From The Doctor’s Desk: Hormone Imbalance A Contributing Factor In Breast Cancer

Hormone Replacement Therapy (HRT) increases breast cancer. Have you read headlines like that? Or perhaps you were told that HRT caused someone’s breast cancer.

Do hormones really cause or lead to breast cancer? Think about this: every women continues to produce hormones, even after menopause. So, it cannot be that hormones in and of themselves cause cancer. Scientific evidence indicates that synthetic hormones and hormone imbalance do contribute to breast cancer.

The ABC’s of Estrogen.

Estrogen’s effects in the body are regulated through two different kinds of receptors: alpha and beta receptors. Estrogen-alpha receptors stimulate breast cell growth. Estrogen-beta receptors inhibit breast cell growth.

• Estradiol, the most potent estrogen, equally stimulates alpha and beta receptors = growth stable
• Estrone, the second most potent estrogen, stimulates alpha receptors 5:1 over beta receptors = pro growth
• Estriol, the weakest variety of estrogen, actually stimulates beta receptors 3:1 = growth inhibitory

The key element here is balance of hormones. Higher levels of estrone present in your body (produced by fat cells) result in more breast stimulation. Higher levels of estriol present in your body results in less breast cell stimulation and, therefore, breast protection. Estriol = Good. Estrone = Bad. If you have heard of someone developing breast cancer after starting Premarin, there’s a logical explanation for that. Guess what Premarin is loaded with? Premarin contains (48%) estrone (estrone = bad = breast cell stimulation).

Here are some more ugly facts about Premarin, also know as conjugated equine estrogen. Premarin actually decreases estrogen beta receptors. So, if you take Premarin, then you are taking high doses of estrone (estrone = bad) and decreasing your estrogen receptors that inhibit breast cell growth. In a nutshell: you are taking more of the bad estrogen and decreasing your amount of the good estrogen. This equates to a prime set up for breast cancer.  Don’t take my word for it. See the wonderful article by Kent Holtorf.

Progesterone: The Growth-Inhibitor Hormone

The confusion out there about estrogen and breast cancer is bad enough, but the confusion is even greater on the subject of progesterone.

Pregesterone is the key hormone in the second half of a woman’s cycle. Estrogen is the dominant hormone in the first half of your cycle (estrogen = growth = growth of the uterine lining to support implantation of an egg). The counteractive hormone to this growth phase is progesterone (progesterone = no growth = sloughing off of the uterine lining). It’s the amazing and fascinating way that woman was created.

Synthetic progestins, often prescribed, are NOT the same as the progesterone your body produces. Just look at the structure and you see that they are not. The one thing they do have in common is they both protect the lining of the uterus against excessive estrogen growth. But, that is where the similarities end.

While there are many differences between the two, our focus here will be on the difference in breast cancer potential. Simply stated, synthetic progestins are pro-breast cancer and bioidentical progesterone is breast protective. The Women’s Health Initiative (link) revealed a 26% increase in breast cancer as a result of taking synthetic progestin. The Nurse’s Health Study (link) found that synthetic progestins tripled breast cancer risk over that of estrogen only. The use of Provera, a synthetic progestin and component of Prempro, has been shown to increase the risk of breast cancer by 800%!

The statistics for bioidentical progesterone are the opposite. Bioidentical progesterone has many positive breast benefits:

• Progesterone decreases estrogen production
• Progesterone moves estradiol to weaker estrone
• Progesterone moves estrone to inactive (sulfated) form
• Progesterone moves estrone to weakest/safest estriol
• Progesterone down-regulates estrogen receptors all together
• Progesterone activates the cancer protection gene, p53

The idea that progesterone is a safer alternative to synthetic progestins is not new at all.  As early as the early 80’s, there has been a call for safer progesterone over synthetic progestin counterparts. In 1981, nearly 30 years ago, L.D. Cowan showed that just having low progesterone levels increases the risk of premenopausal breast cancer risk 5.4 times.

Unfortunately, progesterone-deficient states, (or estrogen dominance) are very common in women today as a result of many factors: being overweight, PCOS, environmental xenoestrogens, excessive estrogen therapy, and perimenopause. Another study, showed progesterone to have a 400% decreased breast growth rate.

The Scientific Evidence Is Clear.

The evidence in the scientific literature is clear with regards to estrogens, progesterone, and hormone balance.

Bioidentical and synthetic hormones should NOT be used interchangeably. They are not equal. They have very different physiologic effects on the breast:  synthetic progestins (Provera notably) increase breast cancer (800%) and bioidentical progesterone protects against breast cancer (400% decrease breast growth rate).

Estrogen therapy is not for everybody and is definitely not a panacea drug; in fact estrogen dominance is a major contributor to breast cancer risk. But if estrogen therapy is needed, then estriol (Estriol = good) is the best.

Hormone balance is the key. Without estrogen and progesterone balance, a women’s cycles are irregular, and infertility can be a big problem.

You know, once we understand hormones and the balancing cycle between estrogen and progesterone, it makes perfect sense that imbalance would cause breast problems. And the scientific evidence indicates just that. In honor of Breast Cancer Awareness Month, it’s time make sure your hormones are balanced and protect yourself from breast cancer.

Confession #6: Evidence and Crazy Talk. Part 3 of 3.

This is the third of three posts in response to a Newsweek headline, “Crazy Talk,” and the accompanying article, “Best Life or Risky Advice?” which blasted talk-show host Oprah Winfrey for many things, including her support and use of bioidentical hormones.

A quick recap. Read the Newsweek article for yourself. Second, make medical decisions based on medical research and evidence. Third, the right approach to bioidentical hormones is balance. Fourth, there is no blanket prescription for womanhood.

Individualized Treatment Results in Balanced Hormones.

In my last post, I talked about the blanket prescription for womanhood that seems to prevail in the medical world out there. But for me, the right answer was a treatment plan that balanced my hormones.

At Seasons, my hormones were tested and found to be terribly out of whack. Dr. Goodyear developed a therapy plan which included several varieties of bioidentical hormones according to my individual needs and life changes like proper nutrition and exercise. After a period of time, they retested my hormones and adjusted my prescriptions. This cycle continues until the body returns to normal hormone levels with no bioidentical hormone support.

My course of treatment will soon come to an end. It has been nearly a two year journey marked by gradual and noticeable improvement. I feel so much better now. And girl has it been interesting! I am so much more educated about my body and how it works.

I also have more courage. I stood up to “hearsay” with scientific evidence. I feel comfortable researching medical issues. I am aware that there are multiple sides to any story. I am confident I made the right choice for me.

Give Kudos To Courageous Women.

Right or wrong, Oprah and Suzanne Somers said, “Hey…traditional medicine isn’t working for us! Is somebody listening?” Many of us echo that sentiment. I’ve had multiple conversations with multiple doctors in different states about my health problems. No one seemed to have an answer other than those treatments du jour I mentioned in Confession #5.

The fact is, Mr. Kosova and Mr. Wingert (authors of the Newsweek article), women listen to Oprah because they identify with her. She listened to us. She is one of us. She came from nothing, worked hard, made her dreams come true, and now helps her viewers and listeners accomplish their goals. She has challenged us to run marathons, read books, and ask questions. We listen when she asks questions! And we listen when she offers solutions.

And this time, she found the same health solution that I did.

Confession #5: Evidence and Crazy Talk. Part 2 of 3.

This is the second of three posts in response to a Newsweek headline, “Crazy Talk,” and the accompanying article “Best Life or Risky Advice?” which blasted talk-show host Oprah Winfrey for many things, including her support and use of bioidentical hormones.

A quick recap. First, read the Newsweek article for yourself. Second, make medical decisions based on medical research and evidence.

Bioidentical hormones are not the “solution of the week.” They are not a trend. Many out there are claiming bioidentical hormones are the cure for all that ails you. Seasons doesn’t make that claim. They are, however, a great solution for many women.

The Seasons Approach to Bioidentical Hormones is Balance.

The key to weathering the hormonal storms of womanhood is balance: balance between what we eat and how much exercise we get; balance between work and play; balance between rest and activity.

We also need balance on the inside. Balance between estrogen, progesterone, testosterone, DHEA, cortisol, thyroid, and melatonin. When these hormones became imbalanced (as mine did), we develop symptoms: hot flashes, fatigue, mood swings, irritability, mental fog, weight gain, just to name a few. This may or may not have anything at all to do with menopause (mine was stress and pregnancy related). But once these hormones are back in balance, the symptoms diminish or disappear.

And, oh, the bliss when the symptoms disappear! Don’t underestimate the value of just plain old “feeling good.” (Ladies, feel free to chime in with an Amen here!)

There Is No Blanket Prescription for Womanhood.

We can’t just take three pills and feel better (and if that doesn’t work, just do a hysterectomy). But that seems to be how modern medicine treats us. Think about it. We all have different bodies, different levels of hormones. These hormones are affected by environment, genetics, stress, pregnancy, etc. There’s no way my hormones and yours could be the same. Our lives are different. Our genetics are different. It just doesn’t make sense that our solutions should be the same.

So why is it that many physicians want to prescribe the same treatment for all of us? Birth control pills and anti-depressants are the prescription du jour for women between 30 and menopause. And for the those approaching/in/completing the BIG change of seasons (menopause), the prescription du jour is synthetic hormones and (yes) anti-depressants. Don’t get me wrong, here. There are some who need an anti-depressant for true symptoms of depression. But as a blanket prescription for womanhood, anti-depressants are a bad idea.

In fact, my husband told me a few years ago that I was the only wife he knew who wasn’t taking an anti-depressant – he and his friends actually had this conversation. That’s not to say I wasn’t having mood-swings. I just flat-out refused to take an anti-depressant even though my physician at the time offered it as an option. I knew depression was not my issue. It was something else. I just couldn’t quite put my finger on it.

You know, when the solutions you are offered in life just don’t work, you have to keep searching, especially when you just don’t feel good and you want your life back. I did keep searching. And I found a solution that worked. In my next post, I’ll complete my comments and share with you my solution.

See you there.

Confession #4: Evidence and Crazy Talk. Part 1 of 3.

Crazy Talk.

I’ve heard that expression before. But when I heard the Newsweek headline about Oprah was entitled “Crazy Talk,” I was scared to read the article.

Why was I scared? You see my own personal experience with bioidentical hormones has made me a huge advocate. When Oprah revealed on national TV that bioidentical hormone therapy had worked for her, I was thrilled! “Maybe Oprah’s support will encourage her viewers to learn more about them,” I thought. “Maybe her media power will help open the closed minds of many traditional doctors…give them a reason to listen when their patients ask questions…”

A week after it was published, I finally mustered up enough courage to read the article. It wasn’t as bad as I anticipated. The article certainly had a negative tone, but it was more about Oprah’s power than bioidentical hormones.

Read the Newsweek Article For Yourself.

The most important thing we can do is think for ourselves. To read the article at Newsweek’s website (“Best Life or Risky Advice?”, Newsweek, published 6/30/09), click here.

The authors, Weston Kosova and Pat Wingert, point a finger at one major issue: Oprah has an unopposed platform to air her views and give credibility to whatever she chooses. That’s true. Oprah’s greatest accomplishment is her media power, through television, radio, print and her website. With that great power comes great responsibility. Mr. Kosova and Mr. Wingert work on the assumption here that Oprah has missed the boat on the responsibility part. And while I might agree with some (or even much) of what they said, I think they “threw the (bioidentical hormone) baby out with the bath water.”

Make Medical Decisions Based On Medical Research and Evidence.

There is definitely controversy on the topic of bioidentical hormones, and plenty of it: controversy between traditional medicine and a more progressive approach to medicine; controversy between drug companies and compounding pharmacists; even controversy between doctors and their patients.

But there is also plenty of research and evidence that supports the use of bioidentical hormones. Loads of it, actually. Spend a little time exploring the Seasons website and you will find numerous links to research articles. I encourage you to read for yourself!

In my next post, I’ll continue with more thoughts on the “Crazy Talk” article.

See you there.

What Is Seasons?

At Seasons, our focus is wellness, not just treatment of disease. In this video, Dr. Nathan Goodyear talks about his vision for Seasons and our revolutionary approach to women’s health care.

open source video, online video platform, video solution

Bioidentical Hormones: What Does The Scientific And Medical Evidence Say?

A young lady came into my office the other day to discuss hormones. She was a breast cancer survivor. Her concern, and rightly so, was her risk of getting breast cancer again. Since she lived in the south (our main office is in Ruston, Louisiana), she had experienced the women’s ritely passage of menopause: “the hysterectomy ceremony.”

Her question to me was: can she take hormones? Years ago, her cancer doctor had placed her on premarin, telling her that it was safe. She also was told that because she had a hysterectomy, progesterone was not necessary. Her gynecologist, in contrast, told her she couldn’t take premarin. Different doctors, different opinions.

I’m not trying to offer a third opinion here. I just want to stay focused on the evidence. That is what evidence-based medicine is all about. Unfortunately, market forces are clouding evidence-based medicine today.

In earlier posts, I’ve talked about progesterone, synthetic progestins and their polar opposite effects on a woman’s breasts. Progesterone lowers risks. Progestin increases risks. I want to get a little more specific today with some information from an outstanding review of the evidence. In Dr. Kent Holtorf January 2009 article, the Bioidentical Hormone Debate, he exhaustively reviewed 196 research articles. (If you aren’t up to reading the full article, you can read an abstract of the review.)

Here is my summary of the risks associated with synthetic progestins:

• increased breast cell growth
• increased conversion of weaker estrogens into more potent estrogens
• promoted the formation of toxic estrogen metabolites (16-hydroxyestrone)
• stimulated the conversion of inactive estrogen to active estrogen (estrone sulfate to estrone)
• had anti-apoptotic effects. (Apoptosis is programmed cell death: which is a way to control cancer growth. Anti-apoptosis means your body lacks this method of controlling cancer growth.).

Contrast this with the benefits of the natural bioidentical hormone progesterone.

• reduced breast cell growth by 400%
• downregulated estrogen receptors in the breast
• induced cancer cell apoptosis (programmed cell death that helps control cancer growth)
• reduced breast cell division and growth
• and in some studies, progesterone actually arrested human breast cancer cells.

After looking at nearly 200 independent studies, Dr. Kent Holtorf concluded that “Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins.” Studies have shown that synthetic progestins increase the risk of breast cancer:

1. by approximately by 25% for each 5 years of use
2. by triple the risk (67%) of breast cancer when added to estrogen therapy
3. double the risk to 4% per year when compared to estrogen therapy alone.

This is in stark contrast to bio-identical progesterone, which reduces the risk of breast cancer by 10%.

“As far as the east is from the west”—that is how different the effects of progesterone and synthetic progestins are on the breast. Holtorf concludes his article in Postgraduate Medicine with statements like this: “With respect to the risk for breast cancer, heart disease, heart attack, and stroke, substantial scientific and medical evidence demonstrates that bioidentical hormones are safer.”

In my next post, I’ll look at synthetic premarin versus bioidentical hormone estrogen.

Related articles by Zemanta

• The Bioidentical Hormone Debate (www.postgradmed.com)
• Abstract: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? (holtorfmed.com)
• Study: Hormone therapy caused breast cancer for thousands (cnn.com)

Bioidentical Progesterone Helps Your Heart

President Eisenhower said, “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened”

In my last post, we looked at some new discoveries in science about the truth of bioidentical hormone therapy. Specifically, we looked at the different ways bioidentical progesterone and synthetic progestins affect the breasts. This week I want to look at the different ways they affect the cardiovascular system.

I can hear what you’re probably thinking. “You mean some hormones might have beneficial effects on the heart? That is not what my doctor told me.”

I don’t know your doctor or your specific situation, but I do know about the latest scientific research.

Synthetic hormones increase cardiovascular risks.

One study, the Women’s Health Initiative saw a large increase in the risk of heart attacks and stroke in women who used Provera. This is not at all surprising since synthetic progestins have previously been shown (in the PEPI study) to negate the positive cardiovascular benefits of estrogen.

These results stand in stark contrast to studies using bioidentical progesterone, which has been shown to provide additional cardiovascular benefits.

Here’s some more down and dirty science. First, you need to understand that blood vessel constriction and plaque formation both increase your risk of stroke and heart attack. Bioidentical progesterone reduced blood vessel constriction and plaque formation by 50%, but synthetic progestins actually increased blood vessel constriction and plaque formation.

Wow. I wish President Eisenhower’s words weren’t so appropriate. The truth is easy when everyone believes it; but the truth is hard to follow when so many people seem blind to it.

Here’s the truth: Bioidentical progesterone provides cardiovascular benefits to women.

Confession #1: The Worst-Case Scenario

My body is in a state of decay. Yes. I said it. You heard it here. This was this big year for me…a birthday with a zero at the end. Okay. I’ll go ahead and tell you. I turned 40.

As I approached this birthday, I had great plans.

1. I would lose the weight I’ve gained in the last 10 years through 2 pregnancies, the death of my father, and a cross-country move.
2. I would regain my health which has really deteriorated because all my energy seems to go to my family with myself being the last priority.
3. I would work on my “look.” It’s been many years since I really put a huge amount of effort into the way I look. And I really just wanted to enter my 40s feeling good about what I saw in the mirror.

So in September of 2007, a good eight months prior to the big birthday, I scheduled the fabulous and always-looked-forward-to ANNUAL VISIT.

You know the one. The pap smear. Ah, yes. You gotta love the stirrups. It’s the most fabulous moment in a girl’s life, isn’t it? So I made an appointment with a new doctor in our new town (refer to the above-mentioned cross-country move) as a first step on my quest for a better life in my 40s.

The annual visit was pretty uneventful until Dr. Goodyear said, “So what are your goals for yourself this year?”

He knew I was turning 40. I started with my list. “Lose weight and get healthy. And I think something might be wrong with my hormones… Something just isn’t right, but I can’t quite put my finger on it. I’ve been tested previously and told that my thyroid was just fine. But I don’t think it is.”

Dr. Goodyear has probably heard this as many times as he has seen patients. But for me, this felt like a scary confession. I’ve felt so alone with my struggles: weight, energy level, and turning 40.

So the good doctor said that we needed to start with my hormones. The testing was different than anything I had done before. In addition to drawing my blood, they made me spit in a cup.

I know. It sounds archaic.

Actually, I had to spit into 4 different vials at different points during the day on the 20th day following the first day of my last period. Did you follow that? It’s much easier than it sounds. But I recommend drinking a lot of water when you do saliva testing. It is hard to get that much spit!

So what happened next, you ask? Test results came back a few weeks later, and I was right. My hormones were all wrong. In fact, after I realized how out-of-whack I really was, I looked Dr. Goodyear straight in the eyes and said, “Am I the worst case you’ve ever had?”

He looked at me and said in the nicest possible way, “Yes.”

So here I am, the worst-case scenario. I am truly the hormonal woman. And I am on a personal mission to make sure that other women like me know that they aren’t alone and that there is help. Every week, I will update my blog and continue to share with you the journey I have been on since September of 2007. I have been using bioidentical hormones for 13 months now, and I am a completely different person than I was when I first stepped into Dr. Goodyear’s office. This journey continues. I’m not there yet. But every day I make another step towards the good health that I want so much.

Please join me on my journey, even if you aren’t a hormonal woman. You probably know someone who is!

–Elizabeth

Who’s Afraid Of The Big Bad Bioidentical Hormone?

What is Progesterone? Do women need progesterone after a hysterectomy? Does it cause cancer as some have been told? Does it disrupt the thyroid as some also have been told? What is truth? What is fiction? What does the evidence show?

Let’s work through some of these questions systematically.

What is Progesterone?

Progesterone is the hormone a woman’s body produces after ovulation each month. It balances the effect of estrogen in the uterus and throughout the body. When everything is working well in your body, estrogen and progesterone balance each other to create a normal menstrual cycle. However, when progesterone levels fall and estrogen dominates, a woman can experience heavy bleeding, irregular cycles, PMS, weight gain…

Some folks would have you believe that synthetic progestins (especially Provera) are identical to progesterone. This just isn’t true. They are not similar in shape, structure, or function. Progestins and progesterone do both protect of the lining of the uterus from excess estrogen. But that is where the similarities stop!

Race for the Cure… and a Better Understanding of Women’s Health

Breast cancer research has received a lot of attention lately through wonderful campaigns like Race for the Cure, Breast Cancer Awareness Month, and similar efforts. All of this research has given us some wonderful insights into women’s health in general. Specifically, the research has revealed clear distinctions between bio-identical progesterone and synthetic progestins.

Numerous large studies have shown that synthetic progestins, such as Provera, increase a woman’s risk of breast cancer. In contrast, bio-identical progesterone can reduce a woman’s risk of breast cancer. This has been clearly tested and consistently confirmed. In fact, just having low progesterone levels makes a woman 5.4 times more likely to get premenopausal breast cancer. Even worse, such women are significantly less likely to survive a fight with breast cancer.

As a doctor, I am horrified by these statistics, and I want to help—through my own practice and through an attempt with many other doctors to educate women.

As a scientist, I am amazed that something as simple as progesterone deficiency results in a higher breast cancer risk.

Still Not Convinced?

Here’s a quick summary of the down and dirty science. Estrogen is a powerful stimulant to breast cell growth. (Remember, cancer is unregulated cell growth). When researchers added synthetic progestin, the growth of breast cells increased significantly. In contrast, when researchers added progesterone, breast cell growth decreased by 400%.

And here’s what that means. A woman’s body needs progesterone even after a hysterectomy. Progesterone doesn’t cause cancer—in fact, the opposite is true! Finally, a woman’s thyroid is not disrupted by progesterone—again, the opposite is true!

Progesterone is safe. Women’s bodies produce it for a reason. They need it.

Oprah Wonders if You Should Replace Your Hormones

I don’t usually watch Oprah, let alone record her show. Not that I don’t like Oprah, I just am busy working during her show hours. But that ended last week when I actually recorded my first Oprah show. I know, I know… why now?

Oprah was discussing her experience with Bio-identical hormones. This is not the first time that Oprah or a celebrity has talked about her personal interests. In most cases, I’m not a big fan of people offering their opinions just because they are famous.

This time, though, I’m actually cheering Oprah on!

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