Hormone Supplements for Menopause

The Perimenopause is that transitional time from around 35 or 40 until age 60 or older. Fluctuations and changes in hormone production are the main cause of difficulties during this time. The ovaries are the main source of female hormones, but as they become less productive, other areas of the body can help. Some women have few symptoms and a very smooth progression. However, many women will experience menstrual irregularity, hot flashes, night sweats, sleep disruption and anxiety/depression.
There can also be changes related to low vaginal estrogen, such as dryness, sensitivity and bladder weakness. In women who have surgical removal of both ovaries, changes could be more abrupt. Every woman is different and hormonal swings can occur frequently and with no real predictable pattern. This makes hormone testing less meaningful in most cases, so I rely more on signs, symptoms, and a scientific understanding of the process.
Each woman has a very individual situation that benefits greatly by good general health and prevention, diet, exercise and guidance from a knowledgeable women’s health expert. The process is constantly progressing, and available options continue to evolve, new information is accumulated and people and attitudes also change. This means that effective help must be re-evaluated on an ongoing basis, at least annually and often more frequently.
Nutritional and Herbal therapy have been used in place of and in addition to hormonal treatment for many years. The potential benefit of healthy and “natural” ingredients is attractive to many people. These treatments have generally not been as well studied and researched as pharmaceutical products. There is however a growing body of evidence to suggest the safety and benefit of many non-prescription and herbal products, especially those from well-known and reputable companies. When the choice is to try these products, I advise starting conservatively, using small dosages. A simple regimen or formula is probably safer than a complex mixture. There are several well-accepted herbs and supplements currently in the market and a variety of products and ideas. We can offer advice and suggest appropriate steps with a non-hormone approach.
“Natural hormones” and “bio-identical” are popular buzzwords today. Although used interchangeably, they mean different things. Most hormones, herbs and even pharmaceuticals are derived from natural plant or animal sources. If a hormone is exactly as found in nature, it’s bio-identical. If exactly as found in your body, we say “human-identical”. Obviously, for a hormone supplement, this seems ideal.
Over 25 years, an entire industry has been created by some pharmacists who produce a custom-made formula with a doctor’s prescription, using any of a variety of ingredients in any chosen dosage. This is the age-old method called “compounding”. The benefit here is that a custom product can be created for each individual patient and adjusted accordingly. This offers significantly more choice in designing a supplement, hormone or drug for a particular purpose. The disadvantage is that a particular formula may not have any clinical research backing or testing and the patient and the physician must have trust in the pharmacist who is actually compounding the product in their store or lab. There may be much more variation in one batch to the next and certainly from one pharmacy to the next.
Pharmaceutical company factory-made products are known for their consistency and standardization although there is not as much variety and choice in ingredients. In order to have a patented product, these companies have to have a unique formula or method of drug delivery. Even slight variations in a chemical compound can dramatically change the way one works, so in general, I suggest using human-identical hormones.
There is major controversy (and misunderstanding) related to the use of hormone therapy. The use of estrogens and progesterone-like compounds have been implicated in a few studies with serious health risks. Your women’s health specialist can discuss this information and how it relates to you as an individual. Despite stories in the media, many scientists have found the hormone-scare reports to be faulty. I have found no valid scientific literature to suggest that human estrogen or pure progesterone in menopausal supplement doses will cause major disease such as cancer. Quite the contrary, there are significant health benefits for many women. I think the research shows that estrogen is protective against cardiovascular disease, osteoporosis and the function of the brain. Natural progesterone has a protective effect on tissues as well. If human estrogen and progesterone caused disease, then the younger (and particularly pregnant) patients would be having more problems. We know that any estrogen can promote the growth of certain already existing tumors but it would be unlikely that cancer is caused by pure estrogen and I think the research supports this idea. Again, I am talking about human estrogen and progesterone, not chemically-altered variations. Also, keep in mind that we purposely use some altered variations to actually treat cancer and other diseases. Unfortunately, for all of us, we will continue to get confusing reports in the media, on-line and even from biased or uninformed professionals.
Many options for hormone therapy are commercially available in pills, capsules, patches, creams and other topical forms. In theory, a topical treatment such as a patch or cream would be more physiologic and is therefore preferred by many of us. Again, I think the research supports this idea.
A variety of other dosage forms for hormone therapy can be prepared by specialized pharmacists to meet the specific needs of individual women. Compounding also can provide unique ingredients not available commercially “off the shelf”, but usually there is a higher cost. We can recommend several local pharmacies for compounded hormones and products, and we also work with several mail order pharmacies.
Michael Swor MD
Swor Women’s Care
Chairman
Department of ObGyn
Sarasota Memorial Hospital