ESTROGEN                                                            

 

Estrogen

Estrogen is not one hormone; it is the name of a group of hormones. There are three principle forms of estrogen found in the human body estrone, estradiol and estriol, also known as E1, E2 and E3 respectively. There is also a group of compounds called phytoestrogens, generally found in food, which can have "estrogen like" effects in the body. Estradiol (E2) is the primary estrogen produced by the ovaries. Estrone (E1) is formed from estradiol. It is a weak estrogen and is the most abundant estrogen found in the body after menopause. Estriol (E3) is produced in large amounts during pregnancy and is a breakdown product of estradiol. Estriol is also a weak estrogen and may have anti-cancer effects. Before menopause estradiol is the predominant estrogen. After menopause estradiol levels drop more than estrone so that now estrone is the predominant estrogen.

For the past 50 years, conjugated equine estrogen, brand name Premarin® has been the most commonly prescribed estrogen supplement in the U.S. Conjugated estrogens are derived from pregnant mare's urine. They must be converted by the body into active estrogens. Premarin® is the most studied estrogen supplement. It is also the most widely prescribed hormone in the world. If you are taking a hormone, it is probably Premarin®. Estradiol (E2) is now widely prescribed in the form of skin patches, tablets and creams and is gaining on premarin in popularity. A combination of E1,E2 and E3 called Triple Estrogen or Tri-Est,has been available for many years. It's proponents claim it is the most natural way to take estrogen. Triple estrogen is difficult to get. It is generally available only by mail order

 

 

Natural Estrogens

So which is natural? Is natural better? If so why?
It all depends on what YOU consider natural, remember, there are many "natural" poisons. If you consider "natural", that which occurs in the body in the highest concentration after menopause, then estrone is the natural estrogen for you. Estrone is easy to get. Most of the prescription estrogens when taken by mouth are converted in your GI tract and end up predominantly as estrone.
If you consider natural, getting your estrogen levels up to where they were before menopause then estradiol is your natural estrogen. The transdermal patches, vaginal rings and estradiol creams provide pre-menopausal levels of estradiol.
If you desire a natural estrogen that is the least likely to cause cancer then estriol may be right. Tri-Est contains mostly estriol. However a dose high enough to prevent hot flashes causes nausea. Therefore the pharmacies add 10% E1 and 10% E2 to Tri-Est. So its mostly, but not totally, estriol

PROGESTERONE

WHAT ARE THEY?

Progesterone means pro (supporting) gesterone (gestation or pregnancy). Progesterone is the OTHER hormone your ovaries make, other than estrogen, and its main function is to support pregnancy. Progestogens can be either natural or synthetic. The natural form when taken by mouth is rapidly broken down by the liver this is why in 1934 a synthetic form was developed. There are now more than 10 synthetic forms of progestogen (see chart). A new form called micronized (broken down into tiny particles) progesterone has recently become available, the micronized progesterone resists breakdown.

WHAT ARE THEY GOOD FOR?

Progestogens have been used for years in infertility treatment and to replace the natural progesterone in women with premature ovarian failure. Progestogens are used to treat abnormal uterine bleeding and for contraception in birth control pills and in Depo-ProveraŇ. They are also used to prevent the negative effects of estrogen on the uterus when used for hormone replacement therapy and they are used for the treatment of PMS.

SO WHERE'S THE CONTROVERSY?

There are two controversial topics you may have heard of. First is the use of natural versus synthetic progestogens in hormone replacement therapy. Second is the use of progesterone in the treatment of PMS, especially the recent popularity of the NATURAL PROGESTERONE CREAMS.

HRT

Hormone replacement therapy (HRT) is recommended for most women after menopause. HRT consists of the hormone estrogen and, if your uterus has not been removed, progesterone. It's commonly known that estrogen supplementation alone can cause endometrial (uterine) cancer. When a progestogen is added, the chance of uterine cancer is reduced below the base line level. One of estrogen's many benefits is its ability to reduce the risk of heart disease. One of the ways estrogen does this is by increasing HDL or (good cholesterol). Synthetic progestogens tend to reduce this benefit. Natural micronized progesterone does not appear to reduce estrogens positive effect on cholesterol. Therefor this is one case where the natural form of progesterone may be better for you.

PMS (premenstrual syndrome) is a major problem for millions of women around the world. Until recently there has been no effective treatment. One of the theories about the causes of PMS is that there is an imbalance between estrogen and progesterone. This theory has led to the treatment of PMS with progesterone. There have been over 20 scientific studies of the treatment of PMS with progesterone, the vast majority of which have found progesterone to be ineffective. There are a few small studies that have shown some relief of some symptoms of PMS with progesterone. Progesterone, especially in EXPENSIVE cream form is marketed as a cure for obesity, depression, foggy thinking, osteoporosis and wrinkles to name a few. These claims, made by some manufactures are unsubstantiated.

WILD YAM (Dioscorea villosa)

Yams produce a compound that is used by the pharmaceutical industry to produce progestogens. The human body can NOT do this. Many PMS and menopausal remedies contain wild yam or Mexican yam extract. Often claims are made that this product is in fact progesterone, it is not. Dioscorea may have beneficial effects and it may be useful for some conditions, but it is not the same as progesterone.

SIDE EFFECTS

Progestogens should not be used if you have had blood clots in the legs (thrombophlebitis) or liver disease. Use in pregnancy requires careful physician surveillance. Progesterone can also cause bloating, breast tenderness, weight gain, headache, moodiness and irregular vaginal bleeding. Progestegens can cause some medical conditions to worsen examples are asthma, heart failure, epilepsy and migraine headache. Natural progesterone tends to have fewer side effects.

HRT

PROTECT YOUR HEART

Several studies have shown those postmenopausal women taking estrogen have one third to one half the risk of heart attack than women not on estrogen. Women may even experience a protective effect from high blood pressure and blood clots if they are on low doses of estrogen (0.625 mg.) If you have several of the following risk factors for heart disease, i.e. high blood pressure, high cholesterol, a family history of heart disease, diabetes and/or an enlarged heart, you may be in a group of women who would live at least three years longer by taking estrogen.

ELIMINATE HOT FLASHES

The FDA has approved estrogen for the treatment of hot flashes, vaginal dryness and osteoporosis. Hot flashes are that sudden wave of heat that starts in your chest and rushes up your neck and face. They are almost always cured by estrogen replacement. Hot flashes occurring at night are known as night sweats and can cause sleeplessness with resulting irritability the next day. Night sweats are almost always cured by estrogen replacement therapy. In fact these symptoms are often used as a barometer to see if the dose of estrogen is correct.

REVERSE VAGINAL AND URINARY TRACT CHANGES

Changes in the vagina and bladder are seen within ten years and can lead to burning, itching, painful intercourse and frequent vaginal and bladder infections as well as urinary incontinence. Both the vagina and the bladder are very sensitive to HRT, and these symptoms are inevitably relieved by oral estrogen (by mouth) or by creams containing estrogen. HRT thickens the vaginal and bladder walls and stimulates the vaginal glands to produce the lubrication necessary to make sexual intercourse enjoyable.

ELIMINATE MOOD SWINGS

There is now sufficient data to conclude that estrogen which enhances mood complaints such as irritability, crying spells and feelings of sadness that typically appear during menopause usually respond to HRT. Estrogen may even boost the effectiveness of some antidepressant medications. Some women who do not respond to antidepressant medication may respond to estrogen. The effect of HRT on mood may be secondary to its ability to relieve irritability and hot flashes thereby enhancing mood in an indirect way. Progesterone therapy, which is added to estrogen to protect against endometrial cancer can exacerbate or cause depressive symptoms. These complexities of mood need to be worked out with your healthcare provider.

REGAIN SEXUAL FUNCTION

The integrity of the female reproductive tract is dependent on estrogen. Degenerative changes ensue when levels of estrogen decline after menopause. There is no question that estrogen can restore the degenerative changes the reproductive tract. First, the vagina becomes more pliable and well lubricated. This primes you for sexual activity. Second, androgen supplementation can increase sexual desire, motivation, fantasies, satisfaction and pleasure.

PROTECT YOUR BONES

Calcium, vitamin D, and exercise are not enough. If you are postmenopausal and at risk for osteoporosis there are measures you can take to protect your bones. If you have a medical reasons not to take estrogen Fosemax® is FDA approved for the treatment and prevention of osteoporosis. The nasal spray Miacalin® is also approved to treat osteoporosis but not to prevent it. Estrogen remains the drug of choice for osteoporosis especially since it adds all the other benefits listed here. Progesterone added to estrogen has been found to increase its beneficial effects and when you add testosterone the effects may be increased even further. Most bone loss occurs within 5-7 years after menopause. Therefore, treatment should be started early. Transdermal and oral estrogen both work well. Other forms of estrogen such as creams or rings may not be effective in treating osteoporosis.

SAVE YOUR SKIN

Hormone replacement therapy will not reverse sun damage or repair broken blood vessels. Smoking damages your skin in ways that estrogen can't reverse. Estrogen plays a role in the way fat is distributed under your skin. Loss of this fat can make your skin look older than it should. Testosterone, which can be prescribed with estrogen helps regulate the skins oil gland activity. With age, oil production decreases and can lead to drying. Women who go through a late menopause tend to have younger looking skin, as do women on HRT. To have younger looking skin is not a reason to start HRT, however, it is a side effect most women don't mind.

RISK OF USING HRT

BREAST CANCER

Many people believe that by taking hormone replacement therapy (HRT) you will increase your chances of developing breast cancer. This is a highly controversial issue in medicine today. Many studies show no increase risk, yet conversely some studies show an increased risk of between thirty and fifty percent with long term (eight to ten year) use of estrogen. If the worst case is true, you could increase your chances of developing breast cancer by thirty to fifty percent. However, by taking HRT you lower your chances of heart disease and hip fracture by fifty percent. What should you do?

You could try to figure out what your personal risk is using your family history and current health status. If, based on family history, you have a high risk of breast cancer and a low risk of heart disease and hip fracture; perhaps you should not be taking estrogen. However, if you have a high risk of heart disease, based on your blood pressure, cholesterol, etc. and a low risk of breast cancer than estrogen may play a role in increasing your life expectancy.

BLOOD CLOTS

HRT can make some blood diseases worse, causing blood clots to form. HRT will NOT cause these diseases. If you have a problem with blood clots, you should discuss with your health care provider.

VARICOSE VEINS

Varicose veins do NOT result from blood clots. They have no relation to blood clots and are usually an inherited disorder. Varicose veins are not related to HRT.

HIGH BL0OD PRESSURE

High blood pressure contributes to heart disease. If you have high blood pressure you probably should be on HRT. High doses of estrogen can make blood pressure worse. If you are on HRT or are thinking about it, a dose of 1 mg. of estrogen should be sufficient. If you need a higher dose, than any blood pressure changes should be evaluated and considered.

GALLBLADDER DISEASE

Estrogen taken by mouth (in pill form) can increase the chance of you developing gallbladder disease. This problem can be overcome by using an estrogen patch.