Estrogen Part 1

Medically, menopause is when a female no longer can ovulate.  This is determined either by a blood test documenting a very low estrogen level, or by history of a female over the age of 43 without a menstrual cycle for a year or more.

Many of us believe that a female is at her mental and physical prime somewhere between 25-30 years of age.

Keeping her hormones (mostly estrogen, progesterone, testosterone and thyroid) at the levels during this time period should maintain her body in a youthful state.  Many studies confirm this.

This only applies to natural or what we call bio-identical hormone replacement therapy (BHRT), and not synthetics.

The bio-identical hormones we will be discussing are estradiol (estrogen) and progesterone.

Synthetic hormones are drugs, not natural, and the breakdown products are definitely not natural and can be problematic.

A few of these noted problems are breast cancer, stroke (CVA), heart attacks (AMI), blood clots (DVT) and clots to the lungs (PE).  

The bio-identical hormones do not share the same problems, yet almost everyone thinks all estrogen and hormones are the same, so all the problems are the same.  Not true.

A sudden increase in weight often occurs following menopause.

Researchers determined that the drop in estrogen levels with menopause is linked to an increase in cortisol.

Untreated women with higher cortisol levels witnessed an increase in abdominal fat when compared to women taking estrogen replacement, who did not gain fat.

One month of estrogen saw a return to premenopausal levels of cortisol and to weight loss.

Our practice favors bioidentical = Isomolecular = safe hormones

Pharmaceutical companies cannot patent natural hormones and, therefore, they  make synthetics (drugs).

Synthetic estrogens are stronger and the metabolic footprints are different from natural estrogen.  This is harmful.

BHRT is safe, better tolerated, and has no complications as with synthetic HRT, which has been demonstrated in many studies.

 

Estrogen deficiency results in:

Urogenital atrophy

Incontinence of urine

Sagging skin and breasts

Increased skin wrinkles on face

Fatigue

Depression

Mood swings

Decreased libido secondary to vaginal atrophy and painful sex.

 

Estrogen protects against major illnesses:

Heart (cardiovascular) disease

In patients with severe coronary heart disease the 10 year survival rate was 60% for never users and 97% in estrogen users.

Diabetes

Stroke

Colorectal cancer

Breast cancer

Osteoporosis

UTI

Alzheimer’s disease and memory loss

Vascular dementia

Macular degeneration is reduced by 70% with the use of estrogen.

Cataracts

Degenerative arthritis

Sleep disturbances

Immune system decline

Sexual dysfunction

Decreased protein synthesis

 

Estrogen improves:

Bladder atrophy, urinary incontinence, UTI’s

Static balance-preventing falls and fractures

Neurologic, cerebral, and neurodegeneration issues

Vascular health

Tooth retention and general oral/dental health

This is all with BHRT.

 

BHRT prevents:

Loss of muscle and strength

Increase in fat

Increase in cholesterol

Thinning of hair, nails, skin

Urogenital atrophy

Impaired mobility

Chronic debility

Loss of independence

Depression

Poor quality of life

Falls

Fractures

Tooth loss

Fatigue

Energy loss

 

BHRT has been proven scientifically proven in our medical literature to:

Improve strength and endurance

Improve lean body mass

Improve all lipid parameters

Increase lifespan

Increase health-span

Improve skin thickness

Improve sleep

Improve work capacity

Improve motivation

 

BHRT has been shown to:

Decrease endothelial (blood vessel) inflammation

Decrease lipoprotein

Decrease homocysteine (associated with high blood pressure)

Decrease fibrinogen (associated with stroke and heart attack)

Decrease plasminogen activator inhibitor (associated with stroke and heart attack)

Decrease visceral fat

Decrease insulin resistance

Decrease insulin levels

Decrease central obesity

Increase HDL

Decrease LDL

Decrease LDL oxidation

Increase vasodilation

Improve metabolism

Improve hemostasis

Increase endothelial function

 

Advantages of BHRT:

Few or no side effects

Decreased risk of breast cancer from progesterone (the synthetic Provera increases the risk)

Improved compliance

Synergistic osteoporosis protection (not with synthetics)

Synergistic cardiovascular protection (not with synthetics)

 

Estriol (a weak bio-identical) affects: 

It is only beneficial for skin and urogenital tract.

It may improve symptoms, but that’s all.

There is no protection of heart, brain, or bones

Use of Estriol keeps women menopausal = not safe.

 

Estradiol is 80 times more potent than estriol.

 

The majority of bioidentical hormones come from a plant product, Diosgenin derived from soy & yam and converted to BHRT in a lab.  

It is identical to the hormones you make in your body; there is no chemical difference.

 

Other products:

Phytoestrogen, black cohosh has no stimulation of estrogen receptors.  Therefore, there is no bone or cardiovascular protection.

 

Trans dermal creams have very poor absorption and are useless.

 

Estrogen side effects = estrogen dominance.

It is important to use the correct dose of estrogen.

Too much (estradiol blood levels greater than 150 pg/ml) can produce anxiety and irritability.  There is also irritability, fluid retention, mood swings, food cravings, hot flashes, fatigue, and breast pain.

Estradiol blood levels less than 50 pg/ml are characterized by anxiety and depression.

That is why we always measure the blood levels.

 

Problems and complications of HRT:

Breast cancer (with synthetics only)

Endometrial cancer (with unopposed estrogen)

Thrombosis (with synthetics only)

Weight gain (with synthetics only)

Gallstones (with synthetics only)

Fibroids (with both HRT and BHRT)

Headaches (with synthetics only)

Fluid retention (with synthetics only)

 

Breast cancer

There is a low risk, if any, from estrogen alone (WHI=Women’s Health Initiative study from July 17, 2002 Vol 288, No. 3)

The data is confusing due to adding progestins (synthetic), not estradiol.

The studies that used synthetic HRT saw an increase when a progestin was used.

The bio-identical progesterone was always protective with less risk of breast cancer.

New studies demonstrate estrogen must be used in conjunction with progesterone only, not with progestins.

 

Uterine: Endometrial cancer

This can occur with unopposed estrogen or when there is insufficient progesterone.  Solution:  add progesterone.

The use of progesterone reduces both breast and uterine cancer.

 

Thrombosis (clots)

This occurs with horse estrogen (Premarin) and synthetics only, not with bio-identical estrogen.

 

Weight gain

This is not from fat, but may be possibly from fluid retention. We can use diuretics, if needed.

Estradiol decreases visceral fat, by reducing a condition called insulin resistance.

 

Gallstones 

These are increased only in the synthetic hormone group, not in the bio-identical estrogen group.

 

Fibroids 

These may grow.

Soluction:  oppose with higher does progesterone, which usually prevents additional growth.

 

Headache – oppose with progesterone.

 

Fluid retention

This occurs usually during the first month till a “steady state” is reached.  Many will use a “water pill” to help.

 

Reasons for not taking estrogen replacement:

1) “I felt I didn’t need it”

2) “The medication may be harmful.”

 

Hot flashes occur in 41% of regularly cycling women more than 39 years of age.

They can occur more than 10 years after menopause.

Patients can have hot flashes with normal or elevated serum estradiol levels.

 

Within 6 to 12 months of discontinuing hormone replacement therapy more than 96% of women showed altered vaginal pH consistent with genital atrophy.

The most common clinical finding was involution of the vulvar structures and rapidly occurring introital stenosis and common complaints of painful sex (from stenosis not from dryness).

 

40% of postmenopausal women have symptoms related to vaginal atrophy.

 

Estrogen deficiency increases the risk of life-threatening illnesses such as osteoporosis and cardiovascular disease.

 

Cardiovascular disease is by far the most frequent cause of death in women over the age of 65.

There is good evidence to support that this is specifically due to the lack of estrogen, rather than due to an aging process.

Estrogen dramatically reduces the risk of cardiovascular disease in previously healthy postmenopausal women by up to 50%.

 

BHRT users notice relief from hot flashes, improved mood, relief of symptoms of urogenital atrophy, a sense of well-being and they continue to have higher bone density than non-users.

 

Optimum benefit is obtained when use is begun early in menopause and continued indefinitely.

To get the 83% reduction in Alzheimer’s disease need HRT needs to be started around the onset of menopause.

 

Women want to lessen the hot flashes, night sweats and depression, plus maintain their youthful appearances, avoid wrinkles, improve their sex life,

prevent ovarian and breast cancer, keep strong, healthy bones, avoid heart problems, memory loss, and weight problems.

We believe the solution is BHRT.

 

A short summary from an article dated 20 years ago.  Why are these points news to some?

 

From the Journal Am Pharm Assoc 41(2);221-228;2001

Estrogen is essential to optimum brain function

Estrogen increases cerebral blood flow through nitric oxide

Estrogen acts as an anti-inflammatory at blood vessel wall protecting it from free radicals and plaque formation.

Estrogen enhances activity at neuronal synapses.

Estrogen exerts direct neuroprotective and neurotrophic effects on brain-renders brain more resistant to disease process.

Gonadal steroids are the most powerful peripherally generated biological signal to the CNS

Lack thereof leads to memory problems, mood changes, hot flashes, decreased brain activity

Estrogen stimulates nerve growth factors, promotes neuronal growth, repairs damaged neurons. Senile changes and Alzheimer’s disease are a result of imbalance.

Estrogen increases neurotransmitters such as serotonin

Estrogen use associated with significant higher scores on verbal memory and abstract reasoning tests. PET scan show increased activity in women using estrogen as opposed to being off estrogen

Estrogen deficiency results in slowdown in speed of brain processing that can be corrected with estrogen

Estrogen functions at brain synapses and then raising serotonin levels, improves mood disorders. Consider estrogen before anti-depressant.

Positive mood enhancement is blunted by progestin and enhanced by testosterone.

Through all these mechanisms, estrogen strongly influences mood, cognition

Brain protection, forestalling disabling disease and symptoms.

-A significant benefit for society.

 

We have known this information for the past 20 years (and confirmed by numerous subsequent studies).

 

Hope this was informative. 

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Women's Health Care of Warren