Dr. Gannage’s blog post discussing “expert” recommendations for the flu vaccine in pregnant women got me thinking. Many health conditions experienced by women—immune fluctuations in pregnancy, hot flashes and mood changes in menopause—have become “medicalized” or “diseaseified”. Natural changes in hormones, which undoubtedly have an effect on our wellbeing, become diagnosed as illnesses within the medical community, leading to, of course, the development of new pharmaceutical drugs…
Time and time again, I see that women are given unnecessary pharmaceuticals before natural and effective treatments are tried. Oftentimes, these drugs relieve symptoms, but create additional health problems, requiring even more medication and the vicious cycle continues.
Hormones, bio-identical and conventional, are prescribed to mitigate the symptoms of menopause—hot flashes, lowered libido, vaginal atrophy, mood changes, insomnia, fatigue and weight gain. Patients are often confused about the difference between the two, seeing conventional as “bad” because of serious side-effects, while bio-identical hormones are seen as a miracle therapy—all the benefit with no risk. But as with any therapy, risks are possible.
Categories of Hormone Replace Therapy
There are three main categories of hormone replacement therapy. Bio-identical Hormone Replacement Therapy (BHRT), aka natural hormones, is derived from plants and is structurally identical to human hormones. For example, estrogens are derived from wild yam and soy—two plants used in herbal medicine to reduce menopausal symptoms. These hormonal preparations differ from the horse-derived estrogens used in conventional hormone replacement therapy (HRT). Conventional HRT is synthetically produced in a lab and is structurally different from human hormones.
The major concern with HRT is that the synthetic structure is broken down and detoxified differently than natural hormones. These breakdown products may be more harmful or linger longer in the body, having a greater impact on tissues.
“Friendlier” hormone replacement therapy is similar to bio-identical hormones, but includes binders, fillers, preservatives and additives in the formulations.
Three types of estrogen are produced in the body and differ in structure—estriol, estradiol, and estrone. Estradiol, made from male sex hormones, is converted into estrone. Both these hormones are converted into estriol, which is the estrogen form of choice for prescribing complementary medical practitioners.
Estriol has both estrogenic and anti-estrogenic effects in the body, similar to soy (don’t worry, this will be discussed in the next blog). A number of studies have demonstrated improvements in hot flashes, insomnia and vaginal atrophy after 3 months of bio-identical estriol therapy. The majority of data indicate the intravaginal estriol does not have an effect on the endometrium, and long-term oral use also does not increase the risk of uterine cancer. Estriol therapy can improve cholesterol levels and bone density—two common concerns for post-menopausal women. While the effects of estriol on breast cancer growth are conflicting, the risk appears to be dose-dependent.
Conventional estrogen therapy has much greater health risks with long-term use. When taken with or without synthetic progesterone, there is an increased risk of developing invasive breast cancer, blood clots, heart attacks and stroke. Without concomitant progesterone therapy, there is a greater risk of uterine and ovarian cancer.
Many women are given hormonal therapy to treat hot flashes and mood changes, only to end up gaining more weight. The Rx creates a relative estrogen dominance in the body, which blocks thyroid receptors and impairs thyroid function. This leads to a sub-laboratory hypothyroidism and subsequent weight gain.
Unlike estrogen, whose production falls to 40-60% of premenopausal levels, progesterone levels decline to nearly zero during menopause. Progesterone has anti-estrogen properties, normalizes water retention AND facilitates thyroid function and blood sugar balance.
Natural progesterone can be administered as a cream, oral capsule, sublingual drop or pellets, lozenges, transvaginal and rectal suppositories and injection. The route of administration is determined by the severity of symptoms and other medications, such as estrogen therapy. Natural progesterone creams are used to reach normal physiological levels to reduce menopausal symptoms, but do not provide adequate protection from uterine cancer when estrogen is taken as well. The research is conflicting on its impact on breast cancer risk; some studies show greater risk, while others show protection. Similarly, progesterone does not prevent heart disease or osteoporosis. The most common side effects of progesterone therapy are breast tenderness, water retention and bloating, irritability and cramping.
After a woman has entered menopause, testosterone production decreases by 50%. When this male hormone is included with estrogen replacement therapy, greater improvements in hot flash severity, sexual desire and sexual satisfaction are seen compared to estrogen replacement alone. Testosterone may improve bone density in post-menopausal women, but has a potential worsening outcome on cholesterol levels.
As the precursor to testosterone and estrogen, DHEA is another sex hormone worth mentioning. Animal studies show benefits on immunity, bone density, cancer prevention, brain function and cardiovascular disease, but human studies show negative effects on cholesterol and no improvements on bone density. Clinically, this hormone is used to increase overall wellbeing, especially in postmenopausal women with fatigue and low libido, but it can cause acne and facial hair growth in women, and effect hormone-dependent cancers.
The bottom-line is that when we see menopause as an illness, medications become overutilized and this unfortunately causes an increased risk of true medical illnesses, such as cancer. Medicalization of menopause places each woman into the same proverbial box and does not account for health factors, such as diet and nutrient status, activity level, stress and mental health, on the severity of these symptoms. Instead of Band-Aids for the superficial boo-boo, build a foundation of health. If you don’t need hormones, then don’t start.
Stay tuned for Understanding Menopause 102 – the comprehensive naturopathic approach to menopausal symptoms that should always be tried first!