Welcome to part 2 of my menopause series! My passion is to educate and empower women to understand menopause allowing you to take control of your life as your body changes. In part 1 of the series “What is Happening to Me?” we looked at what is happening to your body. Do you ever get overwhelmed when thinking about hormones and menopause? You are not alone, each day confused and overwhelmed women ask me for answers regarding the decision about whether and how to treat your symptoms throughout menopause.
There is a lot of confusion about hormone options and the basic, take home message is that every woman must find a knowledgeable, informed health-care provider to dialogue about individual choices. Your menopause is yours. Don’t let entrepreneurs and celebrities determine what you put into or onto your body.
Historically, women have been using hormonal therapies from before they even lived long enough to experience menopause. Thinking that it would promote youthfulness and vigor, women utilized regimes from female or male urine, crushed tissue or fluid from animal ovaries and, eventually, more commercial preparations. The first “bio-identical” hormone, extracted from the urine of pregnant women was discovered in 1928 by a German chemist, winning him a Nobel Prize. Mass production of hormone preparations were soon developed in 1942 using pregnant mare urine, happily reducing the inconvenience to all those pregnant women having to donate their pee in a bottle.
Present day, women spend about one third of their lives menopausal and major advancements in hormone production began in the 1950s and 60s culminating in ERT (estrogen replacement therapy). Estrogen was initially only available from an animal source but soon Diosgenin and Stigmasterol were isolated from yam, cactus and soy plants. Diosgenin undergoes synthetic processing in a chemistry lab to become all of the bio-identical hormones we know today (estradiol, estrone, estriol, testosterone, progesterone, DHEA, cortisol). Yes, “synthetic processing”! This raises some important points that must be clarified about hormones in order to help menopausal women negotiate the aggressive commercial marketing of these products and make informed choices.
Natural means any product produced directly from an animal, plant or mineral source. When something is described as “natural”, it is not automatically safe or even closely resembling anything found in the human body. An example of a natural estrogen is Premarin (from PREgnant MARe urINe).
Bio-identical does not mean natural. The term bio-identical simply refers to the shape of the molecule and the way it fits into the body’s receptors (like a key into a keyhole). In the case of bio-identical estrogen, it started from a plant source but has undergone synthetic processing to be made structurally identical to estrogen found in women. This makes sense since we don’t find human hormones in plants (that would be weird!). An example of bio-identical estrogen is Estrace (estradiol). All bio-identical hormones are derived from Diosgenin or Stigmasterol and this is true whether it is an FDA-approved pharmaceutical version or a “custom-compounded” product.
Bio-identical is not the same as custom-compounded. The term “custom-compounded” refers to the way a pharmacist (as opposed to a commercial pharmaceutical company), blends hormones into a product for sale. These compounded products seem to be in vogue lately but there is no evidence that they offer fewer side effects, safer alternatives or more effective formulations than the ones blended by pharmaceutical companies. In fact, compounding pharmacies and the products they offer are not routinely FDA-approved, supervised or regulated. While this does not make them unsafe (recall these products are made from the very same ingredients as commercially available hormones), safety and efficacy testing has not been performed and package labeling can be incomplete with respect to declaration of potential side effects and risks. Two examples of compounded products are BiEst and TriEst.
So, what should YOU take? While I would prefer to have a personal conversation before recommending a regime, I will summarize what we know to be true below:
If you have no contraindications to hormones (check with your provider on this), and you have systemic symptoms that make you feel like you need to take medications (see part 1), I recommend starting a low dose estrogen formulation by mouth (oral) or applied to the skin (transdermal). I recommend FDA-approved, bio-identical hormones as extensive amounts of literature available (see part 3) had deemed them safe and effective and most women prefer a plant over an animal source, however, both will work fine. If you have a uterus, progesterone must be added to protect the uterine lining from thickening in response to the estrogen. For convenience, the estrogen and progesterone have been combined in some products.
If your main symptoms are urogenital (bladder and vagina), I recommend a vaginal cream, tablet or ring.
If you missed part 1 of the series “Menopause, What is happening to me?” please read here . Through sharing this important Menopause series my goal is to educate, inform and equip you to experience menopause gracefully. Please email or reach out to me on social media and let me know how I can best support you by answering questions or by being here for you.
Next week we will look at “Hormones: The Good The Bad and The Ugly!”
Be well and take care or you this week!