What every woman should know
by Dr. G. Brewer

For the two million American women entering menopause each year, the most difficult decision most will face is whether or not to use traditional Hormone Replacement Therapy (HRT). They are confronted with a variety of contradictory and prejudicial information on the subject and many are unaware that Natural Hormone Replacement (NHR) exists as a safe and effective alternative. The benefits promised by traditional HRT such as prevention of osteoporosis, reduced risk of heart disease, elimination of hot flashes, insomnia, depression and other menopausal symptoms are very desirable indeed. The benefits must be weighed against side effects like fluid retention, anxiety, moodiness, weight gain, breast tenderness, bloating, nausea and most importantly; the increased risks of endometrial and breast cancers. The 1990 United States Nurses Survey demonstrated a 40% increase in breast cancer among women between 50 and 64 years of age who used HRT for more than 5 years. The increased risk of these cancers dissuades many women from considering hormone replacement of any type. Natural Hormone Replacement (NHR) provides all the benefits of HRT and virtually none of the undesirable side effects.

Human ovaries secrete progesterone and three estrogens - estrone, estradiol and estriol. Estriol, the "weakest" of the three makes up 80 to 90 percent of circulating estrogens. Estriol is generally considered to be anticarcinogenic and acts as a regulator of the
other two estrogens. Estradiol and estrone are both generally considered to be procarcinogenic, but together make up less that 10 percent each of circulating human estrogens. Maintaining the 80/10/10 estrogen ratio is necessary to promote appropriate estrogenic effects and minimize undesirable effects. Estrogen's increase water retention, raise blood sugar levels, enhance HDL levels, inhibit bone loss, aid in brain function and control the monthly cycle. If a woman is still cycling regularly she has plenty of estrogen. Progesterone is secreted during the second half of the monthly cycle, after ovulation. If a woman does not ovulate, the adrenal glands are the only other source of progesterone. The adrenals produce a small amount if they have the excess capacity to do so. John Lee, MD states in his ground breaking book , What Your Doctor may Not Tell You About Menopause "Some of Progesterone's effects and functions are: maintaining secretory endometrium necessary for development of fertilized embryo, stimulates new bone growth, facilitates thyroid hormone action, normalizes zinc and copper levels, acts as a natural antidepressant, helps normalize blood sugar levels, enhances sex drive, is a natural diuretic, thermogenesis (the burning of fatty acids for heat), normalizes blood clotting, is a precursor to the stress hormones and helps prevent breast and endometrial cancers."

The negative effects of HRT can be traced to the synthetic and unbalanced nature of the hormones. Premarin, the most popular estrogen replacement drug, is derived from PREgnant MARes urINe. According to Joel Hargrave MD, Director of the Menopause
Center at Vanderbuilt University " the breakdown products of Premarin are stronger than the strongest human estrogen". The Estrogen ratio of Premarin, considered "a conjugated equine estrogen" is 75-80% Estrone, 6-15% Equilin (horse estrogen) plus smaller amounts of Estradiol and two other horse estrogens. The strength and Estrogen ratio of Premarin are very different from the 80/10/10 Estrogen balance occurring naturally in humans. Estriol, the anticarcinogenic and regulatory estrogen is conspicuously absent from Premarin. The official Premarin warning label supplied with each prescription reads “after exposure for more than one year...the risk of endometrial cancer in estrogen users was about 4.5 to 13.9 times greater than in non-users ". Synthetic estrogens, like ethanol estradiol, are man made substances not found in nature. Provera is a progestin or synthetic Progesterone and is very different in overall physiologic effect than natural progesterone. As is the case with synthetic estrogens, the break down products of progestins present problems not associated with the natural counterpart. Provera was added to HRT formulas only after tens of thousands of women developed endometrial and breast cancers due to unopposed Estrogen/Premarin usage. According to Natural Hormone Replacement by Johnathan Wright MD, "The addition of Provera may minimize the risk of endometrial cancers due to synthetic estrogens...but women on standard HRT using Premarin and Provera may actually increase their risk of breast cancer by 30%". Progestins also inhibit some of the normal functions of the body's own progesterone and offer virtually none of the other beneficial effects. Many physicians and researchers do not distinguish between synthetic progestins and natural progesterone.

The predominant current medical view of menopause is that:
- Estrogen levels gradually decrease in cycles that become longer and finally stop altogether.
- It is the lowered levels of circulating estrogens that cause the emotional and physical problems.
- To "cure" menopause one must boost estrogen levels back to normal.
- The ratio of the three estrogens and the estrogen to progesterone ratio are not relevant.
- Progestins are only needed to reduce the risk of endometrial cancers and have no other function. Consider this: When adolescent girls experience weight gain, bloating, breast tenderness and moodiness it is attributed to "overactive hormones" e.g. excess estrogen. When women in their 20s and 30s experience the same symptoms it's "only PMS". When menopausal women have the identical symptoms it is attributed to insufficient estrogen. Why the apparent paradox? The research and observations of John Lee MD, Johnathan Wright MD, James Balch MD, Andrew Weil MD, Cristiane Northrup MD and many others indicate that estrogen dominance is the real culprit; the ratio of estrogen to progesterone is altered to favor estrogen, creating a severe imbalance. In western societies, menopausal women produce about one half the estrogen and only 1/100th the progesterone they did prior to menopause; the check and balance and anti-estrogenic effects of progesterone are gone and estrogen dominates. Circulating estrogen levels are indeed lower than premenopause but it is the ratio imbalance that causes the problems. Estrogen dominance and decreased Progesterone production can occur prior to menopause due to high stress, poor diet and exposure to environmental toxins. During perimenopause estrogen levels may be the same or lower than normal but stress and irregular ovulation may cause progesterone levels to decrease significantly. Progesterone is the precursor to the stress hormones; constant stress sidetracks much of the available progesterone for breakdown into the stress hormones and prevents it from performing other necessary functions. Most beef, dairy and poultry are given estrogen to stimulate growth, water retention or milk production. A daily diet of estrogen laced meats and dairy boost circulating estrogen levels. Pesticides, herbicides, solvents and certain food and cleaning additives also have estrogenic effects on the body.

Natural Hormone Replacement
Progesterone: For many women experiencing the symptoms of perimenopause and PMS, transdermal natural Progesterone cream is all that is needed to rebalance the estrogen/progesterone ratio. Natural progesterone is bio-logically identical to the progesterone produced by the human body and is derived from soy or wild yam extract.
To provide the necessary levels of natural progesterone, the cream must contain 400-500mg of United States Pharmaceutical (USP) Progesterone per ounce. Many yam or "balancing creams" claim to contain progesterone, or progesterone precursors but the human body doesn't have the enzymes necessary to convert yam to progesterone. John Lee MD states "All of the research we reviewed on Progesterone demonstrates that it is supplemental Natural Progesterone that will produce an increase in saliva & serum levels of progesterone, not yam extract." For women still cycling or experiencing PMS, progesterone cream is applied twice daily for the last two weeks of the cycle. For non-cycling women it is applied twice daily for three weeks of each month. For many women this will eliminate the bloating, water retention, hair loss, memory problems, irritability, low libido, apparent thyroid dysfunction and exhaustion. Progesterone has anti-osteoporotic effects and has been shown to increase bone density by as much as 5% per year in postmenopausal women.

Triple Estrogen or Tri-Est. Women that continue to have problems with hot flashes or vaginal atrophy can go one step further and use Tri-Est. Tri-Est is a combination of bio-identical estrogens formulated by a compounding pharmacist. The estrogens are in
the same 80/10/10 ratio of Estriol/Estrone/Estradiol that occurs naturally in women, and are derived from soy or wild yam. A doctor must write a prescription for the tri-est and you may have to have them mailed to you if you can't find a compounding pharmacy locally. Finding a doctor that understands the "big picture" may be most difficult part of the process. Typical dosage is 2.5-5mg daily in capsule form. Women with hot flash or vaginal atrophy problems and with personal or family history of cancer may use Estriol by itself. It is prescribed widely in Europe and is very safe and effective. Typical dosage is 2-4 mg daily in capsule form. Tri-Est and Estriol users should have estrogen levels monitored periodically by via saliva testing. Based on test results, the ratio and
strength of the Tri-Est and can be adjusted accordingly by the doctor and compounding pharmacist.

Natural Hormone Replacement offers a woman the best opportunity to minimize the discomfort associated with menopause and make it a "non-event". The benefits will allow her to maximize her physical and mental abilities and make the "golden years" a more pleasurable and rewarding experience.