PFM Blog


Estrogen is One Part of Your Hormonal Symphony

Let's talk about estrogen. With 400 functions in the body, it's no wonder that when this part of your hormonal symphony is out of tune, there are many consequences! Hot flashes, night sweats, insomnia, anxiety, mood swings, irritability, depression, and memory problems, just to name a few; the consequences can drastically affect your life.

Pre-menopausal symptoms can start as early as 30 in some women, and are often written off as just being stressed out. However, it is also important to note that not all women lose estrogen as they age. Thus it is very important to have lab tests performed to accurately measure your levels.

While all 400 functions cannot be discussed in this article, I am discussing some of them because it is good for women who are afraid to take estrogen to know at least something about what estrogen does. Estrogen:

  • Maintains bone density.
  • Stimulates the production of an enzyme called choline acetyltransferase to prevent Alzheimer's disease.
  • Increases metabolic rate.
  • Improves insulin sensitivity.
  • Helps prevent muscle damage and maintain muscle.
  • Improves sleep.
  • Helps maintain the elasticity of arteries and dilates the small arteries, increases blood flow.
  • Inhibits platelet stickiness, decreases the accumulation of plaque in arteries.
  • Maintains the amount of collagen in the skin.
  • Lowers blood pressure, decreases LDL cholesterol levels and increases HDL cholesterol by 10-15 percent.
  • Reduces the overall risk of heart disease by 40-50 percent.
  • Enhances energy, improves mood, and increases concentration.
  • Increases sexual interest, decreases wrinkles.
  • Lowers risk of developing colon cancer.
  • Aids in the formation of neurotransmitters in the brain, such as serotonin, which decreases depression, irritability, anxiety, and even pain sensitivity.

Many women have estrogen excess (estrogen dominance) as a result of taking too much estrogen, impaired elimination of estrogen, lack of exercise, eating a diet low in grain and fiber, and environmental estrogens. A lack of exercise is probably the number one reason women in the US have too much estrogen. Excess can also result in anxiety, and agitation as well as weight gain, water retention, headaches, poor sleep, panic attacks and swollen breasts.

As an anti-aging specialist, I suggest the replacement of estrogen transdermal or via subcutaneous pellet insertions only. Oral estrogen is hard on the liver, it increases blood pressure, increases triglycerides and increases estrone levels - the estrogen that increases the risk of breast cancer. The metabolism of estrogen also changes after menopause. We check women's estrogen metabolism to see if the wrong kinds of estrogen metabolites are made.
Estrogen deficiency or excess can disrupt your hormonal symphony and take the joy out of life. Next week, I will discuss progesterone and its importance in the balancing act. Remember, your hormones were designed to work together for your own personal hormonal symphony to live life optimally!


Bio-Identical Hormone Replacement VS. Synthetic Hormone Replacement:

What Can I Use?

It creeps up on you silently, insidiously. The fatigue, headaches, depression, bouts of crying, inability to sleep because of constant tossing and turning; am I crazy, or is it perimenopause, menopause, or what?

If you have been wondering what treatments are available for you in the aftermath of the Women's Health Initiative (WHI) study, there are still alternatives to avoid the usual antidepressants, and antianxiety medications. In addition to herbs, nutrition, and other natural remedies, biologically identical hormones are an option.

Bio-identical hormones were once thought of as natural. The definition of natural is anything that has been derived from a natural source. Premarin (conjugated equine estrogen) is technically natural as it is a derivative of something natural. The term bio-identical describes a substance that mimics one naturally found in the human body. Bio-identical's are typically compounded and made from soy or yam where the molecular structure is the same as what already exists in the human body. Estrogen is actually not one hormone, but a group of three hormones: estrone (E1) Estradiol (E2), and estriol (E3) which are natural human hormones. The ratio of estrogens found naturally in the female is completely different than what is found in conjugated equine estrogen. About 40 percent of the estrogens in Premarin cannot be recognized or broke down normally by the human body.

As more and more women are prescribed bio-identical hormones, there needs to be an understanding of the risks of synthetic hormones while also understanding the data that specifically supports the safety and efficacy of bio-identical hormones.

Should we be without hormones in perimenopause and menopause? Climacteric symptoms can span 30 years (age 40-70) and produce progressive erratic decline in progesterone (anxiety, irritability, PMS, 10-15 years before menopause), estrogen (hot flashes, vaginal dryness), and testosterone (loss of libido, muscle loss). Most all tissue and organs in the body have receptors sites for estrogen, progesterone, and testosterone. Declining hormone levels are linked to a lot of diseases such as osteoporosis, colon cancer, heart disease, cognitive decline, tooth loss, and macular degeneration.

Progesterone is typically the first hormone to decline, usually in the late 30s and early 40s. This decline results in symptoms of anxiety and irritability. Progesterone deficiency is an important cause of PMS and heavy bleeding in women and adolescents.

Synthetic progesterone's are associated with weight gain, irritability, acne, and fluid retention whereas bio-identical progesterone's have been found to improve mood, anxiety, and depression as well as inhibit breast cell proliferation. There is some speculation that synthetic progesterone may actually be a culprit in cancer and cardiovascular risk.
The predominant fear of hormone replacement therapy (HRT) is the risk of breast cancer. According to the Journal of National Cancer Institute, the risk of breast cancer increases 29 percent over baseline with the addition of progestin (synthetic progesterone) to HRT. Eighty percent of breast cancers occur after menopause when estrogen levels decline or become unbalanced. Unbalanced being that, estrone surplus from the adrenal give you the imbalance. This imbalance with too much estones and too little progesterone and estriol actually plays a part in breast cancer.

Although more research is needed on bio-identicals, current research and common sense support its use. The benefits of bio-identical HRT clearly out weight the risks if given transdermally or subcutaneous pellet therapy using a physiological dose that is balanced to mimic the normal estrogen ratio.

Call Prairie Family Medicine today for more information.


Menopause: What Can I do?

Menopause, all women will experience the symptoms associated with this natural change in life. During this time the ovaries stop producing eggs, menstrual cycles become less frequent/irregular and eventually stop, and estrogen and progesterone decline. Mild to intense hot flushes, night sweats, weight gain, fatigue, irritability, and insomnia are a few of the most common symptoms experienced. So many women suffer through this most uncomfortable time in their lives for fear of the of risk of breast cancer and rightly so! This fear stems from the results of the 1991 long-term study on the safety and efficacy of hormone therapy, known as the Women’s Health Initiative (WHI). This study utilized traditional/non-bioidentical hormones, NOT bioidentical hormones.

Unlike bioidentical hormones, non-bioidentical hormones are not designed to mimic the natural structure of human endogenous hormones. Non- bioidenticals bind tightly to specific cell receptor sites initiating a long stimulation, which inhibits the natural metabolic process designed for hormone metabolism. Results from large French studies were published in 2008 indicating women using synthetic (non-bioidentical) hormone replacement therapy had a 60% increased risk of breast cancer, while bioidentical hormone users had the same breast cancer risk as women who did not take hormones at all. This study involved 54,548 postmenopausal women lasting 8 years.

Progestin’s (synthetic progesterone) used in conjunction with estrogens revealed compelling evidence of an increased risk of developing breast cancer, while recent trials show estrogen combined with natural (bioidentical) progesterone results in less or even no risk of breast cancer. (European Journal of Menopause). There are many research findings indicating the safety as well as beneficial effects of individualized dosing of natural estrogens and progesterones. Beneficial effects when using natural bioidentical progesterone are improved cardiovascular health, decreased risk of blood clots, protection against atherosclerosis, and maintaining healthy HDL levels.

Other research reveals insight into natural progesterone’s ability to defend against breast cancer. Another study reported in the International Journal of Cancer in 2004 indicated those women with the highest blood levels of progesterone levels who had regular menses experienced 88% decreased risk of breast cancer. In a corroborating study 1,083 women were followed for 33 years, those deficient in progesterone had a 540% increased risk of premenopausal breast cancer. Bioidentical hormones when appropriately prescribed offer a safer and more effective alternative to synthetic hormones. Women should be educated on hormone replacement therapy in order to make an informed decision on how to cope with pre and post-menopausal symptoms.

Call Prairie Family Medicine today to learn more!

November. 2016

Stress and the Cortisol Steal. What you should know.

Too many irons in the fire? Feeling wired, tired, and stressed? Your adrenal glands are trying to keep up with your crazy lifestyle, but when unable, other hormones are then converted to the stress hormone called cortisol. Your hormonal symphony is now out of tune, resulting in a multitude of problems.When the adrenals are stressed, the increased need for cortisol can deplete the progesterone levels by converting to cortisol. This is known as the "Cortisol Steal." As more progesterone is shunted or sequestered to make cortisol, less is available to balance estrogen. Without adequate progesterone available, estrogen then becomes excessive resulting in irritability, anxiety, insomnia, breast tenderness, and weight gain.

Typically, bioidentical progesterone replacement is prescribed as an oral or topical agent taken at bedtime to help with sleep. However, research has indicated on occasion those with high cortisol as a result of stressed adrenals will convert the supplemental progesterone to cortisol during the night resulting in sleep disturbances with increased anxiety and or a feeling of panic. Women with high cortisol cannot experience the full benefit of progesterone therapy until lifestyle modifications are made to decrease the stress overload in their lives.

Chronic high stress leads to overactive adrenals resulting in high blood pressure, stress anxiety, mood swings, depression, destructive personality changes, and other mental instabilities. When the adrenals continue in an overactive state for an extended period, they are likely to become underactive or fatigued - worn down and unable to respond at all. This state of weakened adrenals may result in fatigue, insomnia, allergies, and hypoglycemia.

Diet and lifestyles changes along with nutritional supplements can help restore health and balance to the adrenal function. Start by eliminating the demands in your life, simplify your life. Your health depends on it! Chronic high stress accelerates the aging process, if you want proof take a look at those who are running our country!

Call Prairie Family Medicine today for more information.