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Bio-Identical Hormones: Pros and Cons

pretty blond haired woman Recently, a 52 year old woman came to my office complaining of hot flashes, night sweats, moodiness, depression, apathy, fatigue and weight gain in her abdomen. She said, “I just don’t feel like myself anymore. Am I just getting older or is it my hormones?”

In the U.S. approximately 2 million women reach Menopause ever year. It is estimated that 75% of all women in the U.S. suffer moderate to severe symptoms of Menopause, including hot flashes, night sweats, cold chills, sleeplessness, fatigue, lethargy, decreased sex drive, roller-coaster mood swings, anxiety, irritability, depression, tearfulness, apathy, mental fogginess, difficulty concentrating, confusion, memory loss, vaginal dryness, incontinence, weight gain, thinning skin, osteoporosis, and more.

Fortunately, women are now learning that these symptoms are not merely trivial or vain symptoms that they have to live with. They are signs of hormonal imbalance that will likely lead to osteoporosis, heart disease, or cancer if left untreated.

Women don’t have to suffer with the symptoms of menopause or resort to taking harmful synthetic drugs. They now have a choice, they can take Bio-Identical Hormones, which are safe and effective natural alternatives to synthetic Estrogen and Progestin.

What Are Bio-Identical Hormones?

Bio-Identical Hormones are hormones compounded by pharmacists from natural plant extracts. They are virtually identical to the naturally occurring hormones made by the body, including the three estrogens: estrone, estradiol and estriol, as well as progesterone, pregnenolone, testosterone, DHEA and cortisol.

Because they are identical to what the body makes they are not associated with the severe list of side-effects associated with synthetic hormones.

Because Bio-Identical Hormones come from plants they cannot be patented. In essence, God holds the patent to these plant based hormones. That is the only reason drug companies don’t make them. Without a patent, there is no market exclusivity and hence no financial incentive to bring the product to market.

Which Hormones Should You Take and What is the Best Way to Take Them?

You want to make sure that you avoid Estradiol completely because it has significant cancer causing activity. Estriol, on the other hand provides all of the same benefits but has anti-cancer activity. To balance your hormones you need to take a balanced amount of three key hormones: Estriol, Progesterone and Testosterone.

There are several different ways, or delivery methods, to take these hormones. The best of all is to take a Sublingual, or under the tongue, dose. This allows the hormone to be absorbed rapidly and directly into the blood stream without going to the stomach and liver where it would be metabolized and 80% would be lost before it would get to the blood stream.

Unfortunately, Pellets, the method that may be the most convenient is the worst way to take Bio-Identical hormones. This method uses Estradiol, the cancer causing hormone, because Estriol, the safe estrogen, is metabolized too quickly to last more than a few hours or days. Additionally, the pellets must be sterilized before they can be surgically implanted under the skin. The only two FDA approved methods of sterilization are Gamma Irradiation, which could leave trace amounts of radioactivity in the pellets, or the chemical Ethylene Oxide, which is known to be toxic to brain and nerve tissue.

I recommend using the Sublingual dosing, because it is safe and can be individually adjusted to each patient and changed easily if needed. Compare the various methods below.

Oral Pills (Capsules or Tablets that are Swallowed)
Pros: Convenient Cons: Poor Absorption (only 20%)
80% processed by the liver
Creams and Patches
Pros: No pills to swallow Cons: Inconvenient
Pellets (Implants) Cons: Surgery
Pros: Long lasting Risky
Estradiol (E2) –> Cancer
No Progesterone
Sublingual Pills (Dissolved under the Tongue)
Pros: High Absorption Cons: Requires daily dosing
Fast acting
Estriol (E3)  Anti-Cancer
Dose easy to change

What are Synthetic Hormones?

Synthetic hormones, on the other hand, are altered copies of the body’s naturally occurring hormones. They must be altered in order to qualify for a patent. The chemical structure of these drugs must be altered slightly in order to create a unique chemical not found anywhere else on earth so that it can qualify for a patent.

This altered uniqueness is the distinguishing factor that qualifies them for a patent. The unique chemical structure is similar enough to the original hormone to allow a similar action but unfortunately it is dissimilar enough to cause harmful side-effects.

Synthetic HRT Research

In 2002, the Women’s Health Initiative found that a combination of two synthetic estrogens (estrone and estradiol) plus synthetic progesterone, made by Wyeth Pharmaceuticals, increased a women’s risk of breast cancer by 26%, her risk of a heart attack by 29%, her risk of stroke by 41% and her risk of blood clots by 113%. (Source: JAMA. 2002;288:321-333).

In February, 2009, a study published in the New England Journal of Medicine, found that women who take synthetic estrogen-progestin combination hormone therapy for more than five years suffer a doubling of their risk of getting breast cancer and the risk doubles again every additional twelve months they continue to take the drugs. (N Engl J Med. 2009 Feb 5;360(6):573-87)

Is Natural Always Better?

The quantity and balance of the natural hormones prescribed determines whether or not the therapy is safe. Many women get cancer of the breast, ovaries, or uterus from an imbalanced or excessive production of their own natural Estrone and Estradiol production.

Likewise, the prescription of natural hormones can cause harm if not balanced. Natural, Bio-Identical Estradiol should never be given without also giving natural, Bio-Identical Estriol and Progesterone in order to maintain a woman’s healthy balance.

Just because a hormone is natural, or bio-identical to the body’s own hormones, does not necessarily mean it is safe. Wyeth claims that Premarin is natural. It is extracted from pregnant horse’s urine. It is natural for a horse, but not a woman.

Drug Companies Copied the wrong Estrogens

The drug companies that made the first estrogen drugs copied the wrong estrogens. They copied the two most concentrated estrogens: Estrone and Estradiol.

This made sense from a production standpoint but not from a safety standpoint. Estrone and Estradiol are 1000 times more potent than Estriol. For this reason Estriol was initially thought of as a weak estrogen.

However, nature puts all three estrogens together for a good reason. Estriol protects the body from developing cancer. If your body has enough Estriol it will prevent the other two more potent estrogens from stimulating the breast and uterus where they tend to cause cancer.

Estriol selectively binds to estrogen receptor-beta (ER-beta), which inhibits breast cell proliferation and prevents breast cancer development. (Source: Postgraduate medicine, Vol 121, Issue 1, January 2009; Endocrinology. 2006 Sep;147(9):4132-50. Epub 2006 May 25.)

The pharmaceutical scientists made a mistake by underestimating the wisdom of nature’s hormone balance and synergy and ignored Estriol because they considered it a weak estrogen.

Are Bio-Identical Hormones Proven Safe?

There are several good studies on the safety and efficacy of bio-identical hormones, including one large-scale study of 54,548 postmenopausal women that compared the risks associated with synthetic and bio-identical hormones.

For this reason I recommend testing before and after dosing to make sure your levels are optimal. Click here for more information on hormone testing.

Bio-identical hormones have been used in Europe for almost fifty years. Since bio-identical hormones are available in relatively inexpensive generic forms that can be applied using non-patentable formulations by a compounding pharmacist, American drug companies have no interest in sponsoring studies on the safety and efficacy of bio-identical hormones.


Bio-Identical Hormone Research

In 2005 the Fournier E3N- European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study published in the International Journal of Cancer followed 54,548 postmenopausal women who had not been on any kind of HRT for at least a year before entering the study. The average age was 53, and the study lasted for almost 6 years.

Compared to women who had never used HRT, taking Bio-Identical Estriol alone produced a 30% reduced risk of breast cancer; using Bio-Identical Estradiol plus natural progesterone lead to a 10% decreased risk of breast cancer; while using estradiol alone had a 10% increased risk of breast cancer and worst of all, taking estradiol plus synthetic progestins caused a 40% increased risk of breast cancer.

(Source: Fournier et al, “Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort,” Int J Cancer 2005 Apr 10;114(3):448-54.)

In January 2008, with eight years of follow-up, data was released from E3N showing that women using synthetic HRT had a 60% higher risk of cancer, while women using Bio-Identical Hormones still had the same risk as women using no HRT of any kind.

(Source: Fournier et al, “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study,” Breast Cancer Res Treat 2008 Jan;107(1):103-11.)

Estriol selectively binds to estrogen receptor-beta (ER-beta), which inhibits breast cell proliferation and prevents breast cancer development. (Source: Postgraduate medicine, Vol 121, Issue 1, January 2009; Endocrinology. 2006 Sep;147(9):4132-50. Epub 2006 May 25.)

Progesterone and Cancer

Progesterone increases the Tumor Suppressor Protein known as p53, which activates DNA repair and initiates programmed cell death (apoptosis) when DNA damage is irreparable. Additionally, it decreases the cancer activating protein known as bcl-2.

Estradiol, on the other hand, does the opposite of progesterone. It causes a decrease in p53 and activates bcl-2, which promotes cancer cell growth.

(Source: Ann Clin Lab Sci. 1998 Nov-Dec;28(6):360-9; Int J Cancer. 2003 Jul 10;105(5):607-12)

BHRT is a Safe and Effective Choice for Postmenopausal Women

European Prospective Investigation into Cancer and Nutrition (EPIC) Studies have been ignored in the United States. These studies reveal that Synthetic Hormone Therapy causes cancer, while the Bio-Identical Hormones Estriol and Progesterone have been shown to reduce Breast Cancer risk.

These studies appear to be ignored in the U.S. because Bio-Identical Hormones cannot be patented and therefore are of no interest to pharmaceutical drug companies.

Bio-Identical Estriol and Progesterone provide postmenopausal women with safe and effective natural alternatives to synthetic Hormone Therapy. The addition of Testosterone adds even more synergistic benefits. For more information about Testosterone’s benefits, click here.

Estriol is the Key Estrogen

Avoid Estradiol entirely. Estriol is the only safe Estrogen to supplement. It is a mild estrogen that has been used in Europe for 30 years. Its safety and effectiveness are well established. Many doctors in the U.S. who use natural hormones prescribe Estriol plus natural progesterone to balance the hormones and stop the symptoms of menopause.

Here’s what the medical literature states about Ovestin, a natural, Bio-Identical Estriol made in Europe: “Ovestin contains the natural hormone Estriol, which is a weak estrogen. Unlike other estrogens, estriol is short-acting since it has only a short retention time in the nuclei of endometrial cells.

Estriol prevents hot flashes, bone loss, thinning of the skin and vaginal membranes yet it is 1000 times less stimulating to the breast tissue than is Estradiol. Not only does it NOT promote breast cancer, but considerable evidence indicates that it may protect against and reverse breast cancer.

According to an unpublished study by Lemon, Foley, and Kessinger, “2.5 to 5 mg and occasionally 15 mg of estriol, equivalent to a little more than 0.625 to 1.25 mg of conjugated estrogens and estradiol) was used, with the informed consent of patients, in postmenopausal women with breast carcinoma and metastases. Thirty-seven percent receiving this small dosage had remission or arrest of metastatic lesions.”

Estriol does not induce excessive build-up of the endometrial lining of the uterus. Hence it does not cause a risk of uterine cancer or withdrawal bleedings.

In addition to treatment of hot flashes, mood swings, and other common symptoms of menopause, Estriol is particularly effective in the treatment of vaginal and urinary symptoms.

In case of atrophy of the vaginal tissue Estriol induces the normalization of the urogenital epithelium and helps to restore the normal microflora and the physiological pH in the vagina.

As a result, it increases the resistance of the urogenital epithelial cells to infection and inflammation reducing vaginal complaints such as painful intercourse, dryness, itching, vaginal and urinary infections, pain on urination and mild urinary incontinence.

What does Dr. Hansen Prescribe to his Patients for Menopause?

The first thing that I do for my patients with symptoms of menopause is to test their individual hormone levels. Balance is the key to optimal health and vitality.

We need to know the starting level of all of the key hormones including Estrone, Estradiol, and Estriol, as well as Progesterone, Pregnenolone, Testosterone, DHEA, Cortisol and Thyroid.

Once your levels are determined the correct dose can be chosen for your individual case. it typically takes 1-3 weeks to get the hormone levels back to more optimal levels and get you feeling like yourself again. Or, better yet, some patients say Bio-Identical Hormone Replacement Therapy makes them feel better than they have ever felt before. they feel happier, healthier, stronger, clearer, sharper and more alive than they have ever felt before.

This entry was posted in Bio-Identical Hormones, Estradiol (E2), Estriol, Featured Topic, Female Health, Hormones, Menopause, Progesterone, Testosterone. Bookmark the permalink.

One Response to Bio-Identical Hormones: Pros and Cons

  1. Michelle says:

    I live in Green valley, AZ. I am a 56 year female and I am interested in talking to you about Bio-Identicals. How can I reach you and do you schedule appointments? Thank you.

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