All Estrogens Are Not Created Equal

There is a lot of confusion in the medical and non-medical communities regarding estrogens. Many today think there is only one estrogen. Many today think bioidentical estrogens and synthetic estrogens are identical in structure and function. Many today think estrogen production stops after menopause or after a total hysterectomy. However, this couldn’t be further from the truth.

The body never stops producing estrogens. The body, in fact, produces 3 types of estrogens: estradiol, estrone, and estriol. These are the natural estrogens native to the body and the foundation of bioidentical hormone replacement of estrogen.

A woman’s body produces estrogens in various places. Most people knows that ovaries produce estrogens. But did you know that the adrenal glands and fat cells produce estrogens, too? Think about that for a minute. This explains why women of all ages continue produce estrogen. Our adrenal glands don’t disappear at menopause. And fat cells certainly don’t. So how do we know if a woman needs estrogen?

Let’s look more closely at the 3 main estrogens produced in the body.

• estradiol
• estrone
• estriol

Estriol is a good place to start. Estriol is the weakest of all Estrogens. A woman’s placenta produces very large amounts of estriol during pregnancy. However, estriol is not confined to pregnancy. The liver produces small amounts, too. Estriol primarily affects a woman’s hair, nails, skin, and her vaginal lining. Studies also suggest estriol has potential in breast cancer prevention because estriol binds to specific receptors (beta-receptors) in the breast that inhibit breast cell growth. All other estrogens would be expected to increase breast cell growth (which can lead to cancer) through activity with alpha-receptors.

Estrone is the second most potent estrogen. Estrone is predominately produced in fat cells after menopause. Overweight women have high circulating estrone levels. Unfortunately, 63% of American women are overweight or obese, so many women have high estrone levels. Estrone levels rise even more after menopause, and estrone has been implicated in breast tumors in animal studies. (Scientists say this because estrone has a 5:1 affinity for alpha breast receptors, but that’s pretty technical.) Just remember that alpha-receptors increase breast cell growth. You could say estrone encourages breast cell growth, and that can lead to uncontrolled breast cell growth. We call that breast cancer.

Estradiol is the most potent estrogen. Estradiol is produced predominately from the ovaries. This means a woman will have less estriadiol after menopause because her ovaries are producing less. Estradiol is the main stimulus for growth of the lining of the uterus in the first 2 weeks of the monthly cycle, and it helps in triggering ovulation. Like estrone, estradiol has been implicated in breast tumors. It has a 3:1 affinity for alpha-receptors in the breasts, which promote breast cell growth and can lead to cancer.

That’s a lot of information for one blog post, I know. But remember the overall point. Bioidentical hormone therapy is much more than the use of bioidentical estrogen. It is about which estrogens your body needs to maximize efficacy, reduce side effects, and prevent disease.

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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)

Hormone Symphony

Have you ever heard a great symphony play under a great conductor in a great symphony hall? I have. The music is beautiful.

Of course, it doesn’t matter how good the conductor is or how good the acoustics are—if the orchestra is not good. If the symphony’s tempo is off, or the pitch, or the key, or the volume, then it doesn’t even matter who wrote the music. Beethoven, Mozart, or Bach will just sound like noise to the audience.

Symphony comes from a Greek word meaning “agreement or concord of sound.”

Your hormones are like a symphony. When everything works together, then and only then can you appreciate the beauty of the music.

When your hormones are out of balance, your body will experience symptoms that wreck the music—hot flashes, mood swings, weight gain. Like a symphony, your hormonal balance is more complicated than any individual part. It is not just about your estrogen and thyroid as many would have you believe. Your hormonal symphony requires the balance of all hormones: all estrogen types, progesterone, testosterone, DHEA, cortisol, thyroid, and melatonin. One hormone out of balance can start a ripple effect that results in total hormonal imbalance.

When your hormones are not balanced, your body feels like a bad symphony, just making noise. However, when all hormones are balanced, your body can make beautiful music. If we reduce your diagnosis to estrogen problems or thyroid problems only, we will miss the mark. When we evaluate and treat your hormones as a whole system, your body can be a symphony.

Hormone Therapy May Help You Lose Weight

I am always shocked when I read this statistic: 33% of women in America are obese; 62% are overweight. That’s the bad news. The good news is that obesity among women may be stabilizing.

What is obesity exactly? If your doctor tells you that you are obese, it means your body mass index is greater than 30. A normal body mass index should be less than 25. A body mass index of 25-29.9 is overweight.

Being overweight or obese is the number one health problem facing women today. Period. It leads to diabetes. Hypertension. Cardiovascular disease. Strokes. It can even contribute to cancer. Being obese is a disease, and it should be treated as such.

Here’s what I tell patients who are obese: for your health and longevity, we need to help you lose weight. We’ll start by assessing where you are with your body. Eventually, we’ll put you on a weight loss program, but we need to make sure your body is ready to lose weight first.

How would a body not be ready to lose weight?

Well, if you have estrogen dominance, your body may work against you losing weight. Think about women over forty who start to gain weight around their middle section. They’ve stopped ovulating and stopped producing progesterone. But they are still producing estrogen. That means they’re experiencing “estrogen dominance.”

I know, I know. More medical speak. Don’t worry about what “estrogen dominance” means exactly. Just know that estrogen tells everything to grow… including fat cells. So if you’re in an estrogen dominant state, that’s going to do nothing but promote weight gain.

If we don’t address the estrogen problem, you’re not going to be able to lose weight very efficiently. That’s why we often start with hormone therapy.

Who needs Hormones?

Who needs hormones? The answer is: not everyone. Some need hormones, and some don’t. Additionally, a need for hormone therapy is not unique to women. Men can benefit from hormone therapy as well.

If you have symptoms of hormone imbalances, then hormone replacement therapy may be right for you. However, a “one size fits all approach” is never appropriate. Each individual’s hormone needs are as unique as his or her thumb print.

Hormone testing will help determine the specific hormone imbalances and direct treatment.

Menopause and Hormones 101

If you’re experiencing symptoms of menopause, you are probably wondering about hormones. Everyone is talking about hormones these days. So here’s a quick crash course in the ones that affect your body.

Let’s start with the three estrogens.

1. Estradiol: Estradiol is produced primarily in the ovaries and is the most potent of the 3 estrogens. This estrogen will decrease significantly during menopause or after removal of ovaries. This estrogen is responsible for the symptoms that most associate with menopause.
2. Estrone: Estrone is produced primarily from fat tissue and muscles. This estrogen is the second most potent. It will be elevated in women who are overweight and has been linked to the accelerated growth of breast cancer among other things. In fact, this hormone is best left out of hormone replacement regimens.
3. Estriol: Estriol is the weakest of the 3 estrogens. It is dominate during pregnancy and has been linked to breast cancer protection.

There are several other hormones that you’ll hear about.

• Progesterone: Progesterone is the counterpart to estrogen. Where estrogen promotes growth, progesterone promotes maturation or stabilization. Progesterone is dominant in the latter half of the menstrual cycle. Progesterone has been shown to have PMS, anti-depressant and anti-anxiety benefits. Simply put, progesterone balances estrogen.
• Testosterone: Yes! Women have testosterone too. It is produced primarily from the ovaries before menopause. After menopause, it is primarily produced by the adrenal glands. Testosterone has well known libido benefits.
• T4: This thyroid hormone is produced in the thyroid gland and released for circulation. It can be replaced with such medicines as synthroid and levothryoxine. Low T4 can be a result of iodine deficient diets.
• T3: This is the most potent of the two thyroid hormones and is produced from the conversion of T4 in the liver and kidneys. T3 is present in the medicines armour thyroid and cytomel.
• Cortisol: Produced in the adrenal glands, cortisol is released in large response to stress. High cortisol levels promote slow metabolism and fat storage. Prolonged stress and high cortisol levels, can result in adrenal exhaustion and low cortisol levels. Low cortisol levels cause fatigue and other symptoms that can mimic depression.

ZRT Laboratory has an interactive graphic that is very helpful in giving you an overview of most hormones your body produces.

What symptoms indicate hormone imbalance?

The symptoms of low estrogen include…

• hot flashes
• night sweats
• vaginal dryness
• urinary frequency
• depressed feeling
• sleeping difficulty
• no interest in sex
• no periods

The symptoms of low testosterone include…

• fatigue
• lack of drive
• lack of initiative
• less assertive
• decline in sense of well being
• general depressed moods
• irritable
• lack of self-confidence
• difficulty in setting goals
• decline in mental sharpness
• no stamina/endurance
• loss of muscle mass, strength, or tone
• increased body fat around waist
• elevated cholesterol
• decreased libido
• decreased sexual ability
• sleep apnea

The symptoms of low thyroid include…

• general fatigue or afternoon fatigue
• elevated cholesterol
• difficulty losing weight
• cold hands and feet
• sensitivity to cold
• difficulty thinking clearly
• difficulty concentrating
• poor short term memory
• depressed moods
• hair loss
• constipation
• dry, itchy skin
• fluid retention
• recurrent headaches
• restless sleep
• tingling or numbness in hands and feet
• decreased sweating
• infertility or recurrent miscarriages
• recurrent infections
• muscles aches
• joint pain
• thinning of eyebrows and eyelashes
• enlargement of tongue and teeth indentations
• decreased body hair
• hoarse voice
• slow heart rate
• low blood pressure
• low body temperature
• sleep apnea

The symptoms of high estrogen/low progesterone include…

• premenstrual breast tenderness
• premenstrual mood swings
• premenstrual fluid retention and/or weight gain
• migraine headaches
• severe menstrual cramps
• heavy periods with clotting
• irregular menstrual cycles
• uterine fibroids
• fibrocystic breasts
• endometriosis
• history of infertility
• history of miscarriages
• joint pain
• muscle pain
• decreased libido
• anxiety and/or panic attacks

What are bioidentical hormones?

One of the most frequent questions we here is: “Hey! What is the difference between bioidentical hormones and synthetic hormones like premarin, prempro, premphase, and provera?”

I’m glad you asked! Synthetic hormones include conjugated equine (that’s horse in English) estrogens and progestins. (My wife is not a horse, and I’m pretty sure you aren’t either!)

The key difference between bioidentical and synthetic hormones is molecular structure. In an effort to fully replicate the function of the hormones produced by your body and to minimize the side effects, the molecular structure of the hormones must be identical to those produced in your body.

Synthetic hormones are similar but not identical. These structural differences lead to metabolism by-products that increase the frequency and intensity of unwanted side effects.

Bioidentical hormones are structurally and chemically identical to the hormones your body produces.

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You may have heard that there are not many studies about bioidentical hormones. Certainly, there have not been as many studies of bioidentical hormones as synthetic hormones. But, here’s why.

Pharmaceutical companies fund research for synthetic hormones through profitable patents and mass production. Bioidentical hormones cannot be patented, and thus there are limited funds for research. There are some European studies of bioidentical hormones, but they are small in number and limited in scope.

Related articles by Zemanta and Seasons

• Bioidentical hormones: What does the scientific evidence say?
• 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)