Gill Stannard

Thursday, March 27, 2008

more on bio-identical hormone treatment

Suzanne Summers thinks it’s the only way a woman over 50 can maintain her figure and Dr Sandra Cabot promises she can make you feel 21 again. Both agree that this elixir of youth is natural and safe but are natural hormones as benign as they are made out to be?

In January this year the US FDA issued warnings to some companies making and promoting bio-identical hormones (BHRT). This included the “use (of) the terms "bio-identical hormone replacement therapy" and "BHRT" to imply that their drugs are natural or identical to the hormones made by the body. FDA regards this use of "bio-identical" as a marketing term implying a benefit for the drug, for which there is no medical or scientific basis.“

Closer to home, some of the recent criticisms of BHRT appear to be more of a turf war. Despite the well documented cancer concerns in conjunction with regular HRT, some doctors have spoken out against BHRT on grounds that it is unproven, while supporting pharmaceutical company produced hormone replacement therapy (HRT) as a safer and more effective option.

The following article was first published on this site in August 2006 and has been updated.

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.

Truly natural alternatives to HRT and BHRT

Stress management through exercise, meditation, journal writing, herbs, nutrients, counselling etc. In clinical practice the connection between stress and an increase in negative menopausal symptoms is blindingly obvious. This is time for all women to put themselves first and listen to what they really need.

Herbs for menopause: Black cohosh is the mostly widely researched and used herb to decrease hot flushes, vaginal dryness and other hormone related symptoms. However there have been some isolated cases of liver dysfunction and this herb should be prescribed only by a qualified herbalist.

are plants that promote weak, benign oestrogen-like effect in the body – these include hops and red clover, as well as foods listed below.

Sage tea, often combined with mint, is effective in reducing sweats.

Common herbs to support the nervous system include: chamomile, skullcap, passionflower, lemon balm, oats, withania and lavender.

Creative visualisation: to feel cool, calm and collected.

Phyto-oestrogen rich plants as part of a well balanced diet. Most plant foods contain sterols or isoflavones which are often phytooestrogen. Soy is the most famous food but almost all beans have some effect. Seeds and beans when sprouted have an even more dynamic action. A diet rich in wholegrains, legumes, nuts, seeds, fresh vegetables and even olives is not only beneficial for general wellbeing but can provide a medicinal dose of phyto-oestrogens. Interestingly, these foods are also getting a lot of interest as containing potential anti-cancer properties. Keep eating oily fish but pull back on large amounts of meat. Add some healthy (non-cheesy) vegetarian meals to your menu.

Reduce, or eliminate, alcohol.