Book Review

Natural Hormone Replacement for Women Over 45

Jonathan Wright, John Morgenthaler
Smart Publications

Wright and Morgenthaler begin with a poignant case study of a woman preparing for the second half of her life by changing her diet, using vitamin and mineral supplementation and exercising. The authors explain that hormones affect every cell in the body, not just heart, bone and brain cells, making a point that the only way to supplement what the body has stopped producing is to put back exactly the same natural hormones, including estrogen, progesterone, dehydroepiandrosterone (DHEA), and testosterone. The authors then describe menopause and its symptoms and dispel the error of “estrogen replacement therapy” with the use of Premarin.® They discuss the “unnaturalness” of Premarin and its associated cancer risk, and turn the subject to natural hormone alternatives, citing and rebutting eight myths about natural hormones.

Although the authors discount the importance of understanding the female reproductive system, they state that to be able to understand what is occurring hormonally during perimenopause and menopause and the way hormone replacement therapy (HRT) works in this phase of life requires an understanding of the menstrual cycle. They give a detailed description of the balance between estrogens, progesterone, follicle-stimulating hormone, and luteinizing hormone during childbearing years and describe imbalances occuring during perimenopause and menopause.

They take aim at patentable hormones, claiming that most doctors believe that conjugated estrogens are natural because they come from horse urine. According to the authors, this belief is due to lack of education on natural hormones, and their unavailability. The authors state that the word natural is mistakenly associated with the source of a hormone. They choose to categorize hormones as either patentable or natural, with patentable meaning artificial and natural meaning what the body produces or structurally identical to what the body produces. They describe the regulatory functions of natural hormones and the ways patented or unnatural hormones mimic these functions to some extent but exert their own effects in many instances, causing opposite reactions or side effects.

The focus then turns to relieving and treating common menopausal symptoms with natural hormones. The authors report that estradiol is used most often to treat the first signs of menopause, noting that it does not occur alone in the body but in combination with estrone and estriol. Estradiol is identified as being the most carcinogenic, whereas estriol is thought to be anticarcinogenic; the authors explain that estriol can be used to treat many menopausal symptoms. They feel the osteoporosis danger is worthy of note and discuss how estrogen can be used to stop bone loss, going on to impress upon the reader that progesterone therapy is needed to build new bone in menopausal women. They compare progesterone to medroxyprogesterone, which does not occur in the body and, therefore, causes many untoward effects when used in HRT. A look is taken at progesterone use after hysterectomy. The authors state that many doctors believe that progesterone is only needed to protect the uterus, but they quickly dispel this myth by stating, “Just because the uterus is gone doesn’t mean that the zillions of progesterone receptors elsewhere disappear, too!” To the authors, taking estrogen without progesterone makes no sense. They continue by looking at heart disease and the benefits of natural estrogen and progesterone therapy for maintaining proper lipid levels and heart functioning, touching briefly on the use of natural estrogen therapy for protection against senility and Alzheimer’s disease.

Regarding the use of testosterone, the authors list several functions of testosterone in women: it is a safer way to decrease cholesterol levels than many currently available therapies and enhances libido. Testosterone also has an effect on bone density, as it appears to increase bone mass. The authors then briefly mention DHEA and its usefulness in HRT, claiming that, since it is a precursor hormone to testosterone and the estrogens, it would have the same beneficial effects.

The authors examine natural hormone replacement and its correlation to cancer, a difficult task because most of the research on human breast cancer is related to horse, not human, estrogen. In studies examining the relationship between breast cancer and estrogen, estrone, equilin, estradiol, and ethinyl estradiol have all been isolated to cause cancer in laboratory animals and cell cultures. Although no large studies have been done in humans to examine the possible cancer risk of estriol or triple es-trogen, estriol is not believed to cause cancer and may possibly be cancer protective. But, in order to prove this, large-scale studies are needed. The authors introduce progesterone and its clear protective effect on breast cancer, citing a study in which progesterone- deficient women had a greater risk of premenopausal breast cancer than did women with normal progesterone levels. Again, the authors note that more research is warranted.

The last portion of this book is devoted to teaching the dosing and prescribing of natural hormones. The authors state that, if hormones are to be replaced, estradiol, estrone, estriol, progesterone, DHEA, and testosterone are the only options, to be replaced just like the natural pattern of circulating hormones. They define triple estrogen and state that compounding pharmacies carry this product. Since progesterone occurs naturally with estrogen, the authors give dosing guidelines on how to accomplish this through supplementation. They give suggestions as to DHEA and testosterone doses and advise as to when cyclical therapy should be instituted and when the hormones can be supplemented every day. They suggest food and herbs that can be used along with natural HRT.

A final resource section focuses on how to obtain natural hormones – on prescription from compounding pharmacies. The authors describe a compounding pharmacist and make mention of the special training required. They mention the extra motivation compounding pharmacists have to satisfy each patient with an individualized prescription and list resources for finding a compounding pharmacist and doctors prescribing natural hormones.

Reviewed By:  Gina Ford, RPh
In:  Jan/Feb 1998