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What are natural hormones?

Cathy's friend Susan thinks she is not at risk for side effects from menopausal hormone therapy because she uses "natural hormones" to treat her hot flashes and night sweats. Cathy asked her doctor about them.

The natural hormones Susan uses are estrogen and progesterone made from plants such as soy or yams. Some people also call them bioidentical hormones because they are supposed to be chemically the same as the hormones naturally made by a woman's body. So-called natural hormones are put together(compounded)by a compounding pharmacist. This pharmacist follows a formula decided on by your doctor.

Drug companies also make estrogens and progesterone from plants like soy and yams. Some of these are also chemically identical to the hormones made by your body. You get these from any pharmacy with a prescription from your doctor.

One difference between the natural hormones prepared by a compounding pharmacist and those made by a drug company is that the compounded natural hormones are not regulated and approved by the U.S. Food and Drug Administration (FDA). So, we don't know much about how safe or effective they are or how the quality varies from batch to batch. Hormones made by drug companies are regulated and approved by the FDA.

There are also "natural" treatments for the symptoms of menopause that are available over-the-counter, without a prescription. Some of these are also made from soy or yams. They are not regulated or approved by the FDA.

Cathy's doctor told her that there is very little reliable scientific information from clinical trials about the safety of bioidentical hormones, how well they control the symptoms of menopause, and whether they are as good or better to use than FDA-approved estrogens, progesterone, and progestins.

What's right for me?

There is no "one size fits all" answer for all women who are trying to decide whether to use menopausal hormone therapy (MHT). You have to look at your own needs and weigh your own risks.

Ask yourself and your doctor these questions: How much are you bothered by menopausal symptoms such as hot flashes or vaginal dryness? Like many women your hot flashes or night sweats will likely go away over time, but vaginal dryness may not. MHT can help if your symptoms are troubling you.

Are you at risk for developing osteoporosis? Estrogen might protect bone mass while you use it. However, there are other drugs that can protect your bones without the same risks as MHT.

Do you have a history of heart disease? Using estrogen and progestin can increase your risk. Do you or others in your family have a history of breast cancer? If you have a family history of breast cancer, check with your doctor about your risk.

Do you have a history of gall bladder disease or high levels of triglycerides? Some experts think that using a patch will not make your triglyceride (a type of fat in the blood)level go up or increase your chance of gall bladder problems. Using an estrogen pill might.

Do you have liver disease or a history of stroke or blood clots in your veins? MHT might not be safe for you to use.

Are you over age 65 and thinking about using MHT to prevent dementia? Estrogen and progestin could actually increase your risk of dementia. Estrogen alone might do that also.

Then, like Cathy, talk to your doctor about how best to treat or prevent your symptoms or the diseases for which you are at risk. Ask about your other choices. Remember, these too may have risks and benefits. If you decide to use MHT, the FDA suggests that you use the lowest dose that works for the shortest time needed.

If you are already using menopausal hormone therapy and think you would like to stop, first ask your health care provider how to do that. Some doctors suggest tapering off slowly.

Whatever decision you make now about using MHT is not final. You can start or end the treatment at any time. If you stop, your risks will probably lessen over time, but so will the protection. Discuss your decision about menopausal hormone therapy each year with your doctor at your annual checkup.

Unanswered Questions

Don't forget at your checkup to ask your doctor about any new study results. Research on menopause is ongoing. Scientists are looking for answers to questions such as:

• How long can a woman safely use menopausal hormone therapy?
• Are some types of estrogen or progesterone safer than others?
• Is one form of hormone therapy (patch, pill, or cream, for example) better than another?
• Is MHT safer if you start it around the time of menopause instead of when you are older?

For now, we know that each woman is different, and the decision for each one will probably also be different. But, almost every study gives women and their doctors more information to answer the question: Is menopausal hormone therapy right for me?

Tags: Menopause

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NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.