Many women, faced with the recent news about the risks associated with hormone replacement therapy, are turning to alternative approaches - natural products, bio-identicals, and so on. Dr Michael Goodman, a specialist in peri-menopausal medicine, guides us through the maze of options available in this area.

Dr Michael Goodman is a highly-qualified OB-GYN who has over 33 years' experience in the fields of gynecology, obstetrics, and peri-menopause medicine. He has distilled his knowledge into a book - 'The Midlife Bible-A Woman's Survival Guide' - that will be invaluable to all women before, during, and after menopause. This article is an edited extract from his book. Robert Griffith, Editor.

You can buy The Midlife Bible at Amazon, just click here

Natural and Personalized Hormonal Products in Womens' Health

What is "Natural"? Depends on who you speak with and what they are trying to sell you. By definition, "natural" means "native to plants or animals." But, by that definition, the much maligned female replacement hormone Premarin (made from pregnant mare's urine) would be considered ". . . natural."

In reality, "natural" has become little more than an advertising gimmick, meant to corral people into buying a product. "Natural" for what? Native to whom? Just because it's "natural" doesn't mean it's good, effective or even safe.

Just what is in that supplement? What does it really do? How safe is it; how does it interact with other foods or medications you are taking? Is it really effective or are the "wonderful effects" your neighbor, health food store, or vitamin supplement purveyor is touting simply part of the known 30%-plus placebo effect of most "medicinal products" (which rises to 50% or more for hormonal-type supplements).

Don't get me wrong. PLACEBO IS GOOD. If it helps, doesn't hurt you and doesn't empty your pocketbook, well...great!

Let's be a little clearer and eliminate the word "natural". There are many healthy, low risk, non-"chemical" ways of expanding and personalizing your health and happiness with herbs, botanicals, supplements, compounded preparations and bio-identical hormones without ". . . Better Living Through Chemistry" (although just as "natural" is not necessarily all good, "synthetic" is not necessarily bad).

Let's call a spade a spade. Here are some definitions and information.

• Herbs and Botanicals . Herbs are made from the leaves of certain plants. Botanicals can come from leaf, stem, root or rhizome. Many plant sources have active purported medical effects, but few have been well studied in placebo-controlled blinded studies (remember the large placebo effect found in observational studies, pretty much the only kind of study botanicals have been submitted to). If you take herbal or botanical supplements, you should know what you are getting and any inherent risks. I would recommend consulting a good herbal or Complimentary and/or Alternative Medicine book. I can recommend two: "Tyler's Honest Herbal" by Foster and Tyler, and the "Professional's Handbook of Complimentary and Alternative Medicines" by Fetrow and Avila (see links below).
• Supplements and Vitamins are not regulated by the FDA; therefore, you really don't know if the product you are buying really has what it says it has and at the dosage it says and if it's biologically active. I would recommend consultation with a trusted health food store or herbalist (not just with a sales person), or purchasing from a reputable and trusted source, such as PhytoPharmica ( www.phytopharmica.com ).
• Bio-identicals . Many so-called "natural hormones" are truly bio-identicals. A bio-identical is a compound synthesized from a natural product (estrogen and testosterone from soy; progesterone usually from wild Mexican yam root) to exactly mimic the molecule found in nature. While Mexican yam contains no progesterone , bio-identical progesterone is synthesized from it. Most of the so-called "natural hormone creams" are truly bio-identicals, and they are truly hormonal products (although you never know exactly what and how much you are getting in over-the-counter preparations - it's probably best to have these compounded by a professional). Estradiol, BiEst and TriEst, progesterone in cream lotion or capsule form, and testosterone creams, lotions, capsules and gels are bio-identicals, as are some DHEA and pregnenolone preparations
• Compounding is a process whereby a specially trained pharmacist mixes, or compounds medicinal products (hormonal or otherwise) to the exact specification of the ordering health care provider, and in the vehicle (cream, lotion, gel, drops, capsules, troches, etc.) desired. Several physicians and nurse practitioners (including myself) do their own compounding, carefully adjusting to the exact needs of their patients. There are compounding pharmacies in California here in Davis as well as in Woodland, Sacramento, Gold River, Grass Valley, etc. Contact the International Association of Compounding Pharmacists (IACP) at http://www.iacprx.org/ .
• Phytoestrogens are compounds with estrogen-like activity from common plant sources. Plants manufacture many thousands of different types of chemical substances, all of which contribute some function to their health. That same vast array of substances (known as micronutrients) is present in the human diet whenever plants are eaten. Because of the evolutionary link between human and plant cells and the fact that they share certain basic metabolic functions, it's reasonable to expect that some of these substances will have related effects in both cell types. Thus plants, especially legumes, manufacture estrogen-like compounds, collectively known as phytoestrogens, which fulfill a range of functions within the plant. Phytoestrogen compounds with estrogen-like activity include lignans (vegetables, fruits, nuts, cereals, spices); isoflavones (soy, peas, beans, spinach, fruits, clovers, flax seed); flavones (beans, green vegetables, fruits, nuts); chalcones (licorice); diterpenoids (coffee); triterpenoids (licorice, hops); coumarins (cabbage, peas, spinach, licorice) and acyclics (hops).

  Isoflavones have emerged in recent years as micronutrients which potentially could play important roles in maintaining human well-being, protecting the body from degenerative diseases. Isoflavones, being structurally related to estrogens, are able to mimic some of the effects of estrogens. Dietary isoflavones may therefore contribute to a lower incidence of menopausal symptoms, osteoporosis, hypertension and atherosclerosis as well as breast and prostate cancer. A good supplementary dose of isoflavones is 60-100 mg per day. It is not wise to exceed 120 mg per day.

Many of these and other so-called Complimentary and Alternative Medicine products have a place in maintaining health and well-being (after exercise and a healthy, balanced diet!).

Know what you are taking. Investigate. Don't take a sales person's word for it. "Natural," although frequently helpful, is not always good. Work with an educated practitioner you can trust and ask questions .

You can visit Dr Goodman's website at: http://caringforwomyn.com or send him e-mail at: Mgcaringforwomen@cs.com

Links

• International Association of Compounding Pharmacists (IACP)
• Alternative Medicine: Menopause
• Can Herbal Remedies Douse Hot Flashes?
• New Updates on Hormone Replacement Therapy

Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies by Steven Foster and Varro E. Tyler Professional's Handbook of Complementary & Alternative Medicines by Charles W. Fetrow and Juan R. Avila