Updated 18 August 2015

Bio-identical hormones & others

Bio-identical hormones, phyto-oestrogen and black cohosh are increasingly popular ways of dealing with menopause symptoms. How effective and safe are they?


Many menopausal women consider non-hormone options to deal with menopause symptoms such as hot flushes.

Some women shouldn't use menopause hormone therapy (MHT) due to their specific risk profile, and some wish not to use MHT due its side effects, which can include bloating, headache, nausea, breast tenderness and weight gain. MHT should also only be considered if common sense to manage symptoms and a practical approach doesn’t help.

But unlike MHT, alternative remedies don’t have to conform to the strict requirements of the SA Medicines Control Council (MCC) before they’re made available to the public. They're not registered with the MCC and purity and testing are unknown.

People also often assume medicines derived from plants are safe, but there’s no proof this is really the case. Some herbal medicines can have serious side effects, such as liver damage, while others can interfere with the effects of other medication.

On the other hand, research has proved beyond all doubt that MHT works, and works well.

It’s ironic: people who want to use natural remedies avoid MHT, yet all oestrogen prescribed by doctors has a natural origin (either plant or animal). The oestrogen is adjusted slightly so that it corresponds exactly with the oestrogen naturally produced by the human body. It’s so natural, in fact, that the female body can’t distinguish between its own oestrogen and MHT.

There have, however, been some positive results with a few alternative therapies. We take a closer look...

Natural oestrogen supplements
Natural oestrogen supplements, or so-called phyto-oestrogens, are derived from plants.

Surprisingly, they have an affinity for the receptors in the human body that are designed to attract oestrogen-type molecules. But, this affinity for oestrogen receptors is much lower than that of human or other animal oestrogens.

Most experts agree that phyto-oestrogens can help with some of the symptoms of menopause such as hot flushes. The supplements that are most effective are black cohosh, genistein and soy-based products.

However, the evidence from clinical trials is that these supplements have little or no effect on other problems associated with menopause, such as vaginal dryness, developing osteoporosis, and an increased risk for heart disease.

Another possible problem is that much higher doses of phyto-oestrogens are needed to control symptoms like hot flushes than are needed with conventional oestrogen-containing products. This means that certain oestrogen-sensitive cancers such as breast cancer may be worsened in women taking these products.

Natural progesterone cream
Progest, a natural progesterone cream, is popular among some women. In 1990 a doctor claimed that progesterone absorbed through the skin was better than oestrogen in preventing and reversing osteoporosis.

However, this claim was not supported by clinical trials of the cream, even when it was used at two to four times the amount suggested by the manufacturer.

Bio-identical hormone therapy
According to claims by manufacturers, bio-identical hormones claim to do everything from helping menopausal women lose weight to preventing senility. They're touted as safer and sometimes even more effective than MHT.

But experts warn that these claims are unproven and that the products are potentially dangerous There's little or no scientific and medical evidence to support claims that BHT is safer and as effective as HT.

What's more, many bioidentical hormone formulations are not subject to oversight by the MCC and can be inconsistent in dose and purity.

Marketers of bio-identical hormones often say the products are identical to hormones produced by the body, and these "all-natural" pills, creams, lotions, and gels don't carry the risks of menopausal hormone therapies approved by the MCC.  

Keep in mind that:

  • Approved hormone therapies are available on prescription only.
  • Bio-identicals will have the same risks as the products they're identical to - namely a heightened risk of breast cancer and serious heart problems. There may be other, as yet unknown risks as well.
  • Beware of claims that bio-identical products can be made based on hormone levels measured from a woman's saliva sample. Hormone levels fluctuate constantly. Saliva tests aren't specific enough to determine drug dosages.
  • No drug containing the hormone estriol (the weakest of the three oestrogens produced by the body) has been approved by the MCC.  

- (Health24)


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