Hormonal disorders affect many women, and the clinical pictures vary widely: premenstrual syndrome, anovulatory cycles, perimenopause, menopause, luteal insufficiency, vaginal atrophy, hot flushes and bone fragility. According to William Kadmiry, two approaches come up repeatedly, bio-identical hormones and phytohormones, and confusing them leads to poor strategy.
Three families not to be confused
Bio-identical hormones
They start from plant material and are then chemically processed. Their chemical structure remains strictly identical to that of the hormones the body produces. Plant origin therefore does not mean phytohormone: a bio-identical hormone is still a hormone.
Synthetic hormones
Their structure is different, even if it stays close to that of the natural hormones. Small modifications are enough to change absorption, metabolism and side effects. Examples cited include ethinylestradiol, levonorgestrel and equine oestrogens.
Phytohormones
These are compounds of plant origin, but they are not hormones: they are modulators. Their effect depends on the context (dose, receptors, underlying terrain, microbiota). They do not replace a deficient hormone, but they may modulate a hormonal situation.
Bio-identical hormones in practice
They bind to the expected receptors and follow a physiological metabolism. They are used within a medical framework, at adapted and individualised doses.
- Estradiol: the major oestrogen of the fertile years, systemic effect, used in particular in menopausal hormone therapy, alongside progesterone.
- Estriol: weaker and mainly local, used above all for vaginal atrophy and hydration (pessaries, cream).
- Estrone: the oestrogen of menopause, produced largely in adipose tissue and convertible into estradiol; caution where there is excess weight, as the underlying terrain may favour an excessive oestrogenic load.
- Bio-identical progesterone: oral, vaginal, transdermal or injectable depending on the context; diuretic and anti-androgenic effect, counterbalancing the water retention linked to oestrogens. An excess does not suit every woman: in some, it takes conversion pathways towards the androgens.
According to William Kadmiry, they are discussed in confirmed menopause, in perimenopause with a documented deficiency, in luteal insufficiency or oestrogen or progesterone deficiency, and where symptoms are marked. The lowest effective dose remains the most coherent choice.
Phytohormones: plant modulators
They consist mainly of phytoestrogens, which resemble estradiol but with far lower potency. A distinction is drawn between the isoflavones (soy, red clover) and the lignans (flaxseed, sesame). They mainly target the ER beta receptors, which are more protective and less proliferative than the alpha receptors, and they show a biphasic effect: at low doses they inhibit aromatase, at high doses they may become oestrogenic. Their action also depends on SHBG and on the microbiota.
The gut microbiota profoundly changes the response. Soy contains genistein and daidzein, whose metabolite equol is the most active at the ER beta receptors. Not everyone produces it, however: roughly 20 to 30 % of Western populations against 40 to 60 % of Asian populations. Soy acts above all as a modulator; its effect depends on the underlying terrain, gentle where there is oestrogen deficiency, rather more protective where the oestrogenic load is already high.
Other reference points raised: hops, sage and flaxseed (oestrogen-like effect); chaste tree (indirect progesterone-like effect, through lower prolactin and higher dopamine); lady’s mantle (hormonal balance); green almond, sabal and saw palmetto (anti-androgenic reference points). Yam, often presented as close to progesterone, supplies none of it.
Bio-identicals or phytohormones: how to choose
According to William Kadmiry, bio-identicals are preferred where there is a proven deficiency with marked symptoms, confirmed menopause, oestrogen or progesterone deficiency, or luteal insufficiency. Phytohormones find their place more in premenstrual syndrome, hot flushes, perimenopause, gentle support where hormone therapy is declined, vaginal atrophy (a local approach) or the modulation of an underlying terrain without major deficiency.
Where micronutrition fits
Several situations point first towards micronutrition: catamenial migraine (magnesium, active vitamin B6, coenzyme Q10); hot flushes (omega 3, zinc, and phytohormones depending on the case); bone support (vitamin D, vitamin K2, calcium, physical activity); support for oestrogen metabolism (homocysteine, vitamins B12, B9 and B6, iron, hepatic terrain).
Points of caution
Even when bio-identical, these hormones are not a matter for self-supplementation: oestrogens and progesterone remain prescription only. The oestrogen / progesterone balance is central, an excessive oestrogenic load being associated with increased risk (hormone-dependent cancer, fibroid, water retention). The underlying terrain counts as much as the molecule: microbiota, age, weight, thyroid status, stress, inflammation, hepatic terrain, insulin resistance. Where there is a history of cancer, the thinking is built with the medical team, on a precise analysis of the benefit-risk balance.
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