In my previous articles I touched on the problem of how to distinguish truth from distortion in the vast ocean of health information that is now available to us. Anyone with experience in medicine knows that today’s truth can become tomorrow’s falsehood (or vice versa). It can be changed by a crucial new finding, a compelling piece of research, a re-evaluation of the available information, the seeming dictates of medical fashion, or even a concentrated misinformation campaign by certain interested parties.
If we are to have an even chance of arriving at the real truth, we need to be very precise in the terms and definitions we use in describing our subject. Medicine is usually very good at this part, but for various reasons there are discrepancies in the way different disciplines think and talk about hormones in women’s health, which of course can only lead to confusion and uncertainty among patients, and even their doctors. It is not just about the accumulation of knowledge, but about the development of judgement, discrimination and wisdom.
So the language we use and how we think about a thing is vital in the accurate communication of ideas. In the field of hormones, there are two areas of confusion that seem to crop up again and again. The first is relatively simple to lay to rest, but the second is really important and subject to a misunderstanding which still influences doctors and health writers, with unnecessary consequences for the health of their patients and readers.
What does bio-identical really mean?
The first of these is to do with whether ‘bio-identical’ progesterone is the same as ‘natural’ progesterone. The simple answer is ‘yes’, as this is the way the word natural has been used, being an easier alternative to bio-identical. However, ’natural’ has a much less specific meaning. It can rightly in this context be thought of as meaning ‘natural to the human body’ and therefore bio-identical. Or as meaning ‘of nature’, with the implication of being good for you; however many things are natural in this way (hawthorn berries, certain species of mushrooms, for example), but I certainly wouldn’t recommend anyone to include them in their diet!
Premarin (prepared from pregnant mares’ urine), is a commonly prescribed form of HRT and containing a mixture of estrogens, can be said to be natural, but natural to horses not humans. To complicate matters, just over half of the estrogen in Premarin is estrone, natural to women especially in pregnancy, the rest are mainly ‘equilins’, horse estrogens the exact effects of which on the human body are still subject to debate.
The importance of hormones being ‘bio-identical’, that is of an identical molecular structure to the equivalent hormone found in the human body, is paramount, whether the hormone is ‘natural’, synthetic or even a mixture of the two. An example of this last is the hormone we know as natural progesterone, which is in fact derived from natural plant-based sources such as soy or wild yam, but is altered in the laboratory to conform with the human molecule. Therefore, although it can be said to be both natural and synthetic, the important thing is that it is definitely bio-identical.
The Confusion between the 3 P’s
This leads us to the second recurring confusion; how we use the words ‘progesterone’, ‘progestogen’ and ‘progestin’. Clarity here is vital because it has become established that the synthetic substances are known either as progestogens or progestins depending on UK or US usage. These are used in contraception and in standard HRT but increase risks in the areas of cancer (breast, uterus and ovary), disorders of blood clotting (strokes, heart problems and deep vein thrombosis), and can worsen mood, PMS and depression in vulnerable women.
While the important principle is that ‘bio-identical’ is much safer and often more effective, it is still often not understood that progesterone for instance is not the same as the synthetic progestogens/progestins. However, if you consider the origins of these words this is perhaps not surprising. The word PRO-GEST-erone is derived from the Latin pro (‘for’ or ‘supportive of’) and gestatio (to bear, usually a child in the womb), so it means a substance supportive of pregnancy. Which progesterone certainly is, being important in fertility and the stability of a pregnancy.
Logically, the words progestogen and progestin, being derived from the same root, should mean the same thing; but in fact these terms are used to describe synthetic hormones that block or discourage conception either on their own or combined with estrogens. Their action is in effect the opposite of what one would deduce from their names! This is a very curious state of affairs and could lead to more than a suspicion of obfuscation (from obfuscare, – to blacken, make dark, obscure) in the original naming. If anyone can ‘shine a light’ on this, I will be very pleased to hear from them!
Synthetic progestogens/progestins in use today have been misnamed, so it is not surprising that confusion occurs, in both the media, among women, and in parts of the medical profession. Unfortunately it will probably continue to do so, whether innocently or from a devious intent to disguise their true nature.