Natural Hormone Replacement T... Health Article

NHRT delivery

Natural estriol, estradiol, estrone, and progesterone are available as:

• oral capsules
• oral tablets
• gel caps
• lozenges, drops, or sprays that are absorbed through the mucous membranes under the tongue
• transdermal creams and gels applied to the skin
• injectable solutions
• suppositories
• implants

Estradiols are available as skin patches (Estraderm, Vivelle, Climera) that slowly and continuously release estrogen through the skin into the bloodstream, bypassing the liver. The patches are worn at all times and changed once or twice per week.

Oil-based micronized oral progesterone appears to be most-readily utilized by the body, since the oil protects the progesterone from stomach acids. Some research suggests that a natural vitamin-E base (tocopherol) is more effective and least toxic. Mineral-oilbased preparations may not be effectively absorbed and/or metabolized.

Testosterone as DHEA is available as:

• oral tablets
• lozenges
• transdermal or vaginal creams
• patches

NHRT creams and gels are absorbed rapidly through the skin in areas with high blood flow, such as the lower neck, upper chest, inner wrists, or hands. Lower dosages are used for NHRT creams and gels because they are absorbed into the bloodstream more efficiently than oral NHRT. Transdermal preparations bypass the gastrointestinal tract and the liver where side effects are more likely to occur. With creams and gels, individual dosages can be adjusted easily, according to symptom relief. Low-dosage natural progesterone creams are available without a prescription. However, absorption of transdermals is highly variable between patients. Those with dry skin, poor circulation, etc. absorb less transdermally. Studies also show that transdermal delivery of hormones may result if very high blood levels over time. More research is need in this area, but for this reason some physicians do not prefer transdermal delivery forms.

Some NHRTs mix highly concentrated estrogen, progesterone, and sometimes testosterone in a propylene glycol base for rapid absorption through the skin. Only one to four drops are required daily, costing as little as $70 per year.

Forms of NHRT

Typical NHRTs include:

• estradiol gel applied daily
• micronized ethinyl estradiol (Estrace) as 0.3–2.5-mg daily tablets
• estriol (80%) and estradiol (20%) as 1.25- or 2.3-mg twice-daily tablets (Biestrogen)
• estriol (80%), estradiol (10%), and estrone (10%), as a 2.5–5% gel applied daily (Triest), or as 1.25- or 2.5- mg, twice-daily tablets (Triestrogen)
• micronized progesterone as 50-, 100-, or 200-mg peanut-oil-based tablets or capsules (oral micronized progesterone, Prometrium)
• micronized progesterone as a 5% cream (percutaneous progesterone cream) or gel
• combined NHRT as 1.25-mg Triestrogen tablets and oral micronized progesterone (50–100 mg), twice daily
• oral micronized testosterone as 1.25–5-mg tablets
• micronized testosterone as a 1% cream or gel (Androgel), applied to the inner thigh or scrotum once or twice daily

Vaginal creams, tablets, and rings are not significantly absorbed into the bloodstream. However they can be useful for treating menopausal symptoms such as urinary problems, vaginal dryness, and thinning of the vaginal wall, which can cause painful intercourse. Vaginal NHRTs include:

• micronized estriol cream, 0.5 mg per g of base (Estriol)
• micronized estradiol cream, 1 mg per g of base (Estrace)
• estradiol as a silicone ring with a 2-mg reservoir, changed every 90 days (Estring)
• progesterone gel, 4 or 8% (Crinone)

Most effective NHRTs require a prescription and may be covered by insurance.

Women's symptoms & NHRT

The dosages and duration of NHRT vary according to response, as determined by symptom relief. Dosages in women may be cycled to correspond to the menstrual cycle.

Symptoms of hormone imbalance in teenagers and young women with normal menstrual cycles include:

• acne
• mood swings
• stress syndromes
• night sweats
• sleep disturbances
• premenstrual syndrome (PMS)

A typical NHRT is micronized progesterone cream, 4–6 mg per kg (2.2 lb) body weight, rubbed daily on the neck, upper chest, and inner wrists, for the entire month or for two weeks prior to menstruation, depending on symptoms. It is not used on the face in the presence of acne.

Symptoms of hormone imbalances in women in their twenties and thirties with normal menstrual cycles, in addition to the above, may include:

• occasional or postpartum (after giving birth) depression
• infertility
• bloating from salt and fluid retention
• migraine headaches
• breast tenderness
• decreased attention span
• weight gain
• food cravings

Typical NHRTs for three months to one year:

• micronized progesterone cream, 4-6 mg per kg (2.2 lb) body weight, daily
• estradiol, 6–8 MICROg per kg body weight.

In addition to the above symptoms, hormone imbalances in premenopausal women (aged 35 to over 40), with regular or irregular menstruation, may cause:

• sleep disorders
• hair loss
• hot flashes
• depression
• loss of libido
• digestive problems
• anxiety

Typical NHRTs for three months to one year:

• Micronized progesterone, 4–6 mg per kg (2.2 lb) body weight, daily
• Estradiol, 7–9 micro;g per kg (2.2 lb) body weight, daily

NHRT may be particularly appropriate for perimenopausal symptoms in women aged 40–55. Their symptoms can be similar to those listed above, but may be more pronounced. Menstruation may have ceased or cycles may be irregular. Typical NHRTs:

• micronized progesterone cream, 5–7 mg per kg (2.2 lb) body weight
• estradiol, 6–9 MICROg. per kg (2.2 lb) body weight
• testosterone cream, 10 MICROg per kg (2.2 lb) body weight, applied to the labia and around the clitoris

Daily NHRT is continued for two to four months, followed by a five-day break.

Menopausal and postmenopausal women (usually aged 55 or older) may have, in addition to any of the above symptoms:

• bone loss
• cardiac disease
• urinary incontinence

Typical NHRTs:

• micronized progesterone cream, 5–7 mg per kg (2.2 lb) body weight, daily
• estradiol, 6–9 MICROg per kg (2.2 lb) body weight, daily.