It has been many years since the WHI study caused concern about the safety of hormone replacement therapy (HRT) after menopause. Many women have turned to over the counter supplements and herbals for symptoms relief and have been successful. However, herbal products are drugs too and should be treated as such. I have no idea if phytoestrogens (plant sources of estrogen) have the same risks as pharmaceutical hormone replacement. Each woman, after menopause, needs to take the time to inventory their own belief systems and decide what it best for them. Many national organizations have since taken a closer look at the WHI study and have published position statements on the use of HRT after menopause. The American Association of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society (NAMS), have both published statements which in essence state that the use of HRT after menopause should be for symptom relief, not prevention. Many women have been confused as to what is best for them.

What is natural hormone replacement or the newer term bioidentical hormone replacement? The term natural has been tacked on to so many products that it is very confusing. “Natural” is a marketing term, not a medical term so “bioidentical” is being used more often now. Bioidentical means that it is structurally identical to the substance that naturally occurs in your body. New books on menopause that have been published in the last year have brought this topic to the mainstream but bioidentical hormone replacement is not new. Bioidentical hormones have not become more widely used due to lack of large randomized studies about these formulations. Bioidentical hormones have not been mainstream because of little research about these formulations. The ingredients are not patented and therefore spending millions of dollars for studies would not be profitable for major drug companies. The NAMS position statement is that bioidentical hormones have the same safety issues as traditional hormone replacement. However, for women who have hot flashes, vaginal dryness, sleep disturbances, mood swings and diminished sex drive that are affecting their lifestyle, then a hormone replacement that is more natural is often a relief especially if over the counter remedies have not helped. Many women have chosen to continue hormone replacement simply because they feel better when taking it.

If you decide to use hormones, it is important to work with your health care provider on which type of therapy meets your individual needs. Now if a woman makes the decision to use hormone replacement to treat uncomfortable symptoms, it’s more a question of which type of therapy best meets her needs than whether she will use hormone therapy.

Your body produces three different kinds of estrogen. The primary estrogen produced during the years when you were menstruating is called Estradiol (E2). Generally, it is the hormone that works the best for taking care of hot flashes, night sweats, joint pain, etc. Estrone (E1) is the primary estrogen produced during menopause years by the conversion of adrenal gland hormones. It is weaker than Estradiol. Women who are obese make higher levels of Estrone. Estrone has been hypothesized to possibly being the estrogen that increases the risk of certain breast cancers. The third estrogen is Estriol (E3). Estriol is the weakest estrogen and is primarily available during pregnancy when the placenta produces it. Clinically, Estriol seems to help vaginal dryness better the other two estrogens and is also helpful for skin health such as wrinkles and dryness. The bioidentical estrogens are derived from soy.

To reduce the risk of endometrial (uterine) cancer, progesterone is prescribed along with estrogen products. Women without a uterus would not be at risk for this cancer and often use only estrogen. Progesterone also helps with sleep as one of the side effects can be drowsiness. It is also a mood stabilizer. The bioidentical progesterone formulations are derived from wild yam root.

Many postmenopausal women also note a decrease in their sex drive. The addition of testosterone can improve libido and ability to achieve orgasm. Testosterone in oral formulations can be associated with unwanted side effects such as lowering of the voice, increase in cholesterol levels and hair growth. Therefore, bioidentical testosterone cream can be prescribed in low doses that improve sex drive in some women.

As with any medication, hormones have the potential for side effects. These may include headache, breast tenderness, irregular vaginal bleeding or spotting, nausea and cramping. Generally these side effects are mild and may decrease with time.

If you choose bioidentical hormone replacement you have several options of formulations. There are bioidentical estrogens in pharmaceutical brands such as Estradiol, EstroGel and some patches such as Vivelle, Alora, Climara and Estraderm. Bioidentical pharmaceutical Progesterone is available as Prometrium. If vaginal dryness is the only symptom causing you problems you can get bioidentical Estrace vaginal cream or Estring, a vaginal ring worn in the vagina for three months.

Many women prefer bioidentical hormones that are compounded. Compounding pharmacies are pharmacies that will make or compound a formulation based on the prescription provided by the health care provider. These formulations contain FDA-approved ingredients. By using a compounded formulation the product will be customized to your needs as you and your health provider determine. This can be an advantage as the lowest possible dose can be formulated to control symptoms and prevent osteoporosis.