Treating the Individual
Every person is different. Our philosophy is that every patient requires an individualised treatment plan, and this requires individual assessment. See testing options.
Treatment for hormonal conditions may require accessory supportive treatment for the digestive system, nervous system or stress hormones.
Hormonal treatment itself may take the form of:
- Diet changes
- Nutritional supplements
- Herbal medicine or Homoeopathy
- Natural Progesterone and other bio-identical hormone supplements.
Frequently asked questions about bio-identical hormones
What does "bio-identical" mean?
This is a term first used by Dr. Christiane Northrup. It means identical to biology, and is used to distinguish human hormones from hormone-like drugs. They can also be called 'nature-identical'.
What are bio-identical Hormones (BHRT)?
Bio-identical hormones are supplemental hormones that are exactly identical to hormones found in the human body. This is different than conventional HRT which, in order to be patented, were synthesised to be different from, and stronger than, human hormones. It is because conventional HRT differs molecularly from human hormones that conventional HRT is a risk for cancer.
There are many different types of bio-identical hormones. They are not just one thing. Each one: oestrogen, progesterone, DHEA must be considered individually.
For a current look at research into BHRT see
What is natural progesterone cream?
Progesterone is the most popular and well-known bio-identical hormone. Natural progesterone is exactly identical to the progesterone made by your own body. This is very different than the "progesterone" in the Pill and conventional HRT, which are progestin drugs. Progestin drugs have many side effects, and are fundamentally a completely different thing than natural progesterone.
Natural progesterone can be used effectively to treat many hormonal problems including PMT, painful breasts, infertility, osteoporosis, and peri-menopause.
Is it safe?
The safety of natural progesterone has never been in question. Unlike oestrogen and progestin drugs, natural progesterone may actually protects against breast cancer.
In parts of Europe, 'micronised progesterone' (natural progesterone) has become standard care in gynaecology.
How much should be used?
We recommend that you use the minimal dose necessary for relief of symptoms. Founders of progesterone therapy like Dr John Lee used only 10-20 mg of progesterone per day. This is about what the ovaries would make under normal circumstances. Some Australian doctors have been prescribing up to 10 times this amount. As a patient, if you are using more than 1/2 gram of a 3% cream, or more than 0.5 of a 70mg troche, you need to reconsider what you are taking.
What is DHEA?
DHEA is a very exciting form of natural hormone for menopause and fertility in older women. Please see DHEA article for more information.
Where are they available?
Bio-identical hormones are available by prescription from compounding chemists. Any doctor can prescribe, but many doctors are not familiar with how the prescription should be written. At Sensible-Alternative, we act as an advocate between you and your GP. We provide your GP with information about natural hormones, as well as a detailed assessment of your requirements, and a suggested prescription. For the majority of GPs, this is a simple and effective process. If your GP is not cooperative, we can organise a script for you with another doctor.
Are they effective?
Yes, when they are used properly, nature-identical hormones definitely work. They are real hormones.
Are they safe?
There have been numerous studies documenting the safety of bioidentical hormones, particularly progesterone. For example, a 2005 French study published in the International Journal of Cancer found that, unlike the progestins used in conventional HRT, natural progesterone does NOT cause breast cancer.
- Fournier, A et al. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohert. Int. J. Cancer 2005: 114: 448-454
Please read Good oestrogen-bad oestrogen for more information about safety of oestrogen and oestrogen metabolites.
The safety problem with some BHRT scripts
If you obtain a script for bioidentical hormones from your doctor, be careful. At the right dose, BHRT is a fantastic treatment for PCOS, endometriosis, fibroids, PMS, depression and menopause. At the wrong dose, they will not work for you.
There are three main problems with the way that natural hormones are typically prescribed in Australia.
- They are usually given as troches or lozenges rather than creams. This means that some of the hormone will be swallowed and broken down by the liver into other hormone metabolites. Progesterone metabolites will not work as well, and higher doses must be used.
- Doses are too high. The pioneer of natural progesterone use, Dr. John Lee, recommended using no more than 20mg Progesterone per day (40mg in a troche). That is the amount produced by the ovary in a healthy woman. Higher amounts may be need for severe estrogen dominance, but never more than 60-80mg per day. A dose that is too high will produce no benefit.
- Oestradiol and oestrone are not always necessary. These strong oestrogens are the source of most of the controversy about natural HRT. Of any of the bioidentical hormones, they are the ones with some cancer risk, particularly if they form dangerous metabolites. Bio-identical hormone formulas that contain oestradiol or oestrone are called: Bi-est or Tri-est. Please read Good oestrogen-bad oestrogen for more information about safety of oestrogen and oestrogen metabolites.
At Sensible-Alternative, we recommend "minimal dose" hormone prescriptions, and almost always in a cream form. There are some cases when troche or capsule are more appropriate.
Are there natural estrogens?
Yes. Bio-identical estriol, estrone and estradiol are available from compounding chemists and in some conventional HRT. Except for estriol which is very mild, even bio-identical estrogens have some cancer promoting effects if they are not balanced by progesterone. (This is the source of the controversy discussed above.)
Why doesn't my doctor know about natural hormones?
Although bio-identical hormones have been available for decades, very few doctors know about them. Alternatively, they may know about them, but have dismissed them because they are not well researched. Bio-identical hormones are non-proprietary and unpatentable. For this reason they have been of little financial interest to pharmaceutical research, and have not been promoted to doctors.
Where can I buy natural hormones?
Individualised natural hormone prescriptions are available from compounding chemists. A script from a doctor is required.
How long do I have to take them?
It depends on why you're taking them. PMS symptoms due to progesterone deficiency can be corrected with just a few months of treatment. Menopausal symptoms may require treatment for approximately one year. Long-term use may be used for prevention of osteoporosis. If you do use hormone supplements long term, you should do a safety check with saliva or urinary hormone testing. Blood testing is not good enough.
Will I have to stop my medication?
Bio-identical hormones will replace other forms of hormone replacement that you have been using. Most other medications are safe in combination with natural medicines. Please bring a list of your medication to your appointment, so that our Naturopath can advise you of any interactions of which you need to be aware.
What are Phyto-estrogens?
Phyto-estrogens are plant molecules. They are not true hormones. Instead, they are molecules that gently promote the body's own hormones. They can stimulate estrogen sensitive tissue if estrogen is low, and protect it when estrogen is too high. In this way, they protect against reproductive cancers.
Is Wild Yam Cream the same as Natural Progesterone Cream?
No. Wild yam may work as a herbal medicine, but it does not provide progesterone.
What are Natural HRT formulas available in health food stores?
They are combinations of nutrients and herbs containing phyto-estrogens. Phyto-estrogens are effective for menopause and hormonal imbalance. They are part of the treatment plan at Sensible-Alternative, but they are not hormones.
Should hormones be supplemented?
Before you supplement hormones, try diet and lifestyle first. Do NOT smoke. Reduce your intake of alcohol and sugar. Get enough rest, and enough sleep. Eat well including vegetables, protein and healthy fat.
If you feel that you might need natural hormone supplements, then assess for DHEA and progesterone deficiency first. If they are low, then you can use herbs and supplements to increase their production. If that is not enough then consider supplementing with natural progesterone or DHEA.
If progesterone and DHEA are not enough, then you need to consider oestrogen. The safest oestrogen is oestriol. Oestriol is effective for symptoms and is used widely in Europe. Is is protective against cancer.
If all else fails, then consider using small doses of the stronger oestrogen called oestradiol. If oestradiol is used, it should be taken in conjunction with Natural Progesterone. Artificial progestins should be avoided at all costs.
If oestrogen is used, urinary hormone levels should be assessed.
