FAQ about estrogen

My doctor says I need estrogen and yet I’ve read there are different forms of estrogen. I am confused.

Yes that is correct. There are three ‘classes’ of natural estrogen that are produced in our body: estradiol, estrone and estriol. They are all natural and found in the blood. They are made by the adrenal glands and in the ovaries. There is only one ‘class’ of progesterone produced by the body.

However, there are several man-made estrogens on the market, although doctors refer to estrogen as if it is one specific hormone - which it is not. Some estrogens are natural in configuration while others are synthetic. One particular synthetic estrogen product is harvested from pregnant mares urine (PREMARIN).

You might be prescribed a combination of all three types, or perhaps just the one in the treatment of hormone imbalance. Estradiol seems to be the most popular amongst doctors.

Our approach is to primarily tackle the estrogen dominance symptoms with progesterone cream, and any residual problems after 4-7 months such as continual hot flushing,and dry vagina may warrant estrogen supplementation. Where women are petite, slim and small-boned and/or exhibiting signs of osteoporosis, they may need to consider intelligent use of estrogen in conjunction with progesterone.

Furthermore, don’t discount the huge benefits of phytoestrogens in the over picture of estrogen therapy and natural choices.

Do I need estrogen if I’m still having regular periods?

If you are menstruating, regularly or irregularly, it’s indicative that the body has enough estrogen to build up the uterine lining, resulting in a period when hormone levels fluctuate. So therefore you cannot technically be estrogen deficient. When a woman’s estrogen levels drop low enough, she will stop having her period, signalling, in most cases, the end the of her reproductive epoch (menopause).

Following this theory, many women question the need for extra estrogen therapy offered by their doctors while they continue to menstruate, completely overshadowing progesterone in this equation.

Women ask a similar version of the same question, “do I need estrogen after my periods stop?” Even at menopause after menstruation ceases, it is possible for a women be estrogen dominant. Even a woman with low estrogen levels can have estrogen dominance symptoms if she doesn’t have any progesterone.

Surgical removal of ovaries in the case of an a hysterectomy will mean your body is not manufacturing adequate, if any, progesterone required to oppose estrogen dominance brought about through exposure to xenoestrogens.

Given that your body can convert progesterone into estrogen AND testosterone, supplementing bio-identical progesterone has been known to fix many of the problems associated with hormone imbalance post surgically induced menopause. Sometimes women may need to supplement bio-identical estriol and/or testosterone for vaginal dryness, hot flashes and/or loss of libido.

What is the safest form of estrogen to use if I have to use an estrogen?

Because estrogen (estriol, estradiol and estrone) are natural to our bodies, in balance they are not hazardous. Unfortunately the problem arises when our body is out of balance and there are excessive amounts of estrogen, possibly not opposed by progesterone. Estrogen is the proliferating hormone which encourages multiplication of cells. It is also the factor that is known to promote and cause certain types of cancer, particularly of the breast, ovaries and uterus.

Estrone and estradiol are relatively potent estrogens that can relieve menopausal symptoms, but can also produce very nasty side effects, possibly leading to an increased risk of breast cancer if given in high doses, and over a long period of time, say more than five years. Estradiol is believed to be very effective in slowing down bone resorption.

Because estriol is far less potent that the former two forms of estrogen, it’s less likely to stimulate breast and uterine tissue. Estriol is much safer and produces less side effects. So it is advisable for women to use estriol in the forms of tablets or vaginal creams (pessaries) if they are worried about the stronger estrogens and have a history of breast or uterine cancer in the family.

Overall, if a woman is menstruating, she has adequate levels of estrogen in her body. One would have to question why a woman would need to be on supplementations of estrogen when there are other ways of providing natural estrogenic effects in the body and treating conditions such as vaginal dryness. And we know that progesterone combined with phytoestrogens and diet often controls such symptoms as hot flushes and other menopausal problems.

I want to use Natural Progesterone cream but my doctor wants me to take a tablet.

There is no doubt your doctor is really confused, too, if he has implied a synthetic progestogen tablet contains natural progesterone. In fact, a good many doctors actually believe they are prescribing real progesterone, and we can thank drug companies for at least some of the confusion.

Often times a doctor is absolutely convinced he is prescribing an oral form of real progesterone when the medication it actually a patented synthetic progestogen (also referred to as progestin).

So how does this happen? How can a GP, of all people, be confused? Quite simple really. Doctors derive information and training on the drugs they prescribe from the pharmaceutical companies who manufacture them. If a drug is not produced by these multi-national companies, it’s unlikely your GP will hear about it. Which begs the question why aren’t these pharmaceutical giants mass-producing natural progesterone if there’s a captive audience out there in the marketplace?

It all comes down to ‘owning’ a drug versus being on the same playing field as your competitors. Pharmaceutical companies are not permitted to ‘patent’ (or own exclusive right to) a naturally occurring medicine. And progesterone falls into this category.

Natural progesterone is not produced anywhere in the plant kingdom. ‘Natural’ progesterone is actually manufactured in a laboratory with the aid of an enzyme. The substance diosgenin, found in the Mexican Wild Yam or Soy plants, has to undergo a series of chemical changes whereby it is synthesised or converted from its raw state into United States Pharmacopeia (USP) grade progesterone. This progesterone is referred to as ?natural? because the end result represents the same molecule naturally occurring in the body. It can be introduced into the body with a relative margin of safety when there is a need to supplement progesterone levels.

Yet pharmaceutical companies aren’t so much interested in what’s natural to the body. They need to ‘alter’ the hormone from it natural state in order to apply for and obtain a patent. And unfortunately for us women, in changing natural progesterone’s original molecular configuration beyond its ‘natural’ state, these drug companies transform natural progesterone into a synthetic progestogen (or progestin), rendering it potentially toxic to a woman’s body.

So to claim a progestogen/progestins is real progesterone is incorrect. And women along with their GP ought to be aware of this play on words designed to disguise the truth.

Can natural progesterone protect the uterus when used on combination with estrogen?

Dr John Lee recently received a call from Dr. Helene Leonetti telling him that her study comparing PremPro with Premarin and progesterone cream was complete, was soon to be published in a major peer-reviewed medical journal, and that it is to receive third prize at the American College of Obstetricians and Gynecologists Annual Clinical Meeting this spring.

Dr. Leonetti?s study effectively proves that progesterone cream protects the uterine lining (the endometrium) as well as progestins do.

Most of us know that in conventional medicine, women who have a uterus are always supposed to be given an artifical progestin along with their estrogen to protect them from uterine cancer. In spite of the many negative side effects of the progestins, many doctors have hesitated to prescribe progesterone cream instead, for fear it would not protect the endometrium.

In Dr. Leonetti?s study, uterine tissue was examined before, during, and after using either PremPro (Premarin plus Provera) or a combination of Premarin and progesterone cream. The group using progesterone cream was found to be as well protected as the PremPro group. This should put to rest any concerns that physicians may have about using progesterone cream for hormone replacement.

My doctor wants me to stay on estrogen for my bones and heart but I get headaches and other problems.

We cannot and do not advise women for or against estrogen in the form of HRT prescribed in combination form (if she has an intact uterus). Nonetheless, by the time a woman contacts us she has, in many cases, already trialed HRT. She reports numerous nasty side effects and wants to know how she can get her hands on a safer alternative.

We suggest women research their options. You are entitled to be given access to all information relating to the drugs you are introducing into your body. Particularly an understanding of its contra-indications (indications you shouldn’t be using this particular drug).

Get on the internet and do your research. Make an informed choice when it comes to your health. Don’t leave it all up to your healthcare professional. Because it’s often a fact your doctor doesn’t know what he doesn’t know. Our Network exists because woman out there are prepared to put in the time it takes to become informed and, in so doing, regain control of their health and wellbeing.

There is growing medical evidence that HRT is perhaps not all it’s crack up to be. Clearly, some medical claims are based on myth and not fact, and the jury is still out on whether HRT is as safe as the drug companies would have us believe. But we can tell you, if the hundred upon hundreds of women contacting our Advisory Network are anything to go on, women are no longer prepared to take a passive role in their health regime.