It creeps up on you silently, insidiously. The fatigue, headaches, depression, bouts of crying, inability to sleep because of constant tossing and turning; am I crazy, or is it perimenopause, menopause, or what?

If you have been wondering what treatments are available for you in the aftermath of the Women's Health Initiative (WHI) study, there are still alternatives to avoid the usual antidepressants, and antianxiety medications. In addition to herbs, nutrition, and other natural remedies, biologically identical hormones are an option.

Bio-identical hormones were once thought of as natural. The definition of natural is anything that has been derived from a natural source. Premarin (conjugated equine estrogen) is technically natural as it is a derivative of something natural. The term bio-identical describes a substance that mimics one naturally found in the human body. Bio-identical's are typically compounded and made from soy or yam where the molecular structure is the same as what already exists in the human body. Estrogen is actually not one hormone, but a group of three hormones: estrone (E1) Estradiol (E2), and estriol (E3) which are natural human hormones. The ratio of estrogens found naturally in the female is completely different than what is found in conjugated equine estrogen. About 40 percent of the estrogens in Premarin cannot be recognized or broke down normally by the human body.

As more and more women are prescribed bio-identical hormones, there needs to be an understanding of the risks of synthetic hormones while also understanding the data that specifically supports the safety and efficacy of bio-identical hormones.

Should we be without hormones in perimenopause and menopause? Climacteric symptoms can span 30 years (age 40-70) and produce progressive erratic decline in progesterone (anxiety, irritability, PMS, 10-15 years before menopause), estrogen (hot flashes, vaginal dryness), and testosterone (loss of libido, muscle loss). Most all tissue and organs in the body have receptors sites for estrogen, progesterone, and testosterone. Declining hormone levels are linked to a lot of diseases such as osteoporosis, colon cancer, heart disease, cognitive decline, tooth loss, and macular degeneration.

Progesterone is typically the first hormone to decline, usually in the late 30s and early 40s. This decline results in symptoms of anxiety and irritability. Progesterone deficiency is an important cause of PMS and heavy bleeding in women and adolescents.

Synthetic progesterone's are associated with weight gain, irritability, acne, and fluid retention whereas bio-identical progesterone's have been found to improve mood, anxiety, and depression as well as inhibit breast cell proliferation. There is some speculation that synthetic progesterone may actually be a culprit in cancer and cardiovascular risk.

The predominant fear of hormone replacement therapy (HRT) is the risk of breast cancer. According to the Journal of National Cancer Institute, the risk of breast cancer increases 29 percent over baseline with the addition of progestin (synthetic progesterone) to HRT. Eighty percent of breast cancers occur after menopause when estrogen levels decline or become unbalanced. Unbalanced being that, estrone surplus from the adrenal give you the imbalance. This imbalance with too much estones and too little progesterone and estriol actually plays a part in breast cancer.

Although more research is needed on bio-identicals, current research and common sense support its use. The benefits of bio-identical HRT clearly out weight the risks if given transdermally or subcutaneous pellet therapy using a physiological dose that is balanced to mimic the normal estrogen ratio.

For more information contact Jan Nelson at Balanced Wellness Medical Clinic, (509) 919-4575, jnelson@balancedwellnessmed.com.