Gill Stannard

Sunday, August 13, 2006

“Natural” Hormones

So much is branded natural these days. In the cynical world of advertising marketers know the tag “natural” can vastly increase the value of a product. Gone is the homespun, daggy image – greasy fleece has been transformed into luxurious cashmere.

When it comes to the world of "natural medicines" I am the first to admit it is a minefield, with “natural hormones” topping my list of the most misleading medicines.

In the fallout of the hormone replacement therapy (HRT) scandal, a case of yet another wonder drug not living up to it's promises, women have been scrambling for alternatives to help them traverse some of the unwanted side effects of menopause.

For the last 20 years – ‘natural progesterone’, initially marketed as a cure for PMS, has dogged astute herbalists. What is called natural, in this case was the herb Wild Yam. You could get an overpriced jar of the stuff, rub it into your skin and all your hormonal problems would disappear! But the problem is, though a constituent of the plant was a precursor to a biological process that could enable natural hormone production – the straight plant extract taken transdermally or internally, could not make this happen. Only in the lab can the starting ingredient be synthesised to make this next step - a functional hormone. Like with many early drugs, herbs may have been a starting point but the final product is no more natural than any other modern pharmaceutical drug.

This effective ‘natural’ Wild Yam product, sold as a cream, often in small print had the words ‘derived’ or ‘sourced from’ – as in ‘derived from Wild Yam’. It did work, as did HRT. But the public was duped by the ‘natural’ tag once more, thinking it was free of any potential side effects.

The latest in natural hormones has recently hit the headlines, alerting women to a possible cancer risk. “Nature identical’ or “bio-identical” hormones (BHRT), also known as “natural hormone replacement therapy” (NHRT) are prescribed by a small handful of medical doctors and produced by an even more select group of compounding pharmacists. The source, once again, has a herbal or vegetable (often soya bean or Wild Yam) starting point but a constituent is isolated from the plant and then is further manipulated to make a pharmaceutically active drug. Remember the bean or herb where it all began could not achieve this all by itself. The main point of difference between this and standard HRT is that the dose of the the hormone is individualised, usually through tracking the women’s hormone levels in their saliva or other biological tests. I’d term this ‘dose appropriate’ pharmacy and for women who have found they can’t survive without their wonder drugs, this at least dishes up a more tailor-made product. The ‘natural’ tag however is still misused, to the point that some consider it to be deliberately misleading.

Now we have cleared up the misinformation and understand that this product is in fact a “drug”, it is obvious that it is likely to carry the same risks that are associated with other forms of allopathic HRT. However, to date the three cases of endometrial cancer that are behind this story also appear to be based on shaky science due to such a small sample size.

While further research needs to be done on BHRT, I would caution all women to view it in a similar light to conventional HRT. It is a drug available on prescription only, the natural starting point does not have the same therapeutic effect and must be altered in the laboratory like any other drug to get the desired clinical results, women coming off this medication will usually trigger a return of menopausal symptoms. While it may put the "pause" back into menopause, BHRT like HRT, is only a short term solution.

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