A number of methods available for treating menopausal symptoms are considered 'natural'. They include maintaining a healthy lifestyle through diet, exercise and stress reduction; the use of herbal medicines like dong quai, black cohosh and licorice; and the use of phytoestrogen (plant) products which contain flavones. While many women find these natural therapies helpful, they are not the same as natural Hormone Replacement Therapy (HRT).

Even though natural therapies are healthy choices and sound practices, it is important to remember that diet and exercise do not raise hormone levels. The only way to truly impact hormone levels is to take hormones.

For many years conventional HRT has consisted of a standard prescription of hormones - most commonly

0.625 mg of Premarin® (animal-derived) and 2.5 mg of Provera® (synthetic). Premarin is a combination of estrogens derived from the urine of pregnant mares. Provera is synthesized in the laboratory from natural progesterone, then modified for reasons of product patenting.

As women seek education about options available to them as they enter menopause, and as their demand for more natural products increases, a ripple effect has been created throughout the pharmaceutical industry. The result has been a number of new natural, bio-identical pharmaceutical products

What are Natural Hormones?

Natural hormones are derived from chemical precursors found in plants. Soybeans and wild yams are the most common sources of these chemicals. For a soy or yam precursor to be converted into a hormone, it must be done in a laboratory. Therefore, natural hormones, like their synthetic and animal-derived counterparts, can be pharmaceutical compounds.

Natural hormones are identical in molecular structure to the hormones the body makes, thus they are called bio-identical. When a bio-identical hormone circulates through your system and binds with a receptor, the fit is the same as if your body had produced that hormone.

Animal-derived and synthetic hormones are similar to human hormones, but they do not have the same molecular structure. When one of these binds with its receptor, the fit is not exact, sometimes resulting in side effects. Natural hormones have been growing in popularity because they are very effective and often without the side effects that can come with the use of synthetic or animal-derived hormones.

The Estrogens

By definition, estrogen is not a single hormone; it is a category of hormones which includes estradiol, estrone and estriol. The one most commonly used in the treatment of menopausal symptoms is estradiol, but estrone and estriol are also prescribed.

Progesterone

In the natural form, progesterone is identical to what a woman's body produces every month. Synthetic progestins such as those found in oral contraceptives, on the other hand, can suppress ovulation and lower the body's output of the natural hormone. Synthetic progestins often intensify, rather than relieve, PMS symptoms. Natural progesterone and synthetic progestins cannot be used interchangeably." Most often, progesterone is prescribed to be taken during the second half of the menstrual cycle, from ovulation until menstruation begins. Some people think "natural" progesterone is an herbal or organic substance, something you would buy in a health food store. It isn't. Natural progesterone is a highly purified, quality pharmaceutical preparation derived from soy that is regulated by the Food and Drug Administration (FDA). It is a prescription drug that must be individually compounded by a pharmacist.

Combination Products

The commercial combination products, Prempro® and Premphase® combine Premarin and Provera. To date, there are no pharmaceutically manufactured combination products of estradiol and natural progesterone, however bio-identical estrogen products can be formulated by a compounding pharmacy to include progesterone. Tri-Est and Bi-Est are natural estrogen combination products. Tri-Est is a combination of estradiol, estrone, and estriol. It comes in a 10-10-80% formulation that is designed to match the body's ratio of each hormone and can be prepared by a compounding pharmacy in oral, gel, and cream forms. Bi-Est is a similar product but does not include estrone and is 20% estradiol and 80% estriol. More and more women are using Bi-Est because it does not contain estrone (already plentiful in postmenopausal women) and because there is some research to indicate that estriol is the weaker and safer form of estrogen. Both Bi-Est and estriol alone can be formulated into a vaginal cream. Because of the numerous estradiol receptors in the vagina, these products work well addressing vaginal atrophy and incontinence.

Testosterone

Until recently, the only commercial testosterone products available contained methyltestosterone, a synthetic form of testosterone, in dosages only appropriate for men. Current studies, however, clearly show that testosterone is also an important hormone for women. Now, because of its increased popularity, there has been a rush by both pharmaceutical companies and compounding pharmacies to meet the demand. The estradiol-testosterone combination patch Estratest® provides dosages appropriate for women, but does not contain natural, bio-identical testosterone. Presently, bio-identical testosterone can only be purchased from compounding pharmacies, formulated as tablets, capsules, creams, gels, or sublinguals.