During the past few decades, the use of Bio-identical (Natural) Hormone Replacement Therapy (BHRT) among women has increased tremendously. In the past, BHRT was prescribed for it’s short-term benefits but, more and more, doctors and researchers are becoming aware of and prescribing BHRT for it’s long-term benefits. HRT is used to eliminate or reduce various problems and symptoms at different stages of women’s lives, which may include:

• Premenstrual Syndrome (PMS)
  
• Irregular menstrual periods
  
• Dysmenorrhea (cramps)
  
• Postpartum depression/Postnatal illness (PNI)
  
• Infertility
  
• Uterine bleeding
  
• Perimenopausal/postmenopausal symptoms
  
• Hot Flushes
  
• Mood swings/drop in energy level
  
• Reduced libido (sexual desires)
  
• Vaginal thinning/dryness(painful intercourse)
  
• Urinary tract infection/Urinary incontinence
  
• Night sweats
  
• Mild depression/irritability/anxiety
  
• Poor concentration/memory lapses
  
• Insomnia/disturbed sleep
  
• Heart disease/Arteriosclerosis
  
• Osteoporosis (bone-density loss)
  
• Decreasing the risk of Alzheimer’s Disease
  
• Potential for treating Multiple Sclerosis
  
• Decreasing the risk of Colon/colorectal cancer 3
  
• Potential for treating Arthritis

WHAT IS HORMONE REPLACEMENT THERAPY (HRT)? WHY WOULD IT BE NEEDED?

Hormone Replacement Therapy (HRT) provides women with, or replaces, hormones that their ovaries stop making. The ovaries make estrogen and progesterone as part of the menstrual cycle. The ovaries also make androgens, including testosterone. Hormone levels usually start to change during per menopause, the years just before menopause. In per menopause, many women begin to have symptoms listed above - such as hot flashes, vaginal dryness, irregular periods, insomnia, night sweats, and loss of libido. The reason for the symptoms is usually fluctuating and declining hormone levels.

These hormonal changes are due to aging ovaries that are losing their ability to produce eggs and hormones. Women may have widely varying estrogen levels during their monthly cycles. Often there will be cycles in which no ovulation occurs and no progesterone is produced. This can lead to irregular cycles with abnormal bleeding as a woman approaches menopause.

At menopause, the ovaries stop producing and releasing eggs (ovulating) each month, and monthly periods stop completely. The ovaries are no longer producing estradiol and progesterone (although they continue to produce androgens). Menopause. This drop in hormone level is what produces the various undesirable effects.

A woman who has a surgical menopause, in which her ovaries are removed (usually along with her uterus and fallopian tubes), will have a much more sudden drop in all sex hormone levels than a woman going through natural menopause. This sudden loss of hormones can cause severe symptoms and health problems, especially in younger women, unless adequate hormone replacement is provided.

HRT is most often prescribed to help with the symptoms of menopause HRT may have a number of other benefits, such as preventing bone loss, but it also has risks. Talk to your healthcare provider about all possible options. Depending on your situation, you may decide to use HRT on a short-term basis, a longer-term basis, or not at all.

WHY USE BIO-IDENTICAL (NATURAL) VS. SYNTHETIC HORMONE REPLACEMENT THERAPY?

Researchers believe that significant differences exist between hormones which are natural to human bodies (bio-identical) and those which are synthetic (including animal). They also believe that it is the chemical structure of the synthetic hormones which may be responsible for side effects when used in replacement therapy.1
What Are Bio-Identical Hormones?

Bio-identical hormones have the same chemical structure as hormones produced by the human body. Only hormones whose chemical structure exactly matches the body will reproduce the same effects. These hormones are able to follow normal metabolic pathways so that essential active metabolites (breakdown products) are formed. "Bio-identical" does not refer to the source of the hormone, but rather indicates that the chemical structure of the replacement hormone is identical to that of the hormone it is replacing. Natural hormones are transformed to the human bio-identical hormones from sterile analogies (precursors) found in many plants, primarily wild yams and soy products.

WHAT ARE THE COMPOUNDED NATURAL HORMONES?

After physical examinations, personal and family medical history analysis, and laboratory testing are considered, your physician will prescribe a precise compound to meet your exact needs. Hormones typically prescribed for BHRT are:
Estrogens:

• Estrone (E1)
  
• Estradiol (E2)
  
• Estriol (E3)
  
• Progesterone
  
• Androgens
  
• Testosterone
  
• Dehydroepiandrosterone (DHEA)
  

Often prescribed combinations to re-establish body’s normal physiological balance include:

• Tri-estrogen(Tri-Est) = 80% Estriol + 10% Estradiol + 10% Estrone
  
• Bi-estrogen = 80% Estriol + 20% Estradiol
  

Why Bio-Identical Hormones Are Not Available Commercially?

Natural substances can not be patented. Therefore, side chains are added to a natural substance (i.e. chemically altered) to create a synthetic product that can be patented by a manufacturer, which in turn would be profitable for mass productions!

For any treatment to be effective, compliance is the first step. Yet, only 20% of women on synthetic hormones continue to take them after two years, mainly due to development of side effects.

According to a study by the Mayo Clinic, women reported an overall 34% increase in satisfaction when used micronized progesterone as apposed to their previously used synthetic progesterone. They also reported a 50% improvement in hot flushes, 47% in anxiety and 42% in depression levels. 4-5

Immediate-release dosage forms might cause unwanted side effects due to producing a higher peak blood level of hormones. Slow-release capsules could be prepared to dampen high peaks and low valleys to prolong absorption over several hours to enable less-dosing and improve results. 6

A 1999 study showed women who have had PMS to have a higher chance of developing postpartum depression and those who have had postpartum depression once have over 60% chance of developing it again after another pregnancy. Preventive progesterone treatments can reduce the recurrence to less than 10%.