Natural Options for Hormone Replacement Therapy

By Ron Hunninghake, M.D.

There are approximately 30 million menopausal women in North America today. In addition, over 20 million baby boomers are waiting in the wings of near menopause. This represents a huge slice of our female population. Merely viewed as an estrogen market (as crass as that sounds) the current 12% using Premarin generated $700 million in sales in 1992!

Over 5000 plants have been shown to make progesterone identical to human progesterone.

From the purely human perspective, menopause is quite different from woman to woman. Many suffer no great emotional or physical discomforts. For others, the hot flashes are transient. But for the majority of women, menopause can mean several of the following symptoms: nocturnal hot flashes that disrupt sleep, vaginal atrophy and dryness that interfere with sexual function and urinary control, fluid retention, weight gain, poor libido, mood swings that go beyond simple irritability, even to the point of severe clinical depression and anxiety, headaches, fatigue, declining memory, loss of skin tone with more wrinkle formation, scalp hair thinning, facial hair growth, boney mineral loss (osteoporosis), body achiness, minor cardiac arrhythmia’s that are frightening, and a host of minor symptoms that seem overwhelming and disconcerting.

Conventional dogma is simple: menopause equates to estrogen deficiency. Estrogen is believed to maintain youthfulness in women (especially in the area of preventing vaginal mucosal atrophy), to prevent osteoporosis, to reduce the risk of coronary heart disease, and to carry a tolerable risk for breast cancer. In the minds of the vast majority of doctors, the benefits of estrogen outweigh its risks. The one exception to this is endometrial cancer. Here it has been shown that estrogen used alone carries an unacceptable risk. Hence the push in recent years for women to use progestins in combination with estrogen to reduce this risk.

The side effects of estrogen are often overlooked. Most physicians are simply unaware that estrogen, when not balanced with progesterone (the “other” female hormone) often causes excessive breast stimulation and pain, weight gain in the hip and thigh areas, salt and fluid retention, migraine headaches, depression, diminished thyroid function, enhanced risk for blood clot formation, decreased libido, impaired blood sugar control, loss of zinc and retention of excessive copper, and relatively poor osteoclast restraint (these are the bone cells that break down bone and contribute to osteoporosis.) Many, if not most of these side effects of estrogen, can be controlled with progesterone.

Another major misconception in the medical mind is that progestins are progesterone. More and more physicians are using Provera and other synthetic progestins in an attempt to obviate the side effects of “unopposed estrogen.” However, the synthetic analogs to natural progesterone have their own list (and a rather long one at that) of side effects. Any woman taking a synthetic progestin would be wise to ask her pharmacist for a copy of the package insert that outlines these significant side effects. Natural progesterone, as it occurs in the human body, has none of these undesirable effects.

The benefits of natural progesterone are quite striking. Progesterone has been shown to protect against fibrocystic breast symptoms; it promotes thyroid hormone function and fat burning in the body; it has diuretic and anti-depressant properties; blood clotting mechanisms are normalized by it, as are blood sugar levels; libido is restored; the endometrium is healthier with progesterone; endometrial and breast cancer risks are lowered; osteoblast (the bone cells that build bone) are stimulated; it is a precursor to corticosterone production and facilitates better stress management; and zinc and copper levels get normalized by it.

Estrogen and progesterone function in the body antagonistically. This does not mean one is “good” and the other “bad”. As with most hormonal control mechanisms, there needs to be a balance. Estrogen is harmful when it takes on a dominance that diminishes the natural balance it normally has with progesterone. Many of the severe symptoms of menopause begin occurring several years prior to cessation of ovarian function. This is due to the premature cessation of ovulation. Without ovulation, no progesterone is made. Anovulatory cycles are characterized by estrogen dominance, and are associated with all the symptoms mentioned above under estrogen side effects. One author called this peri-menopausal time
period “perpetual PMS.”

Because estrogen can be made in the adrenals and synthesized from progesterone, a natural alternative to synthetic estrogen and progestin replacement therapy is natural progesterone. Over 5000 plants have been shown to make progesterone identical to human progesterone. One plant, the wild yam, is exceptionally high in natural progesterone. Dr. John Lee, a family physician from California, began using topical wild yam extract with his menopausal patients over 15 years ago. (Note: orally consumed yam extract is largely deactivated by the first pass effect of the liver.) He has written a wonderfully lucid book, What Your Doctor May Not Have Told You About Menopause, that carefully outlines this most difficult topic. The book is worth its cost just for the more thorough understanding it gives on the cooperative nature of female hormones.

The use of wild yam extract topically has been met with extreme suspicion and frank hostility by many physicians. Women who have tried it and found it to be effective, are put in a very uncomfortable position. Their physicians, feeling the professional and medical-legal burden of abiding by the standards of the day, are unwilling to condone the use of a natural substance that they feel is under-researched and non-regulated in its content. Women who have suffered the side effects of synthetic therapy and found the natural alternatives to work better, with no or minimal side effects, feel the obligation to follow their body’s dictates. Throw this into the sociologic environment created by the consumer and feminist movements and it all adds up to a rather complicated situation.

In the final analysis however, we each bear the ultimate responsibility for our health. The best advice includes: follow the “buyer beware” attitude when it comes to natural progesterone creams and other natural alternatives. Maintain an open dialogue with your primary care physician. Practice good lifestyle choices, which are agreed to by both sides of the issue. Try out the alternatives while using the conventional methods of assessment (such as regular pelviC and pap exams, bone density measurements, consultations with experts, etc.) in order to maintain a standard of objective honesty. Bottom line: safety first!