Natural Bioidentical Hormone Replacement Therapy – A Pharmacist’s Awakening

What really kept me learning about BHRT in the beginning of my compounding (about 6 years ago) was the simple fact that I (even as a pharmacist) did not know that there were three different estrogen entities in the human body. I was in fact running under the assumption that all estrogens were the same. The fact that nature made E3 (weak /80%), E2 (strong/10%) and E1 (intermediate strength/10%) in a unique strength and number was intriguing. I also knew nature is accurate or we would not exist. Why would nature need a set of molecules like E3 that are both very numerous and weak? In fact, E3 reminded me of tamoxifen. Tamoxifen was an older shielding, nonbioidentical, manufactured molecule that was given to women to prevent the recurrence of breast cancer. Hence the concept of BHRT’s shielding approach was learned and adopted. I learned that a hormone really has at least three functions:

1) To act on its own receptors

2) To shield /buffer another hormones receptors and

3) To act as a potential filler hormone when it is metabolized by our biochemistry.

Thus, if you introduce a foreign molecule to the human body one or all three of the above functions can get messed up. This reminded me of medroxy-progesterone = MPA (also known as Provera) and the difference in HDL lowering displayed between natural progesterone and MPA in the PEPI study and for mpa alone in the much bigger WHI study. MPA greatly reduced our good cholesterol = HDL, while natural progesterone did not..

BHRT follows the human body as follows: with bioidentical molecules that fit human biochemistry; molecules in the right ratio and titrated to the lowest effective dose; molecules that work together to provide a shielding effect against over stimulation by the estrogen signal; by mimicking and paralleling the female menstrual cycle where possible. In essence, with menopause the protective shield comes down and the net estrogen signal is over-amped. It comes down mainly because the shield progesterone was about 90% made by the ovaries that are no longer working to capacity. Two other shielding hormones E3 and testosterone are usually lowered as well in menopause. The state of the adrenal and thyroid glands factor in as well. Since the net estrogen signal is what caused a female to grow her uterine lining when she was still cycling you could call the net estrogen signal proliferative in nature or “a cellular go signal”.

Thus, menopause is probably not a healthy state to be in as this “go signal “is amped up leading to a host of symptoms, potential and documented cellular changes and a lowered quality of life. It should be noted that conventional therapy rarely focuses on shielding and balancing of bioidentical hormones. Conventional therapy seems to be more concerned with the older, imbalanced way of giving hormones and the negative studies involving foreign, nonbioidentical molecules such as horse estrogen and MPA. Conventional therapy seems to equate the different molecules and therapy in the WHI study with the BHRT molecules and their very different therapeutic approach in general. Sorry doctors, not all estrogens are the same ( the molecules differ in structure for peats sake) and the therapeutic approach and the concepts of balance and shielding do matter!

Robin Small (B.Sc.Pharm), Compounding Specialist and PCCA member

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