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There is so much confusion about HRT..."Hormone Replacement Therapy". Well, let's start with a name change! We are not using the term "Replacement" any more. The reason? The hormones you take after menopause do not replace all the hormones your body made! No, we just give enough to manage your symptoms and prevent osteoporosis and other benefits which are individual."Natural"..."Synthetic"..."Bio-identical"...what does it all mean?
Many women are now asking for 'natural' hormones and what they usually mean is 'plant based'. Most of the hormone preparations are made from soy or yams. Now, not just any yams! These are a specific species of yams. And you can eat a bushel of soy beans or yams and get NO estrogen or progesterone. Actually, a pharmacist or a pharmaceutical laboratory must mix the molecule from the soy or yam with other ingredients to make the molecules of estrogen and progesterone. The scientific name for mixing is 'synthesize'...hence the word 'synthetic'. Even many herbal preparations are synthsized.
'Bio-identical' means that the resulting hormone molecule is identical to what your ovaries made. In our reproductive years our ovaries made Estradiol, Estriol, Estrone and Progesterone. Most of our prescription hormone preparations contain Estradiol because for many years we have believed that it is the one estrogen which was of the most benefit to women. It helps to prevent osteoporosis, stops hot flashes and night sweat, keeps our moods even, etc. Now we are finding that Estriol has many benefits also and we're still studying Estrone as well. There are prescriptive hormones which contain all three of the estrogens, as well as ones that are compounded by a pharmacist. All of them will work!
If it is not prescribed it is not estrogen or progesterone because in order to be estrogen or progesterone the FDA must approve it! Over the counter products that sound like "estrogen" or progesterone" do not contain these hormones!
Our bodies also make progesterone after ovulation during our reproductive years and is responsible for maintaining a pregnancy until the placenta forms. Bio-identical progesterone has been used for many years to treat PMS as well as some pregnancy problems. Now we also use it for HT. However, the most commonly used progestin, Provera, has a long history of use. We know it can protect your uterus from developing endometrial cancer and therefore have used it along with estrogen for many years. Provera is also very useful for treating certain menstrual disorders. It does have some side effects that some women find unpleasant, such as mood swings. We also have evidence that it is not beneficial for your cholesterol and therefore may not be a good choice for some women. Bio-identical progesterone has not had as long to prove its benefit to the uterus, but is usually well tolerated by most women. There is evidence that it is also helpful for the bones as well as other systems of our body.
So, what's a girl to do? Talk to your healthcare provider about your specific risks and benefits of HT. If you would have more benefits than risks, it may very well be worthwhile to use HT. If you have had a hysterectomy you will not need a progestin to protect your uterus, but may want to use bio-identical progesterone for its other benefits.
Educate yourself as much as possible about your choices. Of course, I believe "Speaking of Menopause" is a wonderful educational tool! Remember that not everything on the internet is 'truth'. If you like to study on the internet see my list of web sites that are credible!
Copyright ©1995-2004 Karen Lee, A.R.N.P.,
Advanced Registered Nurse Practitioner
Certified Menopause Practitioner