Natural vs. Bio-identical
You can have one or the other - but not both - when it comes to hormone replacement therapy.
Bio-identical hormone replacement therapy and natural hormone therapy are terms that are often used interchangeably. The latter brings images of beautiful plants, the medicinal value of herbs and roots and trees, the restorative power of Mother Nature; the former is a bit stiff, a bit scientific, a bit intimidating. It isn't surprising that most references to hormone replacement therapy for menopause on the Web and in other media outlets use the term "natural" more often. The term natural progesterone is easily recognized, a stark contrast to the frankly synthetic progestins that have traditionally been prescribed to women at menopause. But, on the other hand, the interchangeable use of natural and bioidentical have caused a good deal of confusion. Natural progesterone is not really natural. More specifically, it is identical to the progesterone made in the human body - bioidentical - but the process used to make it is anything but natural. Let's clear up just exactly what we mean when we talk about natural progesterone and bioidentical hormone therapy.
Non-bio-identical hormone replacement therapy almost always causes side effects - side effects that may be the reason why progestins have been linked with increased risk of heart disease and cancer.
Natural progesterone, which is used to treat pre-menopause, perimenopause, and menopause symptoms and to help prevent chronic age-related disease after "the change," is not a truly natural product. Natural soy or wild yam molecules have to be extensively manipulated to make a bio-identical molecule that has the exact configuration required to fit perfectly into progesterone receptors in the human body. There is no way to distinguish between this so-called "natural" progesterone and that which is made in the body. Progestins, on the other hand, are completely synthetic and are not bioidentical. They have some progesterone-like actions at progesterone receptors, but don't lock in perfectly. Expecting progestins to do the job of bio-identical progesterone is like expecting the wrong key to open a lock. You may be able to slide the key in and wiggle it a bit, but it isn't going to open the door. This poor fit explains why non-bio-identical hormone replacement therapy almost always causes side effects - side effects that may be the reason why progestins have been linked with increased risk of heart disease and cancer.
Although natural progesterone may not be natural in the strictest sense of the word, its configuration - its "key" - is exactly the right shape for opening the "doors" of the progesterone receptors. Estrogens from horse urine, also known as Premarin, are natural. They aren't biochemically altered before they are made into drugs. But they are not bio-identical. Natural isn't always best when it comes to hormone replacement therapy; bio-identical hormones are. According to compounding pharmacist Dana Reed-Kane, Pharm.D., FIACP, FACA, "There is no commercially available or compounded product that is both completely natural and bio-identical." It has become widely accepted to refer to bio-identical progesterone as "natural," although it isn't really correct. Most likely, even if the confusion gets straightened out, it will continue to be called natural progesterone.
Menopause is a natural process, and for some women, it goes relatively smoothly - one or two hot flashes, a few irregular periods, and they're done with sanitary products for life and glad about it. They don't find that the menopausal transition has affected their health in any dramatic way. Other women suffer with a wide range of symptoms that have all typically been blamed on lack of estrogen, including foggy thinking, mood swings, hot flashes, night sweats, changes in skin texture, and loss of libido and vaginal lubrication. Those who have a rougher time during menopause are often the same ones who have a rough time preceding it. In the years of pre-menopause - the ten or so years that lead up to the actual "change" - these women may have irregular periods, problems with fertility, or very uncomfortable or heavy periods. They may develop uterine fibroids that require surgery. These women have signs and symptoms of hormone imbalances. Recent research has established that the risks of using non bio-identical estrogens and progestins outweigh their benefits for these kinds of menopausal problems. At the same time, there is growing consensus that using natural progesterone (and, sometimes, bio-identical estrogen - which, incidentally, is made from plants in a highly unnatural way, just like natural progesterone) will optimize the benefits and drastically reduce the risks of hormone therapy for problems at menopause.
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