Hormones – Frequently Asked Questions

What is Natural Hormone Replacement or Bio-Identical Hormone Replacement?
Natural Hormone Replacement Therapy (NHRT) is an attempt to ‘replace’ some of the normal hormones in your body that have declined as a result of peri-menopause or surgical menopause. One of the differences between the natural vs. synthetic hormones is that the natural hormones are “bio-identical”, meaning they are exactly the same as what your body makes. In fact, if you looked under a microscope at the chemical structure you could not tell the difference between the bio-identical hormones and the body’s hormones.

Where do the Bio-Identical Hormones come from?
Bio-Identical Hormones are just that, they are natural and bio-identical to a person’s body. They are made from plant sources. The source of the estrogen is soy, and progesterone can be obtained from either soy or yams.

Which hormones are in need of replacement?
That all depends on the individual, most commonly women experiencing a decline in hormone levels may require some type of estrogen as well as progesterone. Some patients also take testosterone, DHEA and other hormones.

How do you determine which hormones and how much is necessary?
Various methods can be used to measure levels of hormones, everything from blood to saliva to urine tests. The information that these tests provide is somewhat limited because hormone levels fluctuate normally from day to day and month to month. When you get lab results from a hormone test it is based on a single point in time. Also, the range of hormones is based on ‘the average’, but many people fall outside what is ‘average’. For that reason, many clinicians rely more on the symptoms that patients may be experiencing.

What is Tri-Est & Bi-Est?
Both Tri-Est and Bi-Est contain the bio-identical (and natural) hormones that are found in all people. Tri-Est contains 3 of these estrogens (Estriol 80%, Estradiol 10%, and Estrone 10%), while Bi-Est contains 2 of the 3 estrogens (Estriol 80% and Estradiol 20%).

Does my insurance cover Bio-Identical Hormone Replacement?
Insurance may pay all, part or nothing. It depends on what type of drug coverage you have. We can try to run your insurance through our computer via a modem to find out if it will be covered. If we do not participate in your insurance plan (some plans have limited pharmacy enrollment or specify which pharmacy you must go to) we can provide a universal claim form for you to submit to be reimbursed for the cost according to your insurance plan. Insurance questions can best be answered by your benefits coordinator at your insurance company as they determine what is covered and what is not.

How should I approach my physician or nurse/How do I get a prescription for Bio-Identical Hormone Replacement?
Some doctors and nurses are familiar with Bio-Identical Hormone Replacement while many are not. We suggest that you first educate yourself about natural hormones before discussing it with your doctor or nurse. After learning more about Bio-Identical Hormone Replacement, approach your current GYN or physician first. Often people develop a relationship with their current GYN or physician. If your current physician is unfamiliar with Bio-Identical Hormone Replacement, The Natural Pharmacy can help with dosing questions and specific information. If your physician is unwilling to consider Bio-Identical Hormones, you may want to seek out another physician that is more receptive. The Natural Pharmacy can recommend doctors and nurses that are familiar with Bio-Identical Hormone Replacement, but again, The Natural Pharmacy feels strongly that you should at least approach your current doctor with the request first.

Why would you consider Hormone Replacement?
Throughout their lifetimes, women experience the ebb and flow of hormones within their bodies. Drastic changes often are first felt during puberty, a time when there is a significant increase in estrogens, progesterone, testosterone, as well as other hormones. Puberty and menarche mark the beginning of reproductive life and menopause marks the end of it. During the period between these two phases of a women’s life, her hormone levels will continue to fluctuate, but gradually over time these same hormone levels will begin to decrease.

As a woman makes the transition from the reproductive to the non-reproductive stage of her life, her body undergoes important hormonal changes once again. Estrogen, progesterone, and other hormone levels may decrease and become imbalanced. This change can occur slowly or rather rapidly and can be initiated through hysterectomy. Often the signs of imbalance appear as familiar symptoms such as hot flashes, depression, anxiety, mood swings, vaginal dryness and sleep disruption to mention a few. Long-term, these same imbalances may lead to an increased risk of heart disease and osteoporosis (a decrease in bone density that increases the likelihood of fractures).

It is not uncommon for women to attribute the onset of the above-mentioned symptoms to something ‘age related’. Or perhaps she may have a generalized I-just-don’t-feel-right feeling, but cannot put a finger on exactly just what’s wrong. Often these problems are directly associated with an imbalance of hormones. It’s very reassuring to discover that the source of so many problems may have a single cause that’s related to hormonal imbalance. Physicians can determine if this may be the cause of the problems by measuring a FSH level (follicle stimulating hormone) from a blood sample.

The medical term for this phase in a women’s life is known as perimenopause, or the time prior to complete cessation of her period. Perimenopause is different for all women, but in general it is a time when cycles may shorten and become irregular. A woman’s period may also be irregular and sporadic. Skipping a cycle or failing to ovulate are quite common occurrences during perimenopause. If you imagine a woman’s hormones prior to perimenopause as a rapidly spinning top, the top begins to slow as hormone levels decrease. Perimenopause brings a marked drop in hormones that may cause the hormonal ‘top’ to wobble. This unpredictable wobble is usually when most women first feel the symptoms of ‘the change’. Eventually, the top will stop completely and a woman has now entered menopause.

Hormone replacement therapy (HRT) is an attempt to rebalance a woman’s hormone levels. There are three primary reasons why a woman may want to consider HRT. Short-term it is used to help alleviate the unpleasant symptoms related to ‘the change’ and help improve quality of life. Long-term it is used to reduce risk of heart disease and osteoporosis. Hormone replacement can be accomplished by different means and it is important that every women considering HRT know and understand treatment options.

Most commonly HRT involves using replacement sources of estrogen and progesterone, but it may also include other hormones. There are a few misconceptions concerning estrogen. Estrogen is commonly thought of as a single hormone, and is often called a “female sex hormone”. This is not true. Estrogen occurs in both females and males and actually consists of three separate hormones in the human body: estrone, estradiol, and estriol. All three types of estrogens collectively play an important role in maintaining hormonal balance.

Currently the most commonly prescribed sources of HRT are from drug manufacturers. They have created and patented chemicals or combinations of chemicals that may closely resemble what a human body naturally produces. These synthetic or conjugated estrogens are derived from a variety of sources including plant and animals, however they do not match what is natural to the body. These small differences at the molecular level may cause some of the side effects related to synthetic estrogens such as bloating and weight gain. Conjugated estrogens contain non-human estrogens. Other products may contain only one of the three types of estrogens. In addition, conventional therapy has a limited variety of strengths and sometimes the “one size fits all” does not work. There are alternatives however.

Bio-identical hormone replacement consists of hormones that are derived from plant sources and synthesized in a laboratory. These hormones are considered bio-identical because they match exactly what the human body produces at the molecular level. They are used by compounding pharmacists to custom prepare a balance of hormones that are unique to each individual woman. Since these hormones are identical to what the body makes naturally, they tend not to have the side effects associated with the synthetic hormones. Compounded formulations are custom made to meet the specific needs of each woman based on her individual needs. Most formulations contain the estrogens in approximately the same concentrations as that of pre-menopausal women.

An often-asked question about bio-identical HRT is: why doesn’t a drug manufacturer make a product using these same estrogens? The answer is that these natural hormones cannot be patented anymore than one could patent air. Therefore, there is little incentive to manufacture bio-identical hormones.

Bio-identical hormone therapy has been around for years in Europe and the United States. It offers an alternative to patients seeking a ‘natural’ approach to HRT and to those patients who have tried conventional therapy and failed. As with traditional therapy, bio-identical HRT is available by prescription only and needs to be discussed with your healthcare provider.