asking for — options for menopause symptom relief

We encourage you to do some research on your choices prior to meeting with your healthcare provider. The chart below lists the pros and cons of some of your options for menopausal symptom relief. If you’d like more detail on large hormone studies, please see our article Findings on HRT since the Women’s Health Initiative.

Feeling your best usually takes more than just a prescription. We recommend trying the most natural, least invasive steps first to create a foundation of health and hormonal balance, and then gradually adding remedies, as needed. We formulated Herbal Equilibrium to help balance estrogen, progesterone and testosterone and to relieve the top 10 symptoms of menopause. For a more comprehensive approach, our Hormonal Health Program includes a hormone-healthy diet and lifestyle guide (with recipes!), a rich multivitamin, Omega-3 fatty acids, Herbal Equilibrium, free phone support and exclusive webinars. We also have a program to help women wean themselves off of HRT. No matter what you choose, you have support from Women’s Health Network.

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The purpose of hormone replacement therapy, or HRT, is exactly what the words say — hormones are being replaced as a form of therapy for some condition. Today this is often shortened to HT, for hormone therapy, and some believe the two have different nuances of meaning. But whether we call it HRT or HT, we are fundamentally talking about the use of supplemental hormones in a therapeutic setting.

For more than 60 years, HRT referred specifically to synthetic or “nonhuman” hormones given to menopausal women. Initially the intention was to keep women young and forever feminine. The first brand of HRT in America, Premarin, contained only conjugated equine (horse) estrogens (CEE). However, concern arose in the 1950’s over increasing rates of uterine cancer seen in women using it. This finally led the drug company who manufactures Premarin, many years later, to create Prempro by adding a synthetic progestin.

Over time, doctors were taught that HRT — now offered in a rainbow of brand names, dosages, shapes and colors — prevented heart disease, kept women’s skin and brains youthful, built strong bones, and caused few side effects. Most if not all American women going through menopause were encouraged by their doctors to go on some type of hormone replacement therapy for their menopausal symptoms of hot flashes, mood swings, insomnia, and weight gain. And millions did.

By the late 1990’s, some women were questioning the use of HRT. Did all women need it? Why were all women put on the same dose? What was happening to the pregnant mare whose urine was being used as part of Premarin or Prempro? They wanted to know if there wasn’t some other alternative.

Other women swore by their HRT and never considered the possibility of going off it. Then in 2002 came the results of a large women’s study (the WHI) looking at the effects of HRT (Premarin and Prempro — neither of which are bioidentical hormone forms). Its findings took the medical community by surprise — HRT as it turned out was not found to decrease a woman’s chance of getting heart disease, but rather definitively increased her risk of blood clotting, stroke and breast cancer.

Today there remains controversy about whether the early findings were conclusive, particularly whether they apply to younger women who initiate HRT during perimenopause. In the interim, research has come out that indicates some differences between the effects for a 50-year-old woman placed on HRT and one who begins ten or more years after menopause. Researchers have been tweaking the data from the WHI study to see if there is a subset of women who may benefit from replacement hormones, as well as identifying subsets who should avoid it. Every year, the significance of each reanalysis is hotly debated — 2006, 2007, 2008, 2009 — even among the experts!

Notwithstanding the confusion, women stopped their HRT en masse with the release of the 2002 WHI findings and began seeking alternatives for their menopausal symptoms. So many found that as soon as they quit their HRT, their menopausal symptoms came rushing back. This was terribly discouraging for women struggling to deal with their symptoms but afraid of the health risks of replacement hormones, particularly synthetic forms. And the pharmaceutical companies argued that there were no good alternatives to HRT.

Fortunately, there are natural methods that can help ease the transition off HRT and provide the body the support it needs to minimize or avoid menopausal symptoms. For help during this transition period, see our article on getting off hormone replacement therapy.

Bioidentical hormones

Some women have turned to bioidentical hormones as a superior form of HRT. These are female hormones normally manufactured by our endocrine system, principally the ovaries — estrogen, progesterone, and testosterone — which decline as the ovaries stop releasing eggs. By “bioidentical” we mean that the biochemical structure of the hormone is perfectly identical to the main hormones produced in a woman’s body — neither a horse’s hormone nor an artificially contrived formula almost like but just a little different from what a woman produces.

What took so long for bioidentical hormones to come into play? Pharmaceutical companies have had to develop many nonhuman estrogens and progestins in order to patent their drugs. They had hoped the little changes they made to an estrogen or progesterone molecule would not make a big difference to a woman’s body. But today we know that is often not the case. For example, birth control pills are synthetic estrogens and progestins, and, as any woman who has ever taken them can attest, each brand affects her differently. Some women cannot tolerate them at all. The same is true with hormone replacement therapy — bioidentical or synthetic!

In the 1990’s, pharmaceutical companies began developing and patenting unique methods of administering bioidentical hormones. One example of this would be the Climara patch, which uses a sticky transdermal hormone delivery system. While Climara was patented in 1994, the estrogen itself cannot be patented because it is identical to human estradiol.

Moving into the future of HRT

Mother Nature provides a woman’s bodies with many different types of hormones in constantly shifting ratios, and we cannot precisely reproduce her delivery methods or levels in the body. What we can do is approximate her methods and work alongside her: with good nutrition and supplements, appropriate exercise and other lifestyle changes, most women can manage their menopause symptoms very well!

But there are times when a woman can greatly benefit from a dusting of hormones. While it’s always helpful to partner with your practitioner to work through the challenges menopause presents, it’s especially so if you have severe menopause symptoms, early menopause, or your quality of life is compromised. Then the decision about bioidentical hormones becomes more critical.

If you are facing this decision, we encourage you to read about the many options for bioidentical hormones, as well as our article on talking to your doctor about bioidentical hormones, before you go. Remember, the words on this page are just a slice of the history of HRT. There is much more for us to learn, and just as each year brings us new understanding, each new day we have an opportunity to revise our personal health history. We invite you to continue on the path of learning and wellness with us!

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A: Estradiol patches are best worn on hip, low belly, and buttock areas. Be sure to rotate sites (using a different site each time you change the patch) to avoid skin irritation. Some patches are changed once per week, others twice per week — it depends on the brand, so check with your pharmacist or review the literature that comes with the patch. Transdermal estrogen patches generally stick to the skin fairly well, but they vary in size and the adhesives used, so individual patients may experience more problems with one than another. We encourage you to try different places, and if the brand you are using just won’t stay on, you can request another brand.

Return to:

• FAQ’s on bioidentical hormones and other forms of HRT
• An intro to HRT and alternatives

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