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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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.

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Menopause is not a disease

“First do no harm.” This is from the Hippocratic Oath that every physician takes prior to graduating from medical school.

“First do no harm.” Here’s what that means for me: First, work with the body to prevent disease.

Often, we see patients after they already have a disease. At that point, we begin treatment and intervention—which typically involves introducing a drug not normally present in the body. This is why drug companies have to do so much testing to measure the effects/side effects of any new drug. When I prescribe treatment and intervention, I’m always weighing the benefits of a drug versus the risks associated with that drug. Medical training does a great job of helping doctors understand how to treat disease.

But PMS, perimenopause, and menopause and all the symptoms that go along with them aren’t the result of a disease. They are the result of hormone imbalances. Having imbalanced hormones is not the same as having a disease—and doctors should not treat a hormone imbalance as if they are treating disease.

Instead of medicating with synthetic drugs, doctors can seek to rebalance the patient’s hormones.

Bio-identical hormones represent the essence of this approach. (Dr. Dixie Mills has some good thoughts about Bio-identical hormones at Women to Women.) There is no rocket science or voodoo behind Bio-identical hormones as some may suggest. In fact, if you look at the scientific literature, the support is all for Bio-identical hormones. The rest of the world is way ahead of the US on this one.

Then why are so many physicians still focused on the disease model, instead of the health and prevention model? I can’t answer that question. But I can treat my patients differently—using methods supported by scientific literature as being more healthy and effective.

Bio-identical hormones merely represent understanding how the body works and working within the body’s framework. It makes a lot of sense. Patients receive hormones that are structurally and functionally identical to those produced in your body.

Hormone imbalance is not a disease. But doctors can treat the imbalance with Bio-identical hormones to give you better health and help prevent future disease.

From the Doctor’s Desk: What’s All The Fuss About Saliva Testing?

Confused about saliva testing? Don’t worry, your physician may be just as confused.

I don’t mean to suggest that the science of saliva testing is new. In fact, the clinical use of saliva testing of hormones has been validated over the past 25+ years, and it is well documented in journal publications such as Gynecology Endocrinology, Journal of Clinical Endocrinology, and Menopause. I know, you’re probably not going to run out and subscribe to those now, but these journals are important to doctors. They range from hard-core bench research to more clinical research.

So why use saliva testing for hormones? The short answer is accuracy.

This is going to get technical, so stick with me. See, hormones in the blood stream are mostly bound to carrier proteins (95-99%) for transportation to target tissues. In this transportation form, hormones are inactivated and not available for use. Only when the hormone is released inside the cells of the target tissue does it begin to have an effect. Saliva testing allows us to see your hormone levels inside the cells at the tissue level. That is where these free hormones can cause symptoms like hot flashes, irritability, breast tenderness, and dry skin.

You’re probably wondering, “Then why isn’t every doctor checking my hormones with a saliva test?” Or even worse, you may have been told that saliva testing is dangerous or inaccurate. Unfortunately, physicians are slow to apply new evidence into practice. History has shown this before. The medical community knew vitamin C replacement prevented scurvy on long sea journeys for 193 years before action was taken.

Hopefully, we will not wait that long this go around.

Why you should be concerned about estrogen dominance

October is breast cancer awareness month!

Last week, in a post about three ways to help prevent breast cancer, I talked a little bit about estrogen dominance. You’re probably wondering what it is and why it matters.  I’ll do my best to explain this as thoroughly as I can without getting too technical.

What is it?

Estrogen dominance occurs when you stop ovulating. During the first half of a woman’s cycle, estrogen stimulates growth of her uterine lining. Half way through the cycle, ovulation occurs. At this point progesterone production dominates-which limits further estrogen growth.  Without ovulation, progesterone does not balance the estrogen produced in the first half of the cycle. Instead, a woman’s body continues to produce estrogen resulting in estrogen dominance.

When does this occur?

Estrogen dominance can occurs for several reasons.  First is when young teenagers start their periods. They often have irregular periods for the first two to three years because of lack of ovulation. Second is during perimenopause (the transition to menopause). During perimenopause, a woman again stops ovulating and stops producing progesterone to balance estrogen. Finally, estrogen dominance occurs in women who have polycystic ovarian syndrome. This syndrome is a collection of hormonal symptoms that have at their root cause, lack of ovulation and thus estrogen dominance.

Why is this important?

Estrogen dominance during the perimenopause puts women at a greater risk for weight gain and breast cancer. High levels of estrogen can lead to constant stimulation for growth. This means all estrogen is encouraging all cells to grow-normal cells and abnormal cancerous cells in the breast.

What can we do about estrogen dominance?

During perimenopause, the simple addition of bio-identical progesterone can balance the estrogen. This corrects estrogen dominance, helps women lose weight, and reduces the incidence of breast cancer.

(Special thanks to MesserWoland for providing copyright permission of the pink ribbon through Wikipedia.)

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

Did you say saliva testing?

We use saliva testing to measure hormone levels at our Seasons offices. Naturally, the phrase “saliva testing” raises a few questions.

How do we collect your saliva? We don’t. You do it at home with saliva collecting kits. It isn’t a difficult process, but you do need to follow the directions carefully:

1. 30 minutes before collection, please do no eat or drink anything except water.
2. Rinse mouth thouroughly with cold water 3-4 minutes prior to saliva collection.
3. Following the collection schedule below, collect saliva in each of the 4 blue cap tubes to fill three quarters or more, excluding any foam. Take your time. Recap tubes and place into the zip lock bag.

Morning/Fasting 7 – 8 AM
Noon 11 – 1 PM
Afternoon 4 – 5 PM
Midnight 11 – 12 PM

Each saliva collection kit includes some “pour off tubes.” Here’s how they work.

Pour off enough saliva from the noon and/or afternoon tubes to fill 1/4 of the tubes labeled FL and FT3. Cap tubes tightly. Follow the mailing instructions. If you pour more, do not pour saliva back into the blue cap tubes.

Finally, on the day you are collecting saliva, there are a few things you want to avoid.

• Do Not Eat chocolate, onions, garlic, cabbage, cauliflower/broccoli.
• Do Not Drink coffee, tea, or caffeinated drinks (like coke, guarana, etc.)
• Do Not Use sublingual hormones or troches as of the night before collection.
• Avoid antacids, bismuth medications or mouth washes.
• Stop your current hormone therapy 72 hours prior to the saliva collection.

What hormones will I need and how do I take them?

Bio-identical hormones are available in creams, ointments, sub-lingual drops, vaginal suppositories, pills, and injections. So you have a lot of options on how you can take them.

As to what hormones you will need, this will depend on the individual. Your hormone needs are as unique as your fingerprints. A one size fits all approach is not appropriate in hormone therapy. Therapy will be specifiic to your hormone deficiency.

We use salivary testing from DiagnosTechs Laboratory to determine what hormones you need. Over 300 studies have been published validating the accuracy of hormone salivary testing.

Once we’ve determined what hormones you need, bio-identical hormone therapy draws upon 6 type of hormones:

• Estrogens
• Progesterone
• Testosterone
• DHEA
• Cortisol
• Thyroid

You can read more about the different types of hormones in my post “Menopause and Hormones 101.”

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