If It's Not Prescription, It May Not Help

By Jeanie Lerche Davis
WebMD Feature

Reviewed By Charlotte Grayson

It's difficult enough taking the step toward hormone replacement therapy. Now you must choose to take natural or synthetic hormones.

"It's not always clear what is meant by 'natural'," says James A. Simon, MD, a reproductive endocrinologist and medical director of Women's Health Research at George Washington University in Washington.

"Whether the chemical comes from a plant or from horse urine doesn't mean it isn't natural. It's perfectly natural. These natural substances contain hormones that are similar to those in the human body," Simon tells WebMD.

The hormones found in certain plants and horse urine are what's called "precursor hormones -- they can be made into any steroid hormone like estrogen." For more than 100 years, it's been well known that the urine in pregnant mares is high in many hormones, Simon adds. And that's been the main estrogen component in many HRT options.

However, "those naturally occurring hormones are not rapidly metabolized in the human body" Simon says. "They must be chemically modified to facilitate absorption. They also are not as potent as the hormones that occur naturally in your body. The goal of synthesis is to make a pill-size dose; you don't want to take a tennis-ball sized dose."

Unfortunately, "natural" hormones may have the opposite problem. Some data suggest that they are too rapidly metabolized by the body to do much good.

While HRT has taken heat because of some side effects, "the scientific community and the pharmaceutical industry are working very hard to develop safer and more effective hormone therapies," he says. "They're getting better, but they're not perfect yet."

There are estrogen patches that contain the same estrogen that the human body contains; it isn't chemically modified, he says.

Also, estrogen creams, gels, and lotions contain estrogen; however, "they produce highly variable results because you're spreading it over the skin surface area, and the amount is not always the same. Also, some formulas are absorbed better than others. These products are not FDA-regulated, so they are less well-studied. Most creams gels are formulated by independent compounding pharmacists who are not FDA-regulated."

However, estrogen cream, when applied directly to the vagina can help with the vaginal dryness that often occurs after menopause.

While there's no data on natural hormone therapies, "women have reported fewer side effects like depression when taking natural progesterone," says Lila E. Nachtigall, MD, a reproductive endocrinologist and director of the Women's Wellness program at New York University School of Medicine in New York City. "But there really is no science yet on these products," she adds.

Only one natural progesterone pill, Prometrium, has been approved by the FDA, Nachtigall tells WebMD. And a natural progesterone cream, Crinone, can be used to prevent miscarriage or slow excess bleeding during perimenopause.

"There's a lot of stuff sold over the counter that's not FDA-approved but there is no scientific information about that," she says. In fact, one study of a "very popular cream that you rub over your belly ... found that it didn't work at all -- that women are just wasting their money," Nachtigall adds.

"In fact, the man who markets that cream writes his own reviews and publishes these brochures that are handed out in health food stores, and women read them and believe them. But it's honestly useless. And that in itself is "probably good because if it was active, it would probably do a lot of harm."

When prescribing hormones, "doctors need to keep in mind that every woman is different`" says Simon. "They should not treat her like they would treat their mother or any other woman. She has her own needs, her own goals. It's really important in reducing and eliminating symptoms of menopause."

Originally published Oct. 7, 2002

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