You’re probably most familiar with the steroid hormones progesterone, dehydroepiandrosterone (DHEA), the cortisones, the estrogens, and testosterone. All of these hormones are made from a hormone called pregnenolone, which is made from cholesterol. This is why the myth that all cholesterol is bad is a dangerous one. While your body can manufacture 75 percent of its own cholesterol, the remaining 25 percent comes directly from cholesterol that you eat. Cut out all cholesterol, and you’re asking for a hormone imbalance.
When you drink a glass of juice, your blood sugar rises, and the hormone insulin, secreted by the pancreas, is required to bring it back down by ushering it into your cells. Thyroid hormones, which regulate how the body uses energy, are secreted by the thyroid gland in the neck. Adrenaline, the cortisones, and DHEA are a few of the hormones secreted by the adrenal glands. Your brain secretes the hormone melatonin in response to darkness, but it’s also found in larger quantities in your intestines. Vitamin D, believe it or not, is really a hormone that regulates (among other things) how your bones take up minerals.
Your hormone or endocrine system is actually a group of systems that work via circulation. Hormones are secreted by glands into the bloodstream as the body demands them. For example, when you exercise, you use glucose, which your body can replace by activating cortisol, a hormone that allows you to manufacture more glucose in your liver. As these specialized molecules pass through the body, they are recognized by receptors on cells that fit them like a lock and key. Once the hormone locks on to the receptor, it causes the cell to behave in a generally predictable way. For example, some estrogens can stimulate cell growth and testosterone can stimulate the growth of facial hair.
There are many ways your hormone systems can be thrown out of balance, which will in turn throw your health out of balance. Symptoms may be subtle or blatant. Chronic stress can cause the constant release of cortisol and adrenaline, hormones that were originally designed for occasional use only, under highly stressful circumstances such as hunting a woolly mammoth or fighting a bear for a cave. Routine exposure to bright lights late into the night has most likely thrown our melatonin levels out of balance. Environmental pollution is contributing to hormone imbalance, thanks to plastics and pesticides with molecules that resemble estrogen and fit into estrogen receptors, stimulating an estrogen-like response in the body. The millions of women who have undergone hysterectomies are plunged into instant hormone imbalance, even if their ovaries are intact. Nutritional deficiencies, which are widespread in the United States, especially among the elderly, can cause glands to atrophy and malfunction.
In an ideal world, we wouldn’t need supplemental hormones. But because our environment is less than ideal, small amounts of natural hormone supplements can be safely used to help our bodies function optimally. Physiologic dosages of hormones are very small, just enough to restore balance. They are approximations of what the body itself would secrete under ideal conditions, and they are much safer and work better than pharmacologic doses, which are usually many times more than what the body would make itself.
The typical medical model advocates the “more is better” philosophy. In the case of hormones, this approach not only is ineffective but also can be counterproductive and harmful. Hormones are powerful agents designed for very specific use. The use of pharmacologic dosing (often with synthetic versions of the natural hormones our bodies make) has a lot to do with the negative outcomes in many medical studies of hormone replacement. The following recommendations for hormone supplementation involve only physiologic doses of the natural hormone.
What’s Wrong with Synthetic Hormones?
Synthetic, not-found-in-nature hormones do not behave the same way in the body as natural or bioidentical hormones. A synthetic drug isn’t one that was made in a lab, because they all are (most vitamins are, too); it is one that is not found in nature. Drug companies prefer that you take synthetic hormones not because they are better for you, but because they can be patented, so the companies can charge you more for them.
A natural substance cannot be patented, so drug company scientists take a perfectly good natural substance into the lab and add a methyl group here, an acetate group there, and voilà! They have created a drug that has many of the same effects as the natural substance but can be patented. Nowhere is there a better example of how tragically awry this practice has gone than in the realm of hormones.
John R. Lee, M.D., a pioneer in the use of natural progesterone cream, used to tell a story about a package he received in the mail from a woman who sent him copies of her medical charts and a letter pleading for help. Her physician had put her on a progestin (a synthetic progesterone) and then a few months later had taken her blood and measured her progesterone levels. According to her blood test, her progesterone levels hadn’t risen at all, so he increased the dose of progestins. A few months later, the lab test still didn’t measure any progesterone. Meanwhile, the woman was suffering terribly from the side effects of the progestin.
Dr. Lee pointed out to her that her physician was giving her a progestin but measuring for progesterone; since they aren’t the same, of course it didn’t show up on her blood tests! This confusion is rampant throughout the medical literature, where even in the most prestigious medical journals the terms progesterone and progestin are used interchangeably, and whole theories are advanced on the basis that testing one is the same as testing the other. The real victims of this mistaken identity are the women who are prescribed progestins. Thankfully, the research and medical communities are starting to become more aware and educated about natural hormones, and these errors are increasingly rare.
In case your physician wants to argue with you that progestins and progesterone are the same, you might remind him or her that progesterone is the first and foremost hormone necessary for a healthy pregnancy, while progestins taken during pregnancy can cause birth defects. Progestins almost universally make women feel awful, while progesterone almost universally makes women (who need it) feel better.
Synthetic estrogens aren’t any better. For a while, the makers of Premarin were trying to convince women that the synthetic Premarin is a natural estrogen because part of it is made from the urine of pregnant mares. Horse estrogen is natural if you’re a horse, but it’s not natural if you’re a human. There are actually several different types of estrogens, and horses have estrogens in their bodies that are unique to horses but foreign to the human body. Other estrogens appear in both horse and human urine, but the levels are very different. The relationship between the levels of the three human estrogens—estriol, estrone, and estradiol—in a woman’s body makes a big difference in how she feels and in her state of health. A healthy young woman’s ovaries make about 10 times more estriol, a weaker form of estrogen that doesn’t promote cancer, than it does the stronger versions, estradiol and estrone. In estrogen derived from horse urine, estriol comprises a bit less than 50 percent of the total estrogen content, with an estrogen unique to horses comprising 22 percent and several other fairly strong estrogens making up the rest.
Marla Ahlgrimm, R.Ph., a pharmacist who specializes in providing individualized natural hormone combination creams, has noticed that women taking Premarin suffer more from breast tenderness, water retention, and high blood pressure than those taking natural estrogen.
From the mid-1980s, the use of combined estrogens and progestins for hormone replacement therapy (HRT) increased steadily. Women and their doctors believed—and many still believe today, despite powerful evidence to the contrary—that it is the only answer for uncomfortable menopausal symptoms. Physicians also believed for much of that time that HRT would protect women against heart attacks and osteoporosis without increasing their risks of breast cancer. Some studies showed that colon cancer and ovarian cancer risks were reduced by HRT. In the year 2000, approximately 38 percent of postmenopausal women in the United States were using HRT, usually made up of Premarin and some form of synthetic progestin.
It took a gr
oundbreaking study published in the Journal of the American Medical Association to get the attention of conventional medicine. In 2001, the results of the large Women’s Health Initiative (WHI), conducted by the government’s National Institutes of Health (NIH), were made public. This study involved 16,601 healthy post-menopausal women and was stopped prematurely after five years (three years early) because it had become obvious that the risks of the study drug (Prempro and combination of Premarin and a progestin) far exceeded its benefits. After five years, those using the HRT had a 29 percent higher risk of breast cancer, a 26 percent higher risk of heart disease, and a 41 percent higher risk of stroke. Risk of colon cancer dropped by 36 percent and risk of hip fracture dropped by 24 percent, but these positive results were outweighed by the negatives. Most of these adverse events began to appear within two years of the study’s beginning, with the breast cancer diagnoses appearing at about three years into the study. Since the WHI was published, millions of women have stopped their conventional HRT, and many have turned to natural or bioidentical hormones.
If at all possible, please avoid long-term use of birth control pills, which are also made from synthetic hormones. They suppress ovulation and increase the risk of stroke and breast cancer. It’s just not worth it when so many other forms of birth control are available. Newer forms of hormonal birth control such as vaginal rings (NuvaRing), IUDs (Mirena), patches, and injections contain the same harmful synthetic progestins and/or estrogens found in conventional HRT and found by the WHI to be so harmful to so many women.
Methyltestosterone, a synthetic version of testosterone, has a long list of side effects that natural testosterone doesn’t have.
When it comes to HRT, there doesn’t seem to be any reason why anybody, anytime, would use synthetic hormones instead of natural hormones. It just doesn’t make sense if your goal is optimal health.
Although most of the natural hormones are available by prescription, some are available over the counter. Only the most commonly used synthetic hormones are listed in the following section on replacement hormones. More important is the section “Using Natural Hormones,” where you can learn about taking natural hormones.
Replacement Hormones
Examples of Estrogens
Synthetic estrogens: conjugated estrogen (Pre-marin), conjugated estrogen with a progestin (Prempro), estropipate (Ortho-Est, Ogen), ethinyl estradiol with a progestin (FemHRT), estradiol with a progestin (Activella)
Natural estrogens: estradiol patches (Alora, Climara, Vivelle, Estraderm), estradiol creams (Estrace), estradiol and estriol cream (Bi-Est), estradiol pills (Estrace), estradiol vaginal (Estring, Femring, Vagifem)
What Do They Do in the Body? Natural estrogens have dozens of effects on the body, including the development and maintenance of female sex characteristics such as the ovaries, uterus, and breasts. Estrogens given as HRT during menopause may relieve hot flashes, night sweats, and vaginal dryness.
What Are They Prescribed For? For HRT, usually for menopausal women and women who have had a hysterectomy. Many forms of birth control contain synthetic estrogens. See the following section on birth control. Estrogens are prescribed for the symptoms of menopause, including hot flashes, night sweats, and vaginal dryness.
What Are the Possible Side Effects? Natural estrogens given in small amounts and in balance with progesterone to menopausal women have few, if any, side effects. However, the synthetic estrogens, estrogens in high doses, and estrogens without progesterone can cause water retention, headaches (including migraines), irritability, mood swings, depression, fatigue, lack of libido, breast tenderness, breast and uterine cancer, gallbladder disease, strokes (they reduce vascular tone and strength), increased blood pressure, low thyroid function, cervical dysplasia, breakthrough bleeding, vision problems, asthma, premenstrual syndrome (PMS), and low cellular oxygen levels.
CAUTION!
Please avoid the synthetic estrogens altogether, and use natural estrogens: estradiol, estriol, and estrone.
What Nutrients Do They Throw out of Balance or Interact With? Excess estrogens and synthetic estrogens can block the action of thyroid hormone, leading to low thyroid symptoms with normal thyroid test results. Excess estrogens and synthetic estrogens also increase sodium retention, which causes water retention or bloating.
Excess estrogens and synthetic estrogens cause depletion of the B vitamins in general, but especially of folic acid and vitamin B6, which can lead to elevated homocysteine levels, a major risk factor for heart disease; cervical dysplasia; and carpal tunnel syndrome. They also cause vitamin C to be cleared from the body more rapidly.
There is also some evidence that some types of birth control pills deplete the mineral zinc.
What Else to Take If You Take These Drugs. If you’re taking small amounts of natural estrogens, along with natural progesterone to treat menopausal symptoms, you should be fine. If for some reason you’re using synthetic drugs, it’s important to take supplements of vitamin B6 (50 mg daily), folic acid (400 mcg daily), and vita-min C (500 mg three times daily). You should also be taking vitamin E to offset the risk of blood clots and strokes that comes with taking estrogens. Make sure you’re getting at least 5 mg of zinc in your daily multivitamin.
Examples of Progestins
Medroxyprogesterone acetate (Cycrin, Provera, Amen, Curretab)
Megestrol acetate (Megace)
Norethindrone acetate (Aygestin)
Norethindrone acetate with estradiol (FemHRT)
What Do They Do in the Body? The proges-tins are mainly used as pseudo-progesterones in HRT to offset the cancer-causing effects of estrogens, but these strange hybrid hormones also behave a little like androgens (male hormones) and steroids, and natural progesterone does not. For a more detailed explanation of what natural progesterone does in the body, turn to the section “Using Natural Hormones” at the end of this chapter.
What Are They Prescribed For? In addition to being used in HRT for menopausal women, progestins are used to stop abnormal uterine bleeding, to regulate irregular menstrual periods, in birth control pills, and to control endometriosis.
What Are the Possible Side Effects? The side effects of the progestins are so severe that many women refuse to take them, preferring the risks of unopposed estrogen to the unpleasantness of progestin side effects. Most doctors don’t seem to realize that women can use natural progesterone, which has none of the side effects of the progestins. First and foremost, progestins can cause birth defects. They increase the risk of some types of strokes; they can cause loss of vision, migraine headaches, fluid retention, depression, weight gain, fatigue, back pain, and tender breasts; and they are hard on the liver. They can also cause insomnia, nausea, breakthrough bleeding, and amenorrhea (no menstruation). Like testosterone and other androgens, they can cause excessive hair growth where women don’t want it, hair loss where they do want it, and a variety of skin problems and rashes, including acne. Progestins can also cause high blood sugar, reduced HDL (“good”) cholesterol, raised LDL (“bad”) cholesterol, and photosensitivity.
Like the cortisones, megestrol acetate actually increases appetite, can increase risk of respiratory infections, and may suppress adrenal function.
CAUTION!
Please don’t use the progestins at all, either as HRT or in birth control pills. In rare cases, they may be useful to stop excessive breakthrough bleeding, but otherwise it’s difficult to imagine why any physician who wanted to do the right thing would prescribe these drugs when he or she could prescribe natural progesterone.
Examples of Chemical Contraceptives
Drospirenone and estradiol (Yasmin)
Ethinyl estradiol and desogestrel (Desogen, Ortho-Cept)
Ethinyl estradiol and ethynodiol (Demulen)
Ethinyl estradiol and etonogestrel (NuvaRing)
Ethinyl estradiol and levonorgestrel
Ethinyl estradiol and norelgestromin (OrthoEvra Patch)
Ethinyl estradiol and norethindrone (Genora,
Loestrin, Nelova, Norethin, Norinyl, OrthoNovum, Ovcon)
Levonorgestrel IUD (Mirena, Progestasert)
Medroxyprogesterone acetate (Provera, DepoProvera injection)
Norethindrone (Ortho Micronor, Nor-QD)
What Do They Do in the Body? Oral contraceptives are either a combination of a synthetic estrogen, usually ethinyl estradiol, with a progestin, or a progestin alone.
What Are They Prescribed For? Birth control and to regulate menses. Some versions may be prescribed to control acne.
What Are the Possible Side Effects? Oral contraceptives can cause all of the side effects of the synthetic estrogens and the progestins, and they have their own unique profile of negative effects on the body. One of their most frequent side effects is breakthrough bleeding and spotting.
Oral contraceptives increase the risk of blood clots, stroke, heart attacks, liver cancer, gallbladder disease, and osteoporosis, especially in women already susceptible to those diseases. The risks are higher for women with high blood pressure or high cholesterol, obese women, diabetic women, and women who smoke.
The Ortho-Evra contraceptive patch earned itself an FDA black-box warning that estrogen levels are higher in women using the patch than in women using similar oral contraceptives, thus increasing the risk of potentially fatal blood clots. It’s been known for at least a decade that when hormones are delivered through the skin such as in creams and patches, more hormone gets into the blood compared with hormones taken orally (pill). When you take a hormone orally, a large percentage of it is dumped by the liver and excreted. Nevertheless, those who developed Ortho-Evra missed this basic tenet of hormone delivery and failed to reduce the estrogen dose in their patch, putting millions of women at risk of fatal blood clots. The patch is arguably a better delivery system than the pill, but it needs to be properly dosed.
Prescription Alternatives Page 51