Female Hormone Replacement Therapy

Until recently, it was common practice for women to receive synthetic estrogen and/or progestin for a number of issues, including dysmenorrhea, peri and post-menopausal complaints and to prevent bone loss. Studies show a relationship between declining estrogen levels and increased rates of cardiovascular disease, dementia and bone loss, among a host of other complaints. For years, physicians prescribed Premarin, Provera and Prempro (a combination of Premarin and Provera).

In 2002 the government funded the Women’s Health Initiative (WHI). It was widely expected that this study would show the benefits of hormone replacement therapy (HRT), by replacing female sex hormones (steroids) that declined with age. The study used Prempro, which is basically a combination of Premarin and Provera. Instead WHI was halted before the end of the study because it showed that women using Prempro had significantly higher rates of cardiovascular disease, stroke, blood clots, and cancer and were twice as likely to suffer from dementia. If you are a woman, you know that this was widely reported in the media. Most women stopped hormone replacement therapy and physicians quit prescribing it. Here are a few numbers from the book “Overdosed America”. The author states that about 6,000,000 women were on HRT at the time and that one serious adverse effect from HRT could be expected per 100 women each five years. This translates to over 100,000 cases of breast cancer in the past 10 years, not including all the other issues. No wonder most women discontinued.

Premarin is a hormone derived from the urine of pregnant mares (hence the name). It contains a female sex hormone called Equilin. The three prevalent estrogen hormones in human women are Estriol, Estrone and Estradiol. Human women do not have one single molecule of Equilin in their body. Its effect on the uterine lining is much greater than that of human estrogens, probably explaining the increased rate of uterine cancer seen in women in the WHI study. Second, Premarin is high in Estrone, higher levels of which are linked to increased rates of breast cancer. Last, but not least, the Provera portion of Prempro does not contain human progesterone, but rather a synthetic progestin (called medroxyprogesterone), which once again, is not found in the human female and has a multitude of negative effects.

Estrogen is actually a general term for a couple of dozen chemically related steroid hormones found in the human female. There are “good” and “bad” estrogens, meaning that if imbalances in their ratios are present, negative effects may occur. The “2/16” ratio, or the ratio of 2-hydroxyestrogen to 16-hydroxyestrogen is used to predict the risk of estrogen-related cancers, such as breast, uterine and ovarian. The higher the ratio, the less the risk. There are natural substances (nutriceuticals) that may be used to positively affect this ratio.

Estradiol and Estrone are considered to be pro-carcinogenic. The body rapidly converts them to Estriol, considered to be a mild estrogen that is anti-carcinogenic. Henry Lemon, MD. came up with a risk assessment equation for breast cancer, called the estrogen quotient. The formula is: Estriol/ (Estrone+Estradiol); the higher the number, the less the risk. He studied 34 women who were cancer-free and compared them with 26 women with breast cancer. Those with cancer had a much lower quotient, much less than 1.0 compared to over 1.0 for the cancer free women. There are a number of other studies supporting the hypothesis that higher levels of Estriol are protective against breast cancer. One of the latest studies involved 15,000 women who had been pregnant between 1959-1967. They were followed through 1997. Women who were in the top 25% Estriol levels during pregnancy had 58% less breast cancer over the ensuing 30-40 years.

What are some of the ways one may increase natural estrogen levels without resorting to the use of the discredited drugs Premarin, Prempro, and Provera? For starters, if you are having issues you believe are related to female hormone imbalances it would be a good idea to run a complete hormone panel that would include Progesterone, Estriol, Estrone, Estradiol, 2- and 16- Hydroxyestrogens, DHEA and Testosterone (yes that’s right). Good luck getting your physician to do it, though. A good, relatively inexpensive way to accomplish this is to run these tests using saliva. The benefit of salivary levels, aside from the ease of collection and the lower price, is that this method only measures the free hormone levels versus the bound levels. Only free (or weakly bound) hormones exert an influence. Measuring blood levels generally includes free, weakly and tightly bound hormones. Unless you ask for free levels and also run sex hormone binding globulin you may not receive as accurate an assessment. Additionally, if you are not menopausal, you may want to have your estrogen and progesterone levels checked every other day for a complete cycle, to see exactly when imbalances occur. Again the salivary test is cheaper and certainly more convenient to perform.

After obtaining your results, a health care provider versed in Functional Medicine may suggest a variety of natural alternatives. For example, if you are deficient in estrogen, the female flower of hops contain a phytoestrogen (8-prenylnaringinen) that clinical research has shown to reduce the frequency and intensity of hot flashes. (Other plants and herbs contain phytoestrogens that are not as potent as hops, including soy, red clover and black cohosh). Isoflavones, and lignans from nuts and seeds, some cereals, fruits and vegetables are phytoestrogens with similar weak estrogenic activity. Additionally, many plastics contain compounds that mimic estrogen. The estrogenic activity of hops may partially explain why men who drink large quantities of beer look like pregnant women. The fat from the excess calories is deposited in a pattern more reminiscent of a pregnant female.

Use of another phytoestrogen derived from Norwegian Spruce (Hydroxymatairesinol), may increase the benefit of hops. Studies imply other benefits to phytoestrogens which may protect against certain cancers, cardiovascular disease and bone loss. These lignan phytoestrogens are converted by friendly intestinal bacteria into mammalian lignans called enterolactone and enterodiol that have anti-cancer properties.

Jonathan Wright, MD reports that he has used SSKI or saturated solution of potassium iodide on hundreds of women to increase estriol.

Many women with premenstrual syndrome can be helped by insuring proper calcium/magnesium balance. Today’s diet has higher levels of phosphorus relative to calcium and magnesium. This creates a deficiency of these minerals and leads to estrogen/progesterone imbalances that can cause PMS and other symptoms of estrogen excess. Supplemental calcium, magnesium, vitamin B6, and natural progesterone from wild yams have helped many of my patients with this condition.

This just in- Now it has been reported that women with a prior history of breast cancer who are taking tamoxifen (about 500,000 women) for reduction of risk of recurrence have the effects totally neutralized if they also take Paxil, Prozac or Zoloft. If you are taking these drugs you may wish to reconsider taking the anti-depressant if you are taking tamoxifen.