Bio-Identical Hormone Replacement

You have options on how to support your body hormonally. The best way to assess your unique issues is by having an in depth consultation with Dr. Dekel.

Menopause and Natural Alternatives to HRT
Written by: Duane E. Townsend MD, FACOG is in private practice in Utah. He is board certified in OB/GYN and Gyn Oncology. He has been a professor at UCLA, USC and Univ. of Calif. at Davis. He has over 95 publications in peer review journals.

Baby boomer women are coming of age — menopausal age. More women than ever before are experiencing that infamous marker of life that signals the end of menstruation and childbearing. For decades, many doctors knew less about menopause than their patients. Fortunately, over the last few years physicians have educated themselves about the important physiological chapter referred to as “the change”. A well-informed doctor will focus on improving the quality of a woman’s life after 50, rather than merely working to extend that life. Women now have a life expectancy of more than 80 years.

What this means is that they can expect to live 30 to 40 years after menopause. Today menopause marks a new beginning rather than an ending. Menopause is not a single event that happens out of the blue. A period of time called peri-menopause usually begins several years before the last menstrual cycle. It typically starts around the age of 40 when changes in the menstrual flow and length of the cycle occur. While estrogen levels may be starting to decline, women still experience estrogen surges or dominance. Many patients who enter into the peri-menopause find that their periods become more irregular with the gradual development of PMS which can worsen until menopause

Eventually, as estrogen levels continue to dip, periods will occur more sporadically and then stop altogether. The true beginning of menopause is marked by a dramatic drop in estrogen levels. This decline triggers the primary signal of menopause, hot flashes, which can last from a few months to years. Menopause means that the ovaries no longer produce estrogen and progesterone. The ovaries will, however, continue to produce tiny amounts of testosterone which can be converted to estrogen in adipose tissue (fat stores). Regardless, the amount of circulating estrogen will be very small and progesterone production be reduced to zero


Most women take traditional HRT on the advice of their doctors because advertising campaigns made them believe that they have no other viable choices. These women have been led to believe that if they don’t take HRT, they are putting their bones and heart at risk.

For almost half a century, the FDA has approved scores of estrogen and estrogen/progestin drugs. These drugs contain estradiol, estrone, and estriol and sometimes a pinch of testosterone is added to enhance a woman’s libido. HRT comes in pills, patches, creams and pellets.

The July Bombshell

In July 2002 the news broke — one of the most extensive and largest federal studies of hormone replacement therapy that combined estrogen and progestin was halted because women taking the hormones after menopause were found to have a greater risk of breast cancer, heart disease, stroke, and phlebitis. When the announcement that HRT probably does more harm than good hit the airways, the repercussions were enormous and have yet to die down, but this really wasn’t new. Any doctor that had done his/her homework knew that the data had been there for years.

Ironically, the hope and the hype of the drug companies was that testing an estrogen/progestin drug would yield results confirming that it was safer than estrogen alone. The health effects of estrogen alone are still being studied by researchers at the NHLBI.(National Heart, Lung and Blood Institute).

The trial in question involved over 16,000 women, ages 50 to 79 who still had their uterus. It was to be an eight year trial, but after five years, researchers pulled the plug. The data was alarming — the drug combo of Premarin and Provera (a manufactured progestin) increased the risk of breast cancer, heart attack, stroke and blood clots by almost 35% compared to women who took a placebo. Another separate study in Europe just reported that HRT increased a women’s risk of developing breast cancer by 50%.

Senile Dementia

The hidden problems for HRT just never seem to end. A recent study in the JAMA pointed out that women over 65 who used HRT for 5 or more years had a four fold increase in Senile dementia.

HRT: The Last Word

A woman and her health care providor need to decide for or against using traditional HRT based on what is right for her alone.

As for myself estrogens alone or estrogens combined with progestins [HRT} are just too dangerous. I urge menopausal women to eat right, exercise and stay as close to nature as possible, (even if they choose to go on a synthetic drug). When a woman uses hormonal therapies, ie estrogen, I recommend the lowest possible dose and ALWAYS combine it with phytoestrogens (genistein) and natural progesterone cream.

In the past, estrogen prescriptions were routinely given at 1.25 mg to 2.5 mg per day. Common doses today are .625 or.5 mg. Lower doses are now being recommended in hopes of reducing the risks of these hormones. However, it is extremely easy to significantly lower their risks with isoflavones and natural progesterone.

If estrogen are used, choices are oral preparations, or patches and estrogen creams that are placed directly on the skin. Some drugs are taken daily while others on specific days of the month only. However, I find that most women do just great on the “dynamic duo’ (genistein and natural progesterone cream) alone. It is possible to take low dose estrogen with isoflavones and natural progesterone with little risk. I call this the best of both worlds. And for women with severe hot flashes, osteoporosis risk, etc. this may be the best option.

Plant isoflavones alone naturally protect breast and uterine tissue and lower cholesterol (not to mention other health benefits). Natural progesterone may further lower risk of breast and uterine cancer, may put on bone, reduce fibrocystic disease of the breast, and help prevent or even reverse wrinkling.

Natural Alternatives to HRT

Slowly but surely, more and more physicians are phasing out estrogens and progestins and suggesting more natural ways to replace lost hormones. As is always the case, if you can extract compounds from nature that mimic female hormones, you forgo many of the side effects associated with artificial chemical imposters. Over 75% of woman do absolutely nothing after menopause and they need to become aware of the potential of natural products. It is possible to get progesterone and estrogen cream by prescription from compounding pharmacies. However ,there are no natural estrogens in current drug therapies. They are all manufactured except Premarin, which is obtained from the urine of pregnant mares. However, some estrogens cream such as Bi-est and Tri-est are one step away from being natural.

Isoflavones: Phytoestrogen Powerhouses

Among the isoflavones found in nature, Genistein rules. Numerous clinical studies (over 2000) clearly indicate that Genistein acts as a desirable weak estrogen in the body. Genistein has the unique ability to bind to receptor sites in breast and other tissue that would normally link up with estrogens made by the female body. Consequently, they provide significant protection to vulnerable tissue. In other words, genistein fools the body into thinking that its own estrogen has already been there. In this way, it acts almost as an anti-estrogen. Conversely, genistein can also boost estrogenic effects by stimulating safe estrogenic activity in postmenopausal women.

Genistein is also an antioxidant, blocks certain enzyme pathways that may lead to cancer [prostate] and makes blood vessels more elastic. Clinical studies indicate that isoflavones protect against osteoporosis.

Isoflavones like genistein are metabolized by intestinal bacteria in the gut, absorbed from the intestinal tract and then transported to the liver. One reason soy-eating patients do so well is that continually consuming small amounts of soy protein can maintain steady phytoestrogen levels in the blood. Eating soy-foods that supply 50 mg/day of total isoflavones (close to what Japanese women eat) are able to maintain these levels. Is this a practical suggestion? Yes, It is possible to add a variety of soy-based foods to ones diet (soy nuts, spreads, soy milk, tofu etc.), however, many will or won’t, simply because they don’t like soy. If this is the case, an isoflavone supplement containing genistein may be a better way to go. Unquestionably, eating more phytoestrogenic foods during postmenopausal years is a good thing. If a woman is on any form of HRT, by all means they should eat soy or take genistein supplements as well as well as natural progesterone.

NOTE: For women who have had their ovaries removed and are experiencing premature menopause, low dose estrogen in combination with dietary soy supplementation and progesterone cream is advised. Black Cohash when added to Genistein and natural progesterone also provides excellent relief from hot flashes.

Menopause: A Progesterone Deficiency Disease?

In the great estrogen shuffle of menopause, the role of progesterone, not progestins, has been sorely neglected. First of all, be aware that progestin and progesterone are not the same thing. While estrogen production drops to around 40 percent during menopause, progesterone stops altogether. So even though there is a lot less estrogen , what is present is no longer balanced by progesterone — hence, even in menopause, estrogen can still dominate.

Without the mitigating effects of progesterone, vulnerable tissue (breast and uterine) is still at risk for cancer. To make things worse, giving a woman synthetic estrogen when progesterone is totally missing from her body, is even more risky. In fact, some studies have found that women low in progesterone had a tenfold increased chance of dying from cancer compared with women who have normal levels of progesterone. Replenishing progesterone may be a key to creating the best possible post-menopausal health scenario for women.

Why Don’t More Doctors Use Natural Progesterone Cream?

The lack of medical interest in progesterone stems from simple ignorance. Moreover, because only drugs can be patented, pharmaceutical companies have no way of collecting the huge profits they’ve become accustomed to from natural compounds. Unlike patented drugs, products like natural progesterone can be marketed by various companies.

Natural Progesterone for Menopause

As mentioned earlier, menopause means zero progesterone production and that’s not a good thing. Combining a good natural progesterone cream with soy isoflavones can go a long way to promote post-menopausal female health. I don’t hesitate to require the cream as an integral part of a program designed to address the risks of osteoporosis, heart disease, breast cancer, uterine cancer, hot flashes, vaginal dryness, etc. One needs to ask , “What was the body supplied with when it was in hormonal balance?” First of all, women were continually producing estrogen which was at its highest level during the first two weeks of the cycle. Progesterone was also present and rose dramatically just after ovulation when the estrogen levels dropped. Now, doesn’t it make sense to provide the body with both estrogen and progesterone once the ovaries stop making it? It never fails to amaze me that women who have had a hysterectomy are not told to replenish their bodies with progesterone as well as estrogen. Remember, I’m talking about natural progesterone not progestins (which do nothing but impair the natural chemical reactions that occur in a woman’s body).

While most studies are still in the anecdotal stage, the case for progesterone supplementation is a strong one. For instance, one double-blind study showed that using a topical preparation of natural progesterone cream led to a reduction in hot flashes in 83% of women, compared with improvement in only 19% of those given placebo.

Personally, I have found that combining progesterone cream with a genistein supplement gives even better relief. It seems that where one slacks off, the other picks up.

Micronized Progesterone

In the past, the only effective delivery system for natural progesterone was topically or through the skin. Currently oral, micronized progesterone is available by prescription. It is a form of progesterone that partially survives the digestive process and may offer another alternative to cream products. It appears to have merit for hot flashes, anxiety, depression, sleep problems, and sexual functioning, but is relatively new and more data is needed. Moreover, in order to get the desired effects from micronized progesterone, the required dosage may result in undesired intestinal side effects.

Diet, Diet, Diet

While I’m all for using soy isoflavones, natural progesterone cream and low dose estrogen to combat the foibles of menopause, nothing is as important as what is consumed.

Clearly, a diet of red meat and lots of sugar and white flour foods, is a total disaster and soon patients are taking drugs to control cholesterol, depression ,hypertension and diabetes. Over 60% of the population is overweight, a real boon for the pharmaceutical industry. Like it or not, the human body thrives on certain foods. To our great misfortune, we usually avoid the very foods we need and consume those that shorten our lives

Smart Eats for Menopause

As far as eating for menopause goes, it’s the same plan as eating for optimal health and longevity. A special diet is not needed for individual disorders or diseases. What works for one, usually works for all.

The studies on reducing heart disease, cancer and Alzheimer’s always start with an identical diet. Avoid the trans fatty acids, saturated fats, reduce omega 6 fatty acids and increase omega 3 fatty acids.

Eat more alkaline-producing foods like raw fruits and vegetables, legumes, raw nuts, and whole grains help prevent osteoporosis. Avoid fast foods, processed foods, processed sugar, hard fats and soft drinks. Eat soy foods and decrease or eliminate red meats [unless grass feed or free range, the same for chicken] and most dairy products [unless fat free]. Try tofu, soy milk, tempeh, roasted soy nuts, and other soy-based sources of phytoestrogens.

Supplements containing isoflavones extracted from soy are commercially available. Freshly ground Flaxseed (as opposed to flaxseed oil) is also a good source of phytoestrogens and Omega 3 fatty acids. Phytoestrogens are also found in red clover and kudzu.

Move Your Muscles

It’s not surprising to learn that sedentary women are more likely to have moderate or severe hot flashes and other menopausal symptoms than women who exercise. Many women note that their menopausal symptoms immediately ease up after an aerobic workout. Exercise also raises Human Growth Hormone and endorphin levels (the happy hormone), keeping weight down not only prevents bone loss but actually makes bones stronger. What more could one ask for? I’ll put it this way — exercise is not optional.

The case for diet, exercise and the natural way is clear. By modifying ones diet, exercising and taking a few supplements the cost of health care can be dramatically reduced.

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