Author: Dr. Gary Huber, DO
A factual discussion comparing bio-identical hormones to drug-based hormone replacement threapies
It’s simple really. Drugs are not hormones just as saccharine is not the same as sugar. This article explores and explains the difference in simple detail. Let's dispel myth and study the facts, so that you can decide for yourself how to best treat your body for a healthier and longer life.
Menopause and the years just before menopause may bring the following symptoms as hormone balance begins to change:
- Hot flashes and night sweats
- Mood swings, irritability, and PMS
- Anxiety, depression, and picnic attacks
- Mental change, poor memory, sluggish thought process, poor focus
- Migraine and tension headaches
- Poor sleep, more awakenings through the night, insomnia, weird dreams
- Breast lumps, sore breasts, masses, and fibrocystic changes
- Irregular cycles, heavier cycles, and more cramping
- Vaginal dryness, vaginal odor, vaginal itching
- Loss of sexual interest
- Hair growth on face, and hair loss on scalp
- Painful intercourse
- Urinary tract infections
- Lower back pain
- Bloated, flatulence and indigestion
- Aching ankles, knees, wrists, shoulders, heels
- Frequent urination & urinary leakage
- Varicose veins
- Dizzy spells
- Skin feeling crawly
- Weight gain
This most commonly occurs between years 45 to 55 but can start as early as age 35. The unfortunate history is that back in 1942, Premarin entered the market as a hormone replacement for women. It is made from the urine of pregnant horses and the reality is that it does not behave like normal human estrogen. It is in fact an esterified DRUG and not a hormone. What’s the difference? A hormone is something that your body makes and knows how to use and dispose of. A drug by definition is a compound that is foreign to the human body and does not exist in nature. It is synthetic. The human body was never intended or built to ingest, use or dispose of drugs and therefore a powerful drug like Premarin or any of the synthetic drug based hormone replacements are going to cause abnormal responses from the body and have great potential to cause harm.
Lets look at some of the adverse realities of using synthetic Premarin, a drug based replacement for your natural estrogen:
- Its ability to stimulate your estrogen receptor is 100’s of times more potent than your natural estradiol creating excessive cellular stimulation that is abnormal.
- Estrone is in high concentration in these formulations, and it is the estrogen that is associated with the development of both prostate and breast cancer.
- Equilenin or horse estrogen is not recognized by the body and its metabolites can create significant damage to DNA.
- It has been found that taking synthetic estrogens orally can cause inflammation in the body that correlates with increased cancer risk. This same risk does not seem to occur with the use of bio-identical estradiol when applied topically.
Lets take a look at natural hormones and compare them side by side with drugs used to replace hormones.
As you look at the blackened circles shown on the synthetic progesterone molecule, these are the additions or synthetic changes that the drug company attached to what would otherwise be progesterone and it dramatically changes the way this element behaves in your body. For example, true progesterone is critical in order to allow a women to get pregnant and while pregnant she increases her production of progesterone to large amounts to support a healthy fetus and placenta. Compare that with synthetic Provera (medroxyprogesterone) drug, which in fact causes birth defects. In fact your OB/GYN will tell you that is you have been taking a birth control pill, all of which contain some form of “progestin” (an artificial progesterone drug) then you should avoid attempts to get pregnant for at least 2 months after ceasing the use of these toxic compounds.
Natural progesterone is healthy for the breast tissue and in fact reduces the risk of ever getting breast cancer. Women who get pregnant at a younger age and thus have exposure to progesterone at high doses during the pregnancy early in their lives, have a much lower risk of ever getting breast cancer compared to women who get pregnant later in life. Progestins (Provera, Medroxyprogesterone) on the other hand, dramatically increase the risk of getting breast cancer by 70%. So when comparing the drug Progestin to the natural hormone progesterone there is stark difference, in fact an opposite impact.
Natural progesterone is healthy for your heart and protects blood vessels while Progestins (synthetic Provera) increases risk for heart attack and heart disease.
Natural progesterone improves sleep, cognition and mood while Progestins often cause mood swings, anxiety and depression.
Premarin is a drug made from the urine of pregnant horses. It will bind the estrogen receptor more than 1000 times stronger than natural estrogen which is clearly abnormal and leads to abnormal over-stimulation of the cell. Our bodies are not equipped to clear these drugs efficiently as they are foreign chemicals and thus place an enormous burden on our liver function.
Drug based estrogen replacements along with progestins have been shown to increase risk for a blood clot 100% while the use of natural estrogen and progesterone do not increase that risk even 1%. Why would they? They are a natural part of your physiology and in fact bio-identical hormones contribute to vascular health, not clots. The use of bio-identical hormones will actually reduce your risk of a heart attack by 50% because of their beneficial effect on blood vessels and blood sugar.
Due to everything I have detailed above, most articles you have ever seen on “hormones replacement” have been on the effects of drugs used to replace hormones and NOT the use of bio-identical hormones. Studies exploring the use of bio-identical hormones on men and women at time of menopause have been universally positive. We have not seen a rise in breast cancer or endometrial cancer and in fact have seen some evidence that bio-identical hormones in fact reduce the risk slightly. The term bio-identical means that the hormones used are absolutely identical to what your body makes. The body recognizes the hormone, knows how to use it and knows how to remove it from the body. The risk for breast cancer is grounded in how you treat your body, your lifestyle, your stress and sleep patterns, your exposure to toxins, and a host of other factors and is not simply a matter of whether you have estrogen.
If estrogen was the cause of breast cancer than every 25 year old women making tons of hormone, would be off to see the oncologist.
Estrogen is not the cause of cancer. It is one small factor in a sea of other factors and the reality is that “what you do to your estrogen” is more important than how much you have.
The Healthy Balance of Hormones
Classically we think of “female hormones” being estrogen and progesterone but men and women both have these hormones. Women also make testosterone, which is classically thought of as the “male” hormone. In fact women make more testosterone on a monthly basis, than they do estrogen. So the difference between men and women is the amount of each hormone they make. Men will make more than 10 times the testosterone that women make and of course women make more estrogen and progesterone. But make no mistake that a women needs and wants testosterone as part of her normal healthy balance of hormones and when it fades away near menopause there can be adverse consequences related to bone health, heart health, cognition and energy.
Estrogen and progesterone need to exist in “healthy balance” as they impact the cell response differently when there is imbalance. There is only one progesterone molecule and it is intended to be present to modify or modulate the effect of estrogen on the cell. So how a cell responds to the presence of estrogen is altered by whether there is progesterone present at the same time. Estrogen tends to be a “stimulatory” or excitatory signal to the cell therefore it is great for stimulating brain activity, energy, promote growth of the uterine lining, proper blood sugar metabolism, and a dozens of other beneficial reactions in the body. But if it is present in high quantity or in the absence of it’s sister hormone progesterone, then this excitatory quality can go too far and create headaches, mood swings, bowel irritation, sleep disturbance and cellular growth of the breast and uterine tissue. So it's the balance of estrogen and progesterone that plays a key role in how estrogen makes a women feel.
Why would a woman ever consider taking bio-identical hormones?
The major benefits of replacing hormones can be summed up as follows (short version):
- Flash & Sweats: To quickly relieve symptoms of menopause such as hot flashes and night sweats as well as promote better sleep and mood related to hormone shifts.
- Heart: To reduce the risk of heart disease. Heart attack risk goes down 50%. It also help improve cholesterol and blood sugar management.
- Bone: To reduce risk for osteoporosis and improve bone density.
- Brain: To help restore cognitive function, stabilize mood issues, resolve headaches, improves sleep patterns, and reduces risk for Alzheimers.
- Immune: To support the natural repair of our body a support a healthy immune system.
So why all the confusion?
If bio-identical hormones are so awesome then why doesn't my OB/GYN recommend them? Great question with a complex answer. The truth is that all physicians, including your OB/GYN, receive a medical school education in the proper use of DRUG therapy to reduce symptoms of disease. We are NOT taught about bio-identical hormones because they are not drugs. We are also not taught anything about “health”. I know that sounds ridiculous but the truth is we only study “diseases”, there is no class entitled, “How To Make Patients Healthy”. Menopause is not a disease and bio-identical hormones are not drugs so we receive no education in the use of bio-identical hormones or their application and benefits. Special fellowship training after medical school and residency is required to learn about bio-identical hormone use. I personally travel nationally to conference where I train doctors in the proper use of these valuable hormone therapies. There are a growing numbers of doctors who understand and use these treatments but they represent a mere minority compared to the vast numbers of doctors who are untrained and so the “common opinion” shared by the masses is that hormones are dangerous, spoken by those who are untrained.
Do bio-identical hormones increase my risk for cancer? The short answer is “no” and that is based on large studies done by Dr. Fourneir and others. Breast cancer risk rises as women get older for a host of reasons. The use of intelligently prescribed estrogen when balanced with appropriate progesterone dosing, did not show any increase on breast cancer risk in a 2008 study of 80,377 women. Estrogen use without progesterone may increase risk and certainly we know that drug therapy using the class of drugs called progestins definitely increase risk.
Breast cancer is largely a disease of lifestyle and life choices. Genetics play a very small role in your risk for breast cancer. Of all breast cancers diagnosed, less than 2% of them are related to the dreaded BRCA gene. The BRCA gene can be easily tested for and I recommend that every women have this simple saliva test to rule out risk but it’s real occurrence is quite small.
Problems with conventional “HRT” (hormone replacement therapy) were exposed in 2002 when the Women’s Health Initiative was prematurely halted due to problems seen. This was the largest study ever conducted and it used drugs such as Premarin and Provera but did NOT USE ANY true hormone therapies. The study enrolled 161,808 women total and created quite a stir as the use of these DRUG therapies showed an increase in the following poor outcomes:
- 26-percent increased risk of invasive breast cancer
- 29-percent increased risk of myocardial infarction (heart attack) or death from coronary heart disease (CHD)
- 41% increased risk of stroke
- 200% increased risk of blood clots
- 100% increase risk for developing Alzheimers disease
The most common reasons for discontinuation of HRT (drug therapy) are unwanted side effects and weight gain, with one-third to two-thirds of women discontinuing it within the first two years. Most side effects are attributed to the synthetic progestin portion of HRT, with the most common complaints being bloating, breast tenderness, and irregular bleeding.
Given this information, it is only natural that women began to seek other alternatives, looking for relief of symptoms through the use of hormone therapies that have fewer side effects and risks, and address long-term health benefits to improve a woman’s health and well-being. Bioidentical hormones may provide these benefits. To be perfectly clear there were no bio-identical hormones used in the Women’s Health Initiative.
What are Bio-Identical Hormones and where do they come from?
The body naturally produces three main forms of estrogen: estrone, estradiol, and estriol. Estradiol is the most physiologically active form of estrogen and is made in the ovaries by taking cholesterol and converting it into estradiol. It is removed from the body by the liver and sent to your bowel to exit in the stool. This is part of why constipation is bad for your hormone balance. Bioidentical estrogens are molecularly identical to these naturally produced estrogens and they are made in a lab using the base molecule “sterol” which is a plants version of cholesterol. The end result is a molecule that is an exact replica of your own natural estrogen so the body recognizes it, knows how to use and most importantly knows how to metabolize and excrete it.
Estradiol is often used in conjunction with Estriol for hormone replacement therapies. The value of Estriol, even though it is a very weak estrogen, is that it has some anti-cancer effect and is wonderful for stimulating a healthy lining to the vaginal walls thus reducing dryness and irritation.
There is only ONE progesterone molecule and it is made in much the same way as the bio-identical estrogen in a lab from plant sterols. It is also identical to your own natural progesterone and the body is capable of using and clearing it in a safe and healthy fashion.
Hormones don't work in isolation
Simply sprinkling hormones into your system will not ensure a great result. Hormones are just one piece of an even larger picture that includes the health of your intestines, your adrenal glands and stress response, the thyroid glands, and of course your overall lifestyle and diet. There are dozens of factors that will impact how your hormones are used and metabolized and strong supportive guidance is key to a good result. Be leery of clinics and practitioners offering bio-identical hormones as a one-stop shop “fix-all”. Hormones are a serious medical intervention that offer tremendous benefits but only when done in conjunction with a full medical assessment by a qualified practitioner who incorporates them into a complete lifestyle plan.
Should I Take Bio-Identical Hormones?
That is a question that only YOU can answer and only after a qualified physician has examined your history and discussed the pros and cons. Never let a doctor or clinician pressure you into taking hormone therapy. Menopause is not a disease and does not require treatment. The use of bio-identical hormones can improve your health, improve quality of life and reduce risk for some diseases but it is always a CHOICE and not a requirement. Go into the decision educated and secure with valid knowledge and you will come to a decision that is right for you.
I hope this has helped to uncover some of the truths behind hormones and also dispelled myths while making a clear distinction between drugs versus hormones. If you have further questions then please make an appointment to get the answers you need from Dr. Gary Huber or Dr. Vivien Newbold who are certified practitioners with fellowship training from the American Academy of Anti-Aging Medicine. Also see our website “Education” section for more information in your journey to Discover Your Ideal Health.