By Virginia Hopkins

Some good reading and some misconceptions about natural, bioidentical hormones.

In her book The Sexy Years, Suzanne Somers has done a wonderful job describing the perils of the hormonal imbalances that menopause can bring, and she has certainly put natural, bioidentical hormones on the map with media appearances on everything from Home Shopping Network to the Larry King Show. The Sexy Years is a good read, with plenty of personal stories, helpful descriptions of how hormones work, and some interesting interviews with physicians who use bioidentical hormones in their medical practices.

In particular, Somers draws from her friend, Dr. Diana Schwarzbein (author of The Schwarzbein Principle), an endocrinologist who uses natural, bioidentical hormones. Dr. Schwarzbein has drawn heavily from Dr. Lee’s work over the years, and they even borrowed a slightly altered version of his Three Rules for Hormone Replacement for Somers’ book, which you can find in the original on this website (http://www.johnleemd.com/thruforusbih.html).

Pregnancy, Hormones and Health
Somers does seem to have some misconceptions about a few important issues. When referring to natural, bioidentical hormones, she states that, "These hormones are not available in health food stores or from naturalists or herbalists." In truth, estrogen and testosterone are only available by prescription from a doctor, but progesterone cream is easily available at most health food stores and on the web.

Another statement Somers makes is that, “Postmenopausal women should not be mimicking pregnancy since the risks associated with pregnancy (heart attack, stroke, type 2 diabetes, and breast cancer) increase exponentially with age.” Scharwzbein reiterates this in her interview, but unfortunately does not explain her theory. While a few pregnant women are susceptible to gestational diabetes and eclampsia (high blood pressure), this doesn’t mean that the hormones of pregnancy directly cause these problems. In fact, the majority of women are radiantly healthy during their last trimester of pregnancy, when hormones are the highest. Pregnancy hormones may cause a flare-up of a breast cancer tumor that was already established, but long term, one of the best-established factors that lowers the risk of breast cancer is pregnancy. In fact, the earlier a woman gets pregnant, and the more pregnancies she has, the lower her risk of breast cancer. For details on hormones and breast cancer, with extensive documentation, please read What Your Doctor May Not Tell You About Breast Cancer.

You Don’t have to have Periods to Have Postmenopausal Hormone Balance
It is very true that postmenopausal women do not want to be mimicking pregnancy by using high doses of bioidentical hormones continuously, without a break, and Somers and Schwarzbein make a good case for this in The Sexy Years. As Dr. Lee frequently pointed out, it’s important to take a break from hormones for a week or so each month. That way, if there is any buildup of tissue in the uterus, it can be shed in menstruation.

On the other hand, it is not necessary for a postmenopausal woman to have periods if she is using bioidentical hormones properly. When postmenopausal women use small doses of bioidentical hormones, they rarely, if ever, have periods, nor do they have the risky endometrial buildup in the uterus which is what makes it important to have periods. Estrogen stimulates the buildup of uterine tissue, but there’s no need to take that much estrogen to feel healthy and balanced. Since fat cells create estrogen, women who are heavy may not even need to use supplemental estrogen.

Dr. Lee’s recommendation was always to use 15 to 30 mg of progesterone daily, and the lowest dose of estrogen that would either clear up estrogen deficiency symptoms or show normal levels on a saliva hormone level test. This improves health and well-being, but doesn’t put a postmenopausal woman back into the same hormonal milieu she had when she was menstruating every month.

These misconceptions are undoubtedly due to 1) the use of the oral (pill) form of progesterone (e.g. Prometrium), and 2) the use of blood tests to measure hormone levels.
When you take progesterone in a pill form, most of it goes directly to the liver, where up to 80 percent of it may be dumped, but not before creating a variety of byproducts (metabolites). Thus, it’s necessary to take 100 mg of progesterone in pill form to get 20 mg into your cells. If your liver happens to be working less efficiently on a given day, and excretes less of the progesterone, it’s easy to experience overdose side effects such as sleepiness and bloating. These side effects often have women running for more estrogen to wake themselves up again, but what they really need to do is use progesterone cream, which is a much more efficient delivery method: if you put 20 mg on your skin, virtually all of that will be in your bloodstream within a matter of minutes.

Blood Tests vs. Saliva Tests
The other misconception is that a standard blood test will give an accurate indication of hormone levels. Standard blood tests measure the amount of hormones in the serum, or watery part of the blood. However, the majority of hormones found in serum have been inactivated and are on their way out of the body. Active (bioavailable) hormones are carried on the red blood cells and these are what matters. Some doctors are now doing hormone testing with red blood cells, but it’s much easier and less expensive to test saliva hormone levels. Active hormones are filtered into your saliva, and these can be accurately measured with a simple at-home test.

Overdosing Creates the Same Old Problems
This misconception about measuring hormones has been particularly misleading among those who use bioidentical hormones because one must take massive overdoses of hormones before they’ll show up at all in a standard blood test. This has led to the practice of using way too high a dosage, particularly of estrogen and progesterone, and that just creates further hormone imbalances. Overdosing, even with bioidentical hormones, is a setup for a long list of familiar side effects, including weight gain, bloating, insomnia, hot flashes and night sweats.

Excess estrogen is particularly problematic, not just because it causes the symptoms above, but also because it’s an “upper,” or stimulating, and it can, in effect, become addictive. In excess, estrogen can create a kind of hyper-talkative, restless, even agitated state that passes for increased energy. The brain gets used to the higher level of “excitement” and when estrogen levels drop, it can cause depression and fatigue. If you’re leading a stressful life, taking more estrogen to pump up your energy is akin to taking drugs such as speed – it may produce a temporary high, but there’s always a corresponding low to follow. The wiser strategy is to manage stress by eating well, getting plenty of sleep and exercise, practicing some form of meditation, supporting adrenal function (see What Your Doctor May Not Tell You About Menopause for details), and creating hormone balance.

If you’d like detailed information on how to use natural, bioidentical hormones in a way that creates balance, and is in tune with your body’s natural way of doing things, please read the newly updated and revised edition of What Your Doctor May Not Tell You About Menopause.