One of the most common questions I am presented with in clinical practice is whether or not there are alternatives to synthetic hormones for menopause support. Today I answer the most common questions regarding hormones I encounter in clinical practice.
Q: Is it safe for me to take estrogen?
A: I always assess whether someone is a good candidate for hormone therapy. Anyone who has a personal or family history of uterine cancer, breast cancer, blood clots or gall bladder disease should try non-hormonal options first. Same goes with smokers. Otherwise most healthy women do great with estrogen and tolerate it well. I, of course, prefer bio-identical hormones over synthetic hormones.
Q: What is the difference between bio-identical hormones and synthetic hormones like the Prempro my doctor prescribed?
A: Synthetic hormones are of animal origin, specifically derived from horse urine, then chemically altered to look somewhat like what is found in the body… In the body there are three types of estrogen: estriol, estradiol, and estrone. Estriol is the predominant estrogen in the body (making up about 80%) and has anti-proliferative effects (meaning it doesn’t make cells multiply) and is therefore considered to have a cancer-preventative effect. Estradiol (making up about 10%) has proliferative effects (meaning it makes cells multiply) and has been associated with increasing cancer risks. Even though estriol is the predominant estrogen in the body and has cancer-preventative effects, most prescribed estrogens are actually synthetic estradiol. Also, some synthetic estrogens contain a completely foreign horse estrogen. There are also synthetic progesterone products called “progestins”. Naturopathic doctors prefer to prescribe bioidentical hormones which are hormones created from plants in ratios that are naturally occurring in the body. Another reason I love bio-identical hormones is that I can customize the lowest effective dose for each patient. There’s no need to treat hormone replacement like it’s a one-size-fits-all.
Q: I have a history of blood clots and was told not to take hormones. Do you have other options besides hormonal therapy?
A: One of the benefits of seeing a naturopathic doctor is you will be offered an array of effective treatment options. Medical doctors usually offer antidepressants and sleep aids to women who are not candidates for using hormone replacement therapy but are struggling with menopausal symptoms. While I can certainly prescribe those medications as well, I much rather treat the cause: hormonal imbalance! Now, there are plenty of evidence-based natural medicines like Black Cohosh, Trifolium and Vitex for menopausal symptoms. A naturopathic doctor can prescribe herbal medicines and nutrients to help improve menopausal symptoms and actually balance hormone levels!
Q: Ever since I hit menopause it seems like I am getting bladder infections every single month. I have been on the antibiotic, Cipro, 8 times this year and it has wreaked havoc on my digestive tract. Have you seen this before and do you treat this differently?
A: What you are describing is an extremely common scenario. After menopause, the ovaries are no longer making estrogen which causes the tissue in the vaginal area and uro-bladder tract to become atrophied. This means the cells shrink, get dry and become very vulnerable to infection. This leads to vaginal dryness, pain with intercourse and susceptibility to E.coli which leads to bladder infections. Not only can naturopathic doctors treat bladder infections without antibiotics, but we have tools like bio-identical estrogen to prevent bladder infections and improve the integrity of the uro-vaginal tissue. I’ve had patients just like you go from round after round of Cipro to being free of bladder infection AND back to enjoying intimacy. And nothing is more rewarding to me as a doctor than hearing a patient tell me that this is the longest they’ve gone without antibiotics. Preventative medicine is awesome!