Physician (MD, DO)
Obstetrics - Gynecology
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Dr. E. Jacob Simhaee, M.D.
1201 Northern Boulevard Suite 300
Manhasset, New York 11030 [MAP]
For an appointment, call (516) 365-6167
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Tips & Wisdom

Hormone Replacement Therapy (HRT)

Natural Hormones vs. Bio-identical Hormones


What is the definition?

I am frequently asked by my menopausal patients to place them on "natural hormones." Additionally, many pre-menopausal and newly menopausal patients come to me already taking non-prescription "natural hormones" obtained from their local drug store. I have been asking patients what they think "natural" means and I am amazed at the answers I get!

I asked my patients

Some patients tell me that natural means that the hormone comes directly from nature, unaltered in any way. Some say that natural means that the hormone came from plants. Some believe that natural means that the hormone taken is in the exact same form as what is naturally found in the body. Others have told me that natural means that the hormone is produced in an "organic" way (like organic produce). And some patients have no answer to this question at all. They just take the manufacturer's word that the product is natural without ever asking themselves what natural means!

I asked the experts

When attending medical conventions, I have asked this question to representatives of natural hormone products. They answer that natural really means that all of the initial ingredients were natural prior to any processing or chemical conversions. Sometimes I get new-age answers such as that natural means that the "natural energy" from the original ingredients is maintained by using "gentle" synthetic and purification techniques.

My own definition

After many confusing discussions, I have developed my own definition of what is meant by the term "natural." Basically, any hormone promoted by the pharmaceutical industry is by definition "not natural", and any hormone promoted by the vitamin/supplement or alternative health-care industry is (of course) "natural". I will give you some examples to support this definition.

Is Premarin Natural?

The estrogen hormone Premarin™ is isolated from the urine of pregnant horses. It is not chemically altered in any way – it is just purified and concentrated. This meets the definition of natural as coming from a natural source. Yet as a prescription drug, nearly all patients would declare Premarin not to be natural.

Another example is the estrogen hormone Estrace. This hormone is pure estradiol, the exact same molecule as found in the body. Yet, because it is a prescription drug, many patients still refuse to accept this product as natural. The same is true for Prometrium, a prescription version of pure progesterone (identical to that found in the body).

Not surprisingly, Progesterone cream from yams (Mexican yams) is very popular with patients. They rub it on the skin. It is available without a prescription. Nearly all users would defend this product as natural. The truth is that yams contain molecules which must be chemically converted before there can be any detectable estrogen or progesterone. So then, why is this type of hormone product considered natural? Because it is purchased non-prescription, and is touted by the vitamin/supplement industry as natural.

Please do not assume that my confusion as to the meaning of the term natural means I have a bias against natural hormones or against viable alternative treatments for menopausal women. I do not. At different times, I have placed patients on soymilk, soy extract (available in pills), herbs (such as remifemin, black cohosh, dong quai and others), vitamins, minerals and supplements, traditional prescription hormones as well as my own version of natural hormones.

Don't go by the Product's Name

Have you heard of Estroven? To me, this product is the greatest success story in marketing I have ever seen in the natural products industry. People just love the name of this product. They think that they are buying a non-prescription form of estrogen. They are not. Estroven is just another common non-prescription supplement (of black cohosh, soy extract, herbs and vitamins) used to help menopausal women. Oh, but the name is amazing and clever. Great marketing, Wall Street.

Bio-identical Hormone Therapy

This term has pretty much replaced the term natural hormones. Bio-identical also has different meanings:

  1. Bio-identical hormones are identical chemicals to those found in the human body.
  2. Bio-identical Therapy requires that the hormones have to be taken identical to mother nature. In other words, a post-menopausal woman would have to take cyclic hormones and have a period every month to meet this definition.

Option #1 is the predominant definition. Our medical practice believes very strongly in this approach. If hormone therapy is right for you, we will use bio-identical hormones.

I Object to False Advertising

Many people inherently trust hormone products that are "natural." If it's natural, it must be safe, and it must be good for them. In order to create a market for over-the-counter natural hormones, the "natural" products industry is taking advantage of people's natural fear of prescription drugs, their strong natural desire to be in charge of their own health without having to go to the doctor and their natural trust of natural products.

They are confusing and possibly endangering the public by attaching the word natural to every possible product without ever defining exactly what is meant by natural in the first place.

For a consultation or appointment, call us at (626) 304-2626.


© 2012 Fair Oaks Women's Health, 625 South Fair Oaks Avenue, Suite 255, Pasadena, CA 91105


Infertility is the inability to conceive after one year of unprotected intercourse. Infertility can be brought on by many factors, including:

  • Endometriosis 
  • Male factor infertility
  • Unexplained infertility
  • Problems with the ovaries
  • Blocked or scarred fallopian tubes 

Infertility is a delicate subject and the best options for you and your partner should be discussed with your doctor.

There are several treatment options for infertility. These options include:

Medical therapy is the initial treatment option for correcting ovulation dysfunction—irregular or infrequent periods. The first line of treatment is an oral medication. These medications typically induce normal ovulation in more than 80 percent of patients. However, only about half of these women conceive. 

Reproductive surgery can typically be performed endoscopically on an outpatient basis. Using a laparoscope inserted through the naval, the procedure can be successful in removing scar tissue, treating endometriosis, removing cysts on the ovaries, and unblocking the fallopian tubes. 

Intrauterine insemination refers to an office procedure in which semen are placed into the uterus using a catheter inserted through the cervix. 

Assisted reproductive technologies include:

  • In vitro fertilization where the eggs are fertilized in a culture dish and placed into the uterus. When monitoring shows that the eggs are mature, they are collected nonsurgically. The sperm are collected and added to the eggs in a culture dish. Several days later, two to three fertilized eggs are returned to the uterus using a catheter. 
  • Intracytoplasmic sperm injection involves injecting a single sperm directly into each mature egg using a micro-needle. 
  • Pre-implantation genetic testing (PGD) is performed on a single cell taken from 3-day old embryos produced by IVF. It is an option for patients who are at increased risk for having miscarriages or a child with a genetic problem. 

 For a consultation or appointment, call us at (516) 365-6167.


© 2012 Dr. Eskandar J. Simhaee, M.D., 1201 Northern Boulevard, Manhasset, NY 11030

Last updated: February 14, 2012.

Permanent Birth Control (Sterilization)

Essure (Permanent Birth Control)

Trusted by hundreds of thousands of women and their doctors for over five years, Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor's office or as out patient in surgical suite unit. The beauty of this procedure is that there is no scar in your abdomen and you are back to work the next day.

Essure is covered by most insurance providers, and if the Essure procedure is performed in a doctor's office, depending on your specific insurance plan, payment may be as low as simple co-pay.

Essure offers women what no birth control ever has

  • No scar on your abdomen
  • No hormones
  • No slowing down to recover
  • Performed in less than 10 minutes
  • Peace of mind - your doctor can confirm when you can rely on Essure for birth control
  • Trusted by hundreds of thousands of women and doctors for over five years

With Essure, you'll never have to worry about unplanned pregnancy again. Essure is 99.8% effective with zero pregnancies, making it the most effective form of permanent birth control available.

For a consultation or appointment, call us at (516) 365-6167.


© 2012 Dr. Eskandar J. Simhaee, M.D., 1201 Northern Boulevard, Manhasset, NY 11030

Last updated: February 14, 2012.

Urinary Incontinence in Women

Urinary incontinence is the involuntary loss of urine. It is seen as a symptom or sign of an underlying problem that affects one of body’s many systems including:

  • the lower urinary tract (bladder and urethra)
  • the central nervous system (brain and spinal cord)
  • the peripheral nerves that supply the bladder and urethra

The majority of those who are affected by urinary incontinence are the elderly, but the process of the disease starts in the middle age. With proper testing and selective treatment, urinancy incontinence can be treated. 

There are three main types of urinary incontinence:

  • Stress incontinence which is the involuntary loss of urine during activities such a laughing, coughing, or sneezing. These activities cause an increased pressure on the bladder due to a poorly functioning bladder sphincter. 
  • Urge incontinence which is the involuntary loss of urine due to an abnormal bladder contraction that is generally preceded by a sudden urgency to void.
  • Mixed incontinence which is the involuntarily loss of urine from a combination of stress and urge incontinence. 

There are three major treatment categories for urinary incontinence management. These typically include: 


  • Bladder and habit training 
  • Pelvic muscle exercises 
  • Biofeedback 
  • Vaginal weights 
  • Pelvic muscle electrical stimulation 


•  To promote urine storage: 

  • Drugs that reduce excessive bladder muscle contractions 
  • Drugs that increase sphincteric tone 

•  To promote urine expulsion: 

  • Drugs that increase bladder muscle contractions 
  • Drugs that decrease sphincteric tone

•  Hormones 


  • Office-based procedures 
  • Percutaneous procedures 
  • Laparoscopic procedures 
  • Open abdominal procedures 

To seek the best treatment options talk to Dr. Simhaee about the expected outcomes, risks, and benefits of each.  

For a consultation or appointment, call us at (516) 365-6167.


© 2012 Dr. Eskandar J. Simhaee, M.D., 1201 Northern Boulevard, Manhasset, NY 11030

Last updated: February 14, 2012.

Patient Education Resources

Birth Control Pills-Extended Use
Extended Dosing of The Pill   Introduction Research has shown that birth control pills (BCPs) can be taken in a way that can minimize adverse side effects, increase the interval from one period to the next and still maintain the same high degree of contraceptive benefit (1). BCP packs contain 28 pills. The first 3 weeks of daily pills contain hormones, and the 4th week contains placebo or "sugar" pills (or sometimes iron). This results in a menstrual cycle about every 28 days, similar to a natural cycle. There is no MEDICAL reason for the 28-pill package. The design was intended to increase consumer acceptance by duplicating normal menstrual cycles. Side effects such as PMS, cramping, heavy bleeding, bloating, breast tenderness, headaches and mood swings can be reduced by extending the 3 weeks of daily active pills to 6, 9 or 12 weeks. Many women believe that there is a build-up of the uterine lining that needs to come out. This is not the case. The menstr...
Bone Mineral Density (BMD) Test
Osteoporosis is a disease in which bones become fragile and more likely to break, caused by gradual loss of bone. Osteoporosis is responsible for the loss of height, stooped posture (curvature of the spine) and broken hips or wrists seen in many older women. The diagnosis is nearly always made after someone breaks a hip, or develops a spinal bone fracture (called a vertebral compression fracture). By then, the patient may have lost more than 25% of their total body bone content, a process which occurred invisibly over many years. Currently, 28 million Americans (of whom 80% are women) have either decreased bone density or actual osteoporosis and most don't even know it. The medical costs of dealing with osteoporosis are upwards of $14 billion dollars per year, attributable to 1.5 million osteoporosis-related bone fractures per year. Osteoporosis can be debilitating and even deadly. Two hundred thousand women break a hip every year. Twenty (20) % of these women will die within on...

Conditions Treated

Menstrual Irregularities
Uterine Fibroids

Procedures & Services

Bone Mineral Density (BMD) Test
Prenatal Care
Ultrasound (Prenatal and Gynecologic)
Vaccines (Immunizations)

About Me

Dr. Eskandar Simhaee, MD is a board-certified obstetrician-gynecologist providing care to patients in Manhasset, New York. 

Dr. Simhaee evaluates patients as a whole by not only focusing on your Ob/Gyn needs but by combining extraneous impacts such as diet, nutrition, psyche, and environment for the most complete assessment. 

Even after years of practice, Dr. Simhaee is eager to learn new techniques and staying up to date with medical practices. 


Education & Training

  • Residency in Obstetrics and Gynecology: Maimonides Medical Center
  • Medical School: Albert Einstein College of Medicine

Dr. E. Jacob Simhaee, M.D.

Dr. Simhaee and his associates provide patients with comprehensive Obstetrics/Gynecology with selected services including urinary incontinence, aesthetic services, O-Shot, and FemLift: Life Changer.  

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