From the Doctor’s Desk: Salivary Hormone Testing Backed by Science

Testing hormones through saliva is backed by science. But don’t take my word for it. In fact, it is well supported in the medical literature and is the right thing to do.  Below are links to several abstracts regarding salivary hormone testing. Read them for yourself and learn about the science behind this form of hormone testing.

• Belkien LD, Bordt J, Moller P, Hano R, Nieschlag E. Estradiol in saliva for monitoring follicular stimulation in an in vitro fertilization program. Fertil Steril 1985;44:322.
• Bolaji II, Tallon DF, O’Dwyer E, Fottrell PF. Assessment of bioavailability of oral micronized progesterone using a salivary progesterone enzymeimmunoassay. Gynecol Endocrinol 1993;7:101-110.
• Campbell BC, Ellison PT. Menstrual variation in salivary testosterone among regularly cycling women. Horm Res 1992;37:132-136.
• Aardal-Eriksson E, Karlberg BE, Holm AC. Salivary cortisol- and alternative to serum cortisol determinations in dynamic function tests. Clin Chem Lab Med 1998;36:215-222.

These articles are published in well-respected journals; and if you notice, they are not recent.  Salivary testing of hormones has been well published in the medical literature for some time now.

Here are a few quotes from these studies:

• “…salivary cortisol may be used as an alternative parameter in dynamic endocrine tests.”
• “…assessment of ovarian function…can be performed precisely with the saliva estradiol assay.”
• “…saliva collection has provided the medical and research community with an excellent medium for the monitoring of plasma steroid levels.”

Nowhere else in medicine do we blindly treat people without assessing a baseline and post treatment level(s). Balance is the key; not one individual hormone. Unfortunately, the medical field is very slow to learn and change.

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.

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.

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.

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.)

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.

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)