The justification for conventional hormone replacement therapy is that women's hormones decline with age. Our hormones do not decline because we age. We age because our hormones decline. When we pass through puberty and our hormones spike, they do not make us sick, but thrust us into maturity making our bodies strong and healthy. Restoring levels back to a youthful level would reduce menopausal issues but, the conventional hormone replacement therapy used today by mainstream medical doctors are leading to higher rates of cancer, heart disease, and stroke. Physicians have been using drugs such as Premarin, Prempro, and Provera to combat the symptoms of menopause for many years. These patented non-bioidentical estrogen and progestin hormones are not the same in structure or activity as the ones our bodies naturally produce, the use of which turned out to be fatally flawed, as the Women's Health Initiative showed. Medicine in America has been taken over (some may say to a large extent) by the pharmaceutical industry affectionately called “big pharma.” Conventional medicine has moved away from health care and instead focuses on the business of disease management. The pharmaceutical industry controls medical education through medical school, continuing medical education doctors must do, to which studies are funded and published in medical journals and therefore protocols used in the treatment of patients. Big pharma is a business and like all successful ones their motivation and job is to make money for their shareholders. To do that big pharma must patent drugs to ensure their drugs are the one's doctors prescribe to their patients. Medicine's job, on the other hand, is supposed to be about health and healing, not be profit generators for the pharmaceutical industry.
Conventional wisdom, as well as mainstream health professionals, assume women after menopause are estrogen deficient. This just is not true. Over two-thirds of all women continue to produce all the estrogen they require even if their ovaries are removed. How is this possible? Body fat, hormones are fat soluble and as such store easily in our fat cells. Through an enzyme process called aromatization, the aromatase enzyme converts hormones such as androstenedione and other adrenal hormones found in fat and breast tissue into estrone. In fact, as women age estrogen dominance is a real concern. Patients and doctors alike must be aware that hormones do not work independently but, as a complex network of checks and balances. To evaluate hormones correctly, you must not just consider one hormone’s outright level but, its relationship and ratio with other hormones. It is not necessarily what your total estrogen levels are but what your estrogen, progesterone, and testosterone levels and ratios are. To get the whole picture, an experienced health practitioner will evaluate your primary estrogens (estrone, estradiol, estriol), progesterone, testosterone, adrenals, and thyroid.
All steroid (sex) hormones are produced from cholesterol (see chart 1). Pregnenolone, DHEA, cortisol, progesterone, testosterone, all the estrogens, and many others complete this hormonal cascade. All of these hormones have individual functions but, as you can see are also all interrelated. Sound and responsible hormone replacement therapy should focus on the complete hormonal picture, not just estrogen and or progesterone.
In the 1990's the National Institutes of Health (NIH) started The Women's Health Initiative (WHI). It consisted of three clinical trials as well as an observational study to address some of the major health issues in an aging female population. The estrogen and progestin (non-bioidentical) trial was stopped early when it was found the health risks (cancer, stroke, and heart disease) outweighed the benefits. The WHI study only tested one combination of non-bioidentical hormone Prempro (0.625 mg Premarin (oral equine estrogen) and 2.5 mg Provera (progestin)). Would the outcome be different if a bioidentical hormone combination was used? Many patients and doctors alike find it difficult to understand the difference between conventional hormone vs. bioidentical hormone replacement. This article will explain the difference between the two and how bioidentical hormone replacement can counteract and prevent many if not all the potential health risks associated with hormone replacement therapy.
Estrogen dominance is a term most of us have heard, even if we do not have a complete understanding, the name alone gives us the gist of what's going on. Estrogen dominance can happen at any age but, is most often associated with age and menopause. The production of progesterone declines as menses slows and eventually stops leading to an undesirable progesterone: estradiol ratio making women more susceptible to various health problems. Many women and doctors report not only menstrual problems with estrogen dominance but, it has also been associated with the development of cellulite, hair loss, food cravings, weight gain, migraines, bloating, fibroids, endometriosis, and cancer to name a few. Now, this may seem like estrogen is a dangerous thing that needs to be avoided at all costs but, remember hormones do not exist by themselves in a vacuum. If it were just high levels of estrogen that caused these problems, then we would expect to see a high incidence of these issues in young women of childbearing age. The opposite, in fact, is true as seen in the following cancer statistics.
Another way to look at these number is:
By age 25- 1 : 19,608 By age 30- 1 : 2,525 By age 35- 1 : 622 By age 40- 1 : 217 By age 45- 1 : 93 By age 50- 1 : 50 By age 55- 1 : 33 By age 60- 1 : 24 By age 65- 1 : 17 By age 70- 1 : 14 By age 75- 1 : 11 By age 80- 1 : 10 By age 85- 1 : 9 Lifetime- 1 : 8
While more than fifteen different forms of estrogen have been identified, here we are going to focus on just a few. The three primary forms of estrogen are Estrone (E1), Estradiol (E2), and Estriol (E3), each of which has a particular function or role to play and is dependent upon age. Estrone produced in the ovaries and aromatized in fat cells is the strongest form and most dominant in postmenopausal women. Estrone can more easily convert into three different metabolites or forms of estrogen called 2-hydroxyestrone, 4-hydroxyestrone, and 16-alpha-hydroxyestrone. In layman terms 2-hydroxyestrone is "good" or chemoprotective, while 4-hydroxy and 16-alpha-hydroxyestrone are "bad" and have been associated with cancer development, this is usually expressed as a 2: 16 ratio. It has been shown that by increasing the 2: 16 ratio it is possible to reduce the risk of estrogen-dependent cancers. There are many approaches to improve this ratio, one of the best is the consumption of cruciferous vegetables such as arugula, bok choy, broccoli, brussel sprouts, cabbage, cauliflower, collard, daikon, and kale to name a few. Estradiol is the predominant estrogen in nonpregnant women of reproductive age. Its primary function is ovulation but, also has positive effects on heart, bones, and brain. It is the reduction of estradiol that contributes to many of the most common menopause symptoms. Estriol which is highest during pregnancy is comparatively speaking a very weak estrogen and the one least associated with hormone-related cancers. Estriol is also shown to have other health benefits most notably, cardiovascular disease, bone density, incontinence, as well as sexual well-being, such as vaginal dryness and as a collagen promoter that enhances skin elasticity. Another benefit is estriol’s ability to bind and activate estrogen receptor beta, which is why it is known to be associated with reduced risk of breast cancer. In an attempt to simplify this, here is the ‘cliff note' explanation. There are two base receptors of estrogen in breast tissue, estrogen receptor alpha (ER-a) and estrogen receptor beta (ER-b). Estrogen that bind to ER-a promotes cell growth whereas estrogen that binds to ER-b halt breast cell growth and may slow the development of estrogen-dependent tumors. Estrone and estradiol mainly bind to ER-a while estriol binds to ER-b. It is estriols ability to stimulate ER-b that helps combat the increased effects of estrone and estradiol. This is why many practitioners with knowledge of hormone replacement emphasize the use of estriol in any hormone treatment intended to restore a youthful balance and vigor while decreasing the possible risk of developing breast cancer.
Stay Tuned For Part 2
Disclaimer: I AM NOT A PHYSICIAN, AND THIS POST IS NOT MEANT TO REPLACE PROPER MEDICAL TREATMENT.Make an appointment today for your personalized nutrition consultation. I will create a customized functional nutrition program for you and together we will start we will start you on your wellness journey. If you live in the NYC or LONG ISLAND, you can contact me for physician names qualified to help in BioHRT