‘Natural’ hormones no better

Hormone supplements derived from plants are widely promoted as more 'natural' than hormones from horses, but they carry the same risks - and some more of their own.

The New Zealand Menopause Institute claims to be able to end the symptoms and long-term consequences of menopause through advice on diet, exercise and taking 'natural' hormones. The New Zealand Men's Clinic makes similar claims.

This natural Hormone Replacement Therapy (HRT) uses what are known as bio-identical hormones, which the institute claims on its website are different to synthetic hormones given as conventional HRT. They explain that synthetic HRT is dangerous because it is extracted from the urine of pregnant horses whereas bio-identical hormones are much safer because they are not altered but match the hormones found in the human body. They go on to quote Dr Jonathan Wright (an American advocate of natural hormones) who says "natural oestrogen and natural progesterone provide all the benefits of the synthetic forms, while there is little risk of endometrial or breast cancer." He also explains that "the word natural is used to refer to the structure of the hormone molecule, not its source." The source for natural hormones is wild yam or soya bean; the extract is converted to match the hormones found in the human body, ensuring a much safer match than horse hormones. Bio-identical hormones are extracted from wild yam or soya beans.

Spot the contradiction in their claim: These bio-identical hormones are firstly said to be unaltered then we are told they are converted to match body hormones!

Over the phone a nurse at the institute informed me that the hormone supplementation was natural because the amount prescribed was tailored (compounded) to the needs of the patient and may even be in extremely tiny amounts (warning bells!).

Aside from the issue of extremely small amounts used as a treatment modality I wanted to find out whether there was any evidence that bio-identical hormones worked and were safer than conventional HRT.

Looking on-line, there seems to be a lot of scientific evidence that bio-identical HRT has the same risks and benefits as other forms of HRT. The nurse I spoke to said she only knew of anecdotal evidence from thousands of patients. And Oprah Winfrey.

This is from the Harvard Medical School website (www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm ):

"Bio-identical oestrogens are 17 beta-estradiol, oestrone, and estriol. (Estradiol is the form of oestrogen that decreases at menopause.( Bio-identical progesterone is simply progesterone. It's micronized (finely ground) in the laboratory for better absorption in the body.

"Bio-identical hormone therapy is often called "natural hormone therapy" because bio-identical hormones act in the body just like the hormones we produce. But here again, that tricky word natural muddies the waters. Pregnant mares' urine is natural, but Premarin is not bio-identical, at least not to human oestrogen. The same goes for Cenestin, which is made from plants but is not bio-identical. Technically, the body can't distinguish bio-identical hormones from the ones your ovaries produce."

An informative Wikipedia article on bio-identical hormone replacement therapy cites a large number of studies showing that bio-identical hormones not only have the same risks as conventional HRT but can present extra risks due to compounding.

The International Menopause Society, American Congress of Obstetricians and Gynecologists, Society of Obstetricians and Gynecologists of Canada, The Endocrine Society, The North American Menopause Society (NAMS), United States Food and Drug Administration, American Association of Clinical Endocrinologists, American Medical Association, American Cancer Society and the Mayo Clinic have all released statements that there is a lack of evidence that the benefits and risks of bio-identical hormones are different from well-studied non-bioidentical counterparts; until such evidence is produced the risks should be treated as if they were similar; and that compounded hormone products may have additional risks related to compounding. A major safety concern in bio-identical hormone replacement therapy is that there is no requirement to include package inserts, despite the potential for serious and possibly life-threatening adverse effects associated with HRT. Regulatory bodies require pharmacies to include important safety information with conventional hormone replacement therapy (CHRT) via package inserts.

The US Food and Drug Administration website (www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm) says:

"Many claims have been made by marketers of compounded "bio-identical" hormones, also known as "bio-identical hormone replacement therapy" (BHRT). But these claims are unproven. FDA is concerned that claims like these mislead women and health care professionals, giving them a false sense of assurance about using potentially dangerous hormone products."

My concern is that the many ads on the radio for treatment at the New Zealand Menopause Institute (as well as its counterpart New Zealand Men's Clinic) will - as do so many ads for natural health products - mislead people into parting with a large amount of money for something that could do them a lot of harm.