Is Natural Hormone Replacement Therapy Better?

A pharmacist discusses its effectiveness and risks.

Medically reviewed by Femi Aremu, PharmD

Natural hormone replacement therapy (NHRT) is considered an alternative approach to conventional hormone replacement therapy (HRT). It may use natural or "bioidentical" treatments to restore hormonal balance and promote overall well-being.

The following article covers NHRT's effects, benefits, and safety considerations.

What Is Natural Hormone Replacement Therapy?

Traditional HRT uses hormones like estrogen or progesterone to counter the sharp decline in hormone levels that occurs during perimenopause and menopause. The U.S. Food and Drug Administration (FDA) approves medications used in traditional HRT.

HRT was enormously popular throughout the 1980s and '90s. Almost half of U.S. women over age 50 took these medications by 2001. But the prescribing and use of HRT took a nosedive the next year: research showed that taking prescription hormones was associated with the risk of heart disease, stroke, and breast cancer.

NHRT has gained traction in recent decades as traditional HRT has fallen out of favor. NHRT focuses on "natural" remedies to support hormone balance, such as:

• Bioidentical hormones, often custom-made by compounding pharmacists based on hormone levels in saliva

• Supplements like plant-based estrogens that may help control symptoms of menopause or other hormonal imbalances

• Lifestyle modifications, such as aerobic exercise and resistance training

• Dietary changes, like restricting calories, eating foods rich in calcium and vitamin D to promote bone strength, or foods with soy isoflavones, lignans (from flaxseed), and coumestan (from Pueraria mirifica) to increase estrogen levels

What Are Bioidentical Hormones?

The term "bioidentical hormones" can be confusing for a few reasons.

First, the definition itself. According to the Endocrine Society, bioidentical hormones are chemically identical to hormones made in the body. However, many people use the term "bioidentical" to refer to hormones that are compounded, derived from plants, or not synthetic (made in a lab).

Secondly, the FDA has approved several bioidentical hormones. These are available in tablets, patches, gels, creams, and sprays. Some of these prescription products include:

• Estradiol products like Estrace pill, Climara patch, and Estrace vaginal cream

• Progesterone products like Prometrium pill and Prochieve vaginal gel

• Testosterone products like Testim gel and Androderm patch.
  

Compounded bioidentical hormones are custom-made in compounding pharmacies, and the FDA has not approved them. This article refers to this kind of bioidentical hormone.

What the Research Says

Despite all the hype and advertising surrounding compounded bioidentical hormones, there isn't enough evidence to determine if they're safe or effective. More research is needed to know the long-term effects of these hormones on heart health and cancer risk.

There is also limited data to recommend supplements (e.g., herbs, vitamins, etc.) instead of traditional HRT. Some plant-based products have been shown to improve symptoms like hot flashes in up to 2 out of 3 postmenopausal women, but the same effects were seen with a placebo (sugar pills).

On the other hand, physical activity (both aerobic exercise and resistance training) and eating a balanced, healthy diet have been shown to help maintain hormone levels throughout aging. Added benefits to these lifestyle changes include increased bone strength and mental function.

Balancing Your Hormones

When people talk about HRT, they are usually referring to supplementing with prescription versions of the following sex hormones:

• Estrogen

• Progesterone

• Testosterone

These chemical messengers play a crucial role in various processes in the body, including:

• Metabolism. The hormones insulin and estrogen metabolize (break down) food. Low levels of these hormones are associated with conditions like diabetes, heart disease, and obesity.

• Reproduction.

• Mood regulation. Estrogen helps regulate emotions and the body's response to stress. Testosterone helps protect against anxiety and depression.

• Immune function. Estrogens act to increase the body's immune response, while progesterone decreases it. Testosterone may help protect against autoimmune disorders.

Hormone levels fluctuate throughout the life cycle and can be exaggerated by some medical conditions. Events that are associated with hormonal changes include the following:

• Perimenopause, the two to five-year period before menopause that's marked by decreases in estrogen and progesterone levels in females

• Menopause is when menstrual periods stop, and estrogen levels sharply decline. During this transition, many women experience hot flashes, trouble sleeping, and mood changes.

• Oophorectomy (surgical removal of the ovaries) is characterized by a sudden decrease in estrogen

• Cancer treatment, which can also be associated with dramatic menopause symptoms due to changes in hormone levels

• Andropause, a decline in testosterone levels in men that begins around age 20 or 30

Maintaining hormone balance is crucial for overall health, vitality, and quality of life. But as with many things, finding this balance can be very tricky.

Common Hormonal Imbalances

Common hormonal imbalances that can affect both men and women include:

• Estrogen dominance. High levels of estrogen in the body can cause autoimmune disease, cancer, polycystic ovary syndrome (PCOS) in women, and gynecomastia (male breast enlargement) in men.

• Progesterone deficiency. Low levels of progesterone are associated with infertility or miscarriage, premenstrual dysphoric disorder (PMDD), and postpartum depression in women.

• Low testosterone (low T). Testosterone levels in both men and women decline with age. Low T in men can contribute to sexual dysfunction, risk of heart disease, and decreased muscle mass. Low levels in women can affect sexual desire and libido.

• Thyroid dysfunction. Hyperthyroidism occurs when there is an excess of thyroid hormones. Hypothyroidism happens when the body doesn't make enough thyroid hormones. Hashimoto's is when the body attacks its own thyroid tissue, which can cause hypo- and hyperthyroidism.

Signs and symptoms associated with hormonal imbalances include the following:

• Fatigue

• Weight gain

• Mood swings

• Sleep disturbances

• Libido changes
  

These can be vague and aren't always associated with hormonal issues. Your healthcare provider can help you determine if your symptoms are related to a hormonal imbalance and develop a treatment plan if so.

Benefits of Natural Hormone Replacement Therapy

Some people use NHRT to address hormonal imbalances and promote well-being. NHRT is marketed for uses like the following:

• Relief from menopausal symptoms (e.g., hot flashes, night sweats, vaginal dryness).

• Improvement in mood, energy levels, and cognitive function.

• Support for healthy aging, bone density, and cardiovascular health.

• Enhancement of libido and sexual function.

Keep in mind that while traditional HRT has proven benefits for some menopausal symptoms, NHRT has not been proven effective. This doesn't mean that NHRT can't help, but it does mean that more research is needed before these alternative treatments can be routinely recommended.

Supplements for Natural Hormone Replacement Therapy

Dietary supplements that have been studied for hormone replacement therapy include

• Calcium and vitamin D: Can increase bone mineral density and prevent fractures after menopause.

• DHEA: Your body uses DHEA to produce the female and male sex hormones estrogen and testosterone.

• Isoflavones: Found in soybeans, these compounds act like estrogens. They've been shown to reduce hot flashes and promote bone strength.

• St. John's wort: Used to relieve symptoms of menopause.

• Valerian: Used for anxiety, hot flashes, and sleep problems.

• Black cohosh: Used to alleviate menopausal symptoms such as hot flashes and night sweats, though it's unclear whether it is effective or not.

• Dong quai: Typically used with other herbal supplements for menopausal symptoms or reproductive issues in females.

• Maca root: Believed to help balance hormones and improve energy levels and libido.

• Vitex (chasteberry tree): Often used to support hormone balance and relieve premenstrual syndrome (PMS) symptoms.

• Vitamin E: Some research shows it can reduce the severity of hot flashes, but more evidence is needed.

• Wild yam (Dioscorea villosa): Several menopause products contain wild yam, which is claimed to help reduce hot flashes due to its diosgenin content. However, your body cannot convert the diosgenin in wild yam into progesterone; this can only be done in a lab.

All supplements carry a risk of side effects and drug interactions. Discuss using these and other dietary supplements with your healthcare provider, pharmacist, or registered dietitian before adding them to your medicine cabinet.

Choosing a Supplement

In the United States, the FDA does not regulate supplements like prescription drugs. This means some supplement products may not contain what the label says.

When choosing a supplement, look for third-party tested products and consult a healthcare provider, registered dietitian nutritionist (RDN or RD), or pharmacist.

Side Effects and Risks

Many people believe that NHRT is safer or more effective than traditional HRT because it is "natural." But this is not the case.

In general, NHRT, which uses compounded hormones, is likely to have the same risks as traditional HRT. However, since these products aren't standardized, additional risks are involved. Formulations with too much or not enough estrogen or progesterone, for instance, can cause side effects or limit effectiveness.

The FDA does not approve compounded bioidentical hormones. This means these products don't have to be proven safe or effective. They also aren't required to have a black box warning about their risks, like prescription hormone products.

Other risks associated with compounded bioidentical hormones include:

• Increased risk of endometrial cancer

• Possible increased risk of heart disease

• Risks associated with the process of compounding

• Inconsistent drug levels

• Side effects aren't reported

Keep in mind that people with a history of the following conditions should not use HRT of any kind:

• Breast cancer

• Endometrial cancer

• Heart disease

• Deep venous thrombosis (DVT) or pulmonary embolism (PE)

• Stroke

• Liver disease

• Unexplained vaginal bleeding

Supportive Strategies

Regular exercise and eating a healthy, balanced diet help the body continue to produce hormones, even during aging.

Some specific findings:

• Weight-bearing exercise helps build muscle mass, which is important to maintain as you age.

• Both resistance training and aerobic exercise ("cardio") improve bone strength and help prevent fractures.

• Achieving a healthy weight can help control symptoms of menopause, like hot flashes and urinary incontinence.

Other supportive strategies to complement traditional HRT or NHRT include:

• Cognitive behavioral therapy (CBT). Recommended by the North American Menopause Society, CBT has been shown to improve symptoms of menopause like hot flashes.

• Mindfulness practices like yoga and meditation. While these don't seem to benefit menopause symptoms, some research shows they can improve quality of life and sleep during this transition.

• Avoiding alcohol and drugs (including tobacco). These substances can cause testosterone levels to nose-dive.

Summary

NHRT is an alternative to traditional HRT to promote hormonal balance and overall health.

Common forms of NHRT include bioidentical hormones and dietary supplements. These have a reputation for being safe because they are considered "natural."

The bottom line is that there's insufficient evidence to know whether these products are safe or effective. Risks associated with NHRT are similar to those with conventional HRT and include cancer and heart disease, plus the unknowns associated with medications that the FDA hasn't approved.

If you are experiencing signs of a hormonal imbalance, such as fatigue, mood swings, or libido changes, your healthcare provider can help determine the optimal treatment plan for you.

Read the original article on Verywell Health.