Sooner or later, all women will go through menopause. Menopause is the stopping of ovulation and the ceasing of monthly periods. It typically begins in the 40s and can last for several years. Estrogen levels tend to decrease over time until finally the ovaries cease to produce estrogen. Small amounts of estrogens will still continue to be produced in the body by the fat tissue, however, but this amount is not enough to retain the ovulation cycle. Many women experience troublesome symptoms when menopause hits. Hot flashes, night sweats, trouble sleeping, mood swings and vaginal dryness are all common symptoms of menopause. Women who experience severe symptoms may find relief from medication therapy.

Chances are, if you have required medication therapy for your menopause, you were given a prescription for Preparing or a similar 'conjugated estrogen' product. Premarin is a synthetic estrogen made from the urine of pregnant horses. Other conjugated estrogen products like Enjuvia and Cenestin, are made synthetically from plant sources.

The problem with conjugated estrogen products like Premarin is that it not only contains human-like hormones, it also contains other hormones that are unlike human estrogens, like horse hormones. Many medical experts question if our bodies really know what to do with these equine estrogens. It is thought that some of the ill effects sometimes experienced by women taking Premarin, such as migraine and fatigue, are caused by these horse hormones.

There has for some time now been an alternative to traditional synthetic hormones like Premarin available. Bioidentical Hormones, as they are known, have been around for many years. However, up until now, they have not been widely advertised or promoted by the medical community. This is a shame as many women are finding relief from their menopause symptoms without the possible ill effects of Premarin. Times are changing though. The medical community may be seeing the potential benefits of bioidentical hormones. The American Medical Association (AMA) has just vowed to make patients and physicians "more aware of the safety and efficacy of bioidentical hormone compounds."

Bioidentical hormones are hormones that are 'identical' to human estrogen hormones on a molecular basis. These hormones are typically isolated from natural sources such as soy beans and yams, but are modified so that they are just like the human hormone. There are a couple of commercially available bioidentical products available. These include Ogen, Ortho-Est, Estrace, Estraderm and Prometrium. Ogen and Ortho-Est are crystallized forms of a single human estrogen. Estrace is a single hormone estradiol. Estraderm is estradiol in a patch. Prometrium is a bioidentical form of progesterone. Bioidentical hormones can also be compounded by specialty pharmacies called 'compounding pharmacies'. Compounding pharmacies are pharmacies that will 'compound' ('prepare' or 'mix') the medication according to your doctor's order. These types of pharmacies can compound formulations that are not commercially available. Bioidentical hormones are typically ordered under the names 'Triest' or 'Biest'. Triest is a combination of 3 human estrogens; estradiol, estrone, and estriol. Biest is a combination of two of these hormones; estriol and estradiol. These formulations are nice because they contain two or three of the 3 human estrogens. The doses of these hormones can also be better tailored to the patient since the pharmacy can compound anything according to the doctor's order.

'Bioidentical' and 'natural' estrogens should not be confused. Bioidentical hormones are 'identical' to the actual human hormone, whereas 'natural' hormones typically are not. Natural hormones usually refer to plant-based 'phytoestrogens' which are not the same as human estrogens. Sometimes these natural hormones can be converted into bioidentical hormones, but in their normal plant form, they are not bioidentical. Sometimes herbs like black cohosh and red clover are referred to as 'natural hormones'. Personally, I do not recommend these herbs as their effectiveness is questionable and black cohosh has been associated with liver toxicity.

Up until now, compounded bioidentical estrogen products were not overseen by the FDA. This has changed as now, the FDA will conduct surveys for purity and dosage accuracy and require compounding pharmacies to complete mandatory reporting on these products. For the consumer, this is potentially good news as it will help ensure the quality of such compounded products. They are also requiring these compounding pharmacies to keep track of the reported adverse events ('unwanted effects') of these products.

The Bottom Line

If your symptoms are not really that troublesome, you may not require hormone therapy. If you and your doctor decide that you would benefit from hormone therapy, you may want to consider a bioidentical hormone product vs. a synthetic one. Whether you choose a bioidentical product that is commercially available or one that is compounded is up to you. One advantage of choosing a compounded bioidentical product is the dose can be customized for you. As with any other medication, it is important to use the smallest, effective amount of the hormone that will provide you symptom relief. To find a compounding pharmacy near you, you can look in the Yellow pages under 'Pharmacies, compounding' or ask your local retail pharmacy where you might find one.

Author: Christi Larson, Pharm. D.