Dr. Greenbean

Natural or bioidentical hormones commonly used for perimenopausal and menopausal women include progesterone and the natural estrogens (estradiol, estrone, and estriol), DHEA, and testosterone. They can be compounded in special unique doses and combinations, in unique delivery methods to meet the needs of each woman, and in consultation with her practitioner.

These are hormones made from a natural substance and are bio-chemically identical to human hormones (called bioidentical hormone therapy or BHRT) and then compounded by a pharmacist as a customized dose and in a customized preparation. Compounded bioidentical hormones can be customized for the individual and meet the unique needs of each woman with lower doses, special combinations, and unique delivery methods. Compounded bioidentical hormones are prescribed by a health care provider and made by a compounding pharmacy. Many women are better able to tolerate them because they are identical to her hormones and can be delivered in individualized doses. Natural, or bioidentical progesterone creams sold over the counter also are available in unique low doses. Look for brands that contain USP progesterone, have supporting research, and are paraben free.

The bioidentical hormones from pharmaceutical companies come in limited doses and delivery method.

Hormones made from a natural substance and are bio-chemically identical to human hormones, as in bioidentical compounded hormones, but now these are made by a pharmaceutical company, in standard doses, not customized formulations, and may include the specific (patented) additive of a binder, filler, preservative, dye or adhesive. (Examples include Vivelle, Prometrium, Climara)
Compounded bioidentical hormones are available from specialty compounding pharmacies with a prescription from your health care provider, and bioidentical progesterone creams are available over the counter.
Over the past decade, millions of women have used bioidentical hormones with great success and improvement in health. Research studies done in the U.S. and Europe on bioidentical hormones have confirmed this. Bioidentical hormones include the following hormones:

• Estrogens
  Bi-estrogen (Bi-Est), a combination of estriol and estradiol. From 50% to 80% of Bi-Est is estriol, which has been shown to protect against breast cancer in animal studies. Estriol causes little or no stimulation to the uterine lining and is clinically effective for the treatment of symptoms caused by estrogen deficiency, such as vaginal dryness and atrophy, painful intercourse, and urinary tract disorders (incontinence, frequent urinary tract infections). Estradiol relieves symptoms such as vaginal thinning and dryness. It decreases hot flashes and night sweats; improves mood, energy level, sleep patterns, memory, and cognitive function; and reduces bone loss and the risk of developing type 2 diabetes. It also helps to lower blood pressure.
• Tri-estrogen (Tri-Est), a combination of 80% estriol, 10% estradiol, and 10% estrone. Only a few women may need supplemental estrone, which is the primary estrogen produced after menopause. Estrone is produced from hormone precursors in peripheral fat tissue, so it is typically reserved for underweight women or those of low normal weight.
• Progesterone
  Progesterone is a hormone commonly prescribed for women with too much estrogen relative to the level of progesterone produced by the body. Progesterone minimizes the stimulating effects of estrogen on coronary arteries, and when given alone or combined with estrogen, it may improve bone mineral density. Progesterone improves sleep, may increase libido, acts as a diuretic, lowers blood pressure, and improves the insulin-glucose balance to facilitate blood glucose control.
  Special note: “Progestins” are sometimes erroneously referred to as “progesterone.” A progestin is very different and is not a bioidentical hormone, it is a synthetic hormone made to mimic the effects of progesterone. Some practioners do not make the distinction between progestin and progesterone, which has caused much confusion. For example progestins are given to women to prevent pregnancy, whereas progesterone is used to assist fertility. The two could not be more different. Since progestins are foreign to a woman’s body, sometimes they create adverse effects on a woman’s brain, blood vessels, skin, heart and breast.
• DHEA is prescribed for women whose hormone profile as determined by saliva, blood or urine testing indicates a low level of DHEA. DHEA enhances libido, helps to build bone mass, lowers the levels of cholesterol and triglycerides, improves the sense of well-being, and increases alertness.
• Testosterone is prescribed for women deficient in that hormone. It can help to improve libido, help to build bone mass, improve mood and the sense of well-being, increase muscle mass and strength, lower levels of cholesterol and triglycerides, normalize blood glucose levels, and decrease body fat.

Hormones that are not bioidentical

These are hormones that include some that are natural  - to a horse - but not bio-chemically identical to a woman’s hormones.  Called conjugated equine estrogens, they are manufactured to “act like” human estrogens.  Premarin, made from the estrogens found in pregnant mare’s urine, is an example of this.  Many women experience side effects because the chemical structure does not match a woman’s biological hormone receptors.

Not derived from a natural substance and not bio chemically identical. Synthetic hormones were created by pharmaceutical companies to attempt to mimic the effects of female natural hormones. For example progestins, such as Provera, are not the same as progesterone, which is the natural female hormone. The difference between synthetic progestins and progesterone is very significant. For instance, progestins are given to women to prevent pregnancy, whereas progesterone is used to assist fertility. Since progestins are foreign to a woman’s body, sometimes they create adverse effects on a woman’s brain, blood vessels, skin, heart and breast. In selected cases however, they may be a necessary option.
In most cases, dr greenbean believes that if a woman needs to supplements her hormones she should work with her health care provider, and only if hormone treatment is needed, choose bioidentical hormones in appropriate physiological doses.