ProactiveHealth's Balanced Approach to Natural Hormones

Background on Natural Hormones

Natural hormones have been around for decades, first used in Europe. The logic of hormone optimization with plant-based substances that are identical in chemical structure to the human hormones is clear. But conventional medicine has traditionally used synthetic hormones manufactured by the pharmaceutical industry. Synthetic hormones have been promoted since they can be patented and thus more profitable. While synthetics do effectively address menopausal symptoms, there have been concerns about risks and side effects for years. Few physicians were trained in and few patients have been aware of natural hormones until recently.

The NIH Study Cancellation

The National Institute of Health was conducting a study of synthetic hormones called the Women's Health Initiative. See http://www.nhlbi.nih.gov/whi. This long-term study began in 1991 and involved over sixteen thousand of post menopausal women between the ages of 50 and 79. In an unprecedented action, the NIH canceled a major portion of the study in July of 2002 after only 5 years, announcing that the data showed use of a combination of mare's urine estrogen and synthetic progestin (medroxyprogesterone)increased the risk of breast cancer (26%), heart attacks (29%), blood clots (200%) and strokes (41%). An abstract of this action was published in the Journal of the AMA. See http://jama.ama-assn.org/cgi/content/abstract/288/3/321. There had been other studies that showed some negative side effects, and there was growing suspicion among doctors. But confirmation of the risk in such a large study was major news. This has been a wakeup call for the medical community on the treatment of women who need hormonal replacement.

Studies on Natural Hormones

One of the questions that women and men have is whether there is a better hormone optimization therapy than synthetic hormones.  ProactiveHealth believes that natural hormones are the answer.  There have been a number of studies and books that support the proposition that natural hormone optimization is a better alternative. Some of these are discussed below:

The PEPI Study  

The major study is the Post-menopausal Estrogen/Progestin Interventions Study (known as the PEPI Study).  It was first published in the Journal of Obstetrics and Gynecology and then in the Journal of the American Medical Association (JAMA 1995, 273: pp 199-208). It compared various combinations of synthetic and natural hormones.  Natural progesterone (also know as MP or micronized progesterone) surprised the researchers in that it had protective cardiac effects.  The JAMA article by the Writing Group for the PEPI Study discussed the fact that the surprise of the trial was the benefit of progesterone on the good cholesterol. This had not been anticipated, but the results clearly showed that the natural progesterone was superior to synthetic progestin.

In a Washington, DC conference organized by the University of Florida College of Medicine, Dr. Lorrain Fitzpatric MD, Director of the Women's Health Fellowship at the Mayo Clinic, expressed the view that the PEPI trial, like the NIH study had shown that synthetic progestin promoted coronary artery disease, clotting and insulin resistance and thus diabetes where natural progesterone had not. This is important as heart disease is the leading cause of death for women.   

In a Health on the Net News article, published on November 2002, Dr. Robert Langer of the University of California at San Diego, the Principal Investigator of the Women's Health Initiative, stated that natural progesterone was better for another reason:  Micronized progesterone . . . is chemically identical to the progesterone that the woman makes herself. . . .  It was as effective for the endometrial protection as any other of the combinations across the board, but the number of problems was strikingly lower with the micronized progesterone.

Dr. Phillip Sarrel, Professor Emeritus of obstetrics, gynecology and psychiatry at Yale University School of Medicine agreed, saying, Micronized progesterone is what works best. It is the only thing I use.

Quotes from Other Studies on Natural Progesterone 

There are other studies on the benefits of natural progesterone.  For example it has been found beneficial to bone formation:   

Progesterone seems to promote bone formation and/or increase bone turnover.

Prior JC.  Progesterone as a bone-trophic hormone.  Endocr Rev 1990 May;11(2):386-98.  Article available through:  http://www.ncbi.nlm.nih.gov

In combination with estrogen it has been found to be beneficial to heart health:

Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on the exercise-induced myocardial ischemia in postmenopausal women.

J Am College Cardiology 2000 Dec: 36(7):2154-9

Quotes from Studies on Natural Estrogen (Estriol) 

Similarly natural estrogen (estriol) has been found to be beneficial, including the blood chemistry associated with heart health:

Beneficial effect of oral estriol on the basic lipoprotein pattern and demonstrate that this treatment effective in reducing concentrations of Lp(a) lipoprotein in postmenopausal women;

Haines C, Chung T, Chang A, Masarei, J, Tomlinson B, Wong E. Effect of oral estradiol on Lp(a) and other lipoproteins in postmenopausal women.  A randomized, double-blind, placebo-controlled, crossover study.  Arch Intern Med 1996 Apr 22; 156(8):866-72.  Article available through:  http://www.ncbi.nlm.nih.gov 

Estriol has also been shown to be beneficial for preventing bone loss: 

Estriol prevented postmenopausal bone loss and improved climacteric symptoms effectively with low incidence of genital bleeding;

Minaguchi H, Uemura T, Shirasu K, Sato A, Tsukikawa S, Ibuki Y, Mizunuma H, Aso T, Koyama T, Nozawa S, Ohta H, Ikeda T, Kusuhara Ochiai K, Kato J, Kinoshita T, tanaka K, Minagawa Y, Kurabayashi T, Fukunaga M. Effect of estriol on bone loss in postmenopausal Japanese women a multicenter prospective open study. J Obstet Gunaecol Res 1996 Jun;22(3):259-65. Article available through: http://www.ncbi.nlm.nih.gov. 

And estriol has been found to be beneficial for a variety of menopause symptoms: 

Estriol appears to be effective at controlling symptoms of menopause, including hot flashes, insomnia, vaginal dryness, and frequent urinary tract infections

  Head KA. Estriol:  safety and efficacy.Altern Med Rev 1998 Apr;3(2):101-13. Article available through:  http://www.ncbi.nlm.nih.gov 

Quotes from Studies on Natural Testosterone 

Natural testosterone has also been show to help women who have had a hysterectomy: 

In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being 

Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, Burki RE, Ginsburg ES, Rosen RC, Leiblum SR, Caramelli KE, Mazer NA.  Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med 2000 Sep7;343(10):682-8.  Article available through:  http://www.ncbi.nlm.nih.gov

Books on Natural Hormones 

Natural Hormone Balance for Women, Uzzi Reiss, M.D./O.B. GYN

Natural Hormone Replacement, Jonathan V. Wright. M.D.

What your Doctor May Not Tell You About Premenopause, John Lee M.D. and Jesse Hanley,M.D.  

Women's Bodies, Women's Wisdom, Christianne Northrup (Bantam Books 1998)  

The Importance of Hormonal Balance

For women the critical balance is estrogen/progesterone.  Looking at the effect of estrogen dominance, i.e. low progesterone relative to estrogen, two studies show the importance of balance. The first on was done by Emory University in conjunction with the National Cancer Society.  It was an 8 year 240,000 patient study that showed unopposed estrogen patients had a 72% higher chance of ovarian cancer. American Journal of Epidemiology 114: pp 209-217 (1981).

In 1981 Dr. Cowan of Johns Hopkins (American Journal of Endocrinology) found that women with estrogen dominance had a 5.4 times higher chance of breast cancer if they were perimenopausal.  And a recent study in the January 2000 issue of the Journal of the American Medical Association confirmed the original increased risk of estrogen dominance, finding an increased uterine cancer, fibroids, endometriosis and gall stones.  Maintaining estrogen and progesterone in balance is one of the keys to hormone health.

Conclusion 

ProactiveHealth believes strongly that there are two critical factors in achieving good hormonal health:
1) the use of natural hormones and 2) hormonal balance.  ProactiveHealth uses only natural hormones that are custom-compounded for each patient. The company tests each patient to determine individual levels and balance. The natural hormones are the formulated based on symptoms and test results. The goal is good hormonal health for each patient.