How long may I safely use Estriol?

Hi Catherine

I use Estriol suppositories twice a week. I use progesterone twice a day. I go 3 weeks on and one week off with this regime. My question is: how long may I safely use Estriol? I hope there is no limit as it really helps me in so many ways.

Thank you,

Gloria

Dear Gloria

It’s such a pleasure to receive emails from women like yourself who have achieved hormone balance and, in so doing, a sense of optimal health.

Without going into too much detail, here’s an overview of the estrogen metabolites you need to know about.

The “early days” of estrogen research focused mostly on three estrogen metabolites called:

• Estrone (E1)
• Estradiol (E2)
• Estriol (E3)

We know that estrogens stimulate cell proliferation, specifically unopposed estradiol is implicated as the cause of some types of cancers.

It is now believed that the two major hormones present throughout pregnancy - progesterone and estriol - could may well offer protection against breast cancer.

Women who are currently on a program of estrogen replacement therapy should perhaps give consideration to estriol cream as a safer alternative in the treatment of vaginal dryness and/or atrophy, severe hot flashes, urinary incontinence, painful intercourse, and other associated symptoms.

We know that estriol does not induce endometrial proliferation to the extent of the other estrogens. However, we do need to include a progesterone cream to balance the estrogenic effect of estriol.

As a treatment for osteoporosis, E3 significantly improved Bone Minerial Denisty by inhibiting bone resorption and therefore, estriol might be effective for use in HRT in elderly patients.

Estriol is able to be excreted easily from the body in the urine. It is water-soluble and as such does not need to be broken down by the liver; thus it does not build up in the body. For these reasons the safest estrogen to use is estriol applied to the vulva and lower vagina every day (except during breaks).

The reassuring thing about using the weak estrogen called estriol on the vulva is that very lilttle, if any, will be absorbed into the circulation.

It would appear, by all accounts, that estriol is a safe and effective alternative for relieving climacteric symptoms in postmenopausal women.

But how long should we use estriol?

Henry Lemon, M.D. (a women’s cancer specialist), came up with an equation that can estimate a woman’s risk of breast cancer. He called this idea the estrogen quotient, or EQ, and formally it’s the amount of estriol divided by the sum of the amounts of estrone and estradiol. In mathematical terms, it looks something like this: EQ = E3 / (E1 + E2).

If a woman’s EQ is low, her risk of breast cancer is higher. Basically, the higher the EQ, the better. Time after time the EQ proved itself.

In 34 women with no signs of breast cancer, Dr. Lemon found the EQ to be a median of 1.3 before menopause and 1.2 afterward. The picture was quite different in 26 women with breast cancer. Their median EQ was 0.5 before menopause and 0.8 afterward.

In another study, Dr. Lemon found that women with higher EQs survived significantly longer after cancer surgery than women with lower EQs.

So, knowing that women need more estriol to boost their EQs, Dr. Lemon also tried using estriol treatments for breast cancer. He asked a small group of women with untreatable breast cancer (because it had metastasized to bones) to take large dose of estriol. By the end of the study, an astounding 40 percent of these women had their cancers go into remission.

Less estriol, more cancer.

After a decade or two of neglect, the EQ and the “estriol hypothesis” of estrogen-related cancer prediction and prevention (and maybe even treatment, like Dr. Lemon’s unpublished research) are back! And some researchers are even starting to admit that maybe, just maybe, estriol in its natural form might work as well (even better than) synthetic drugs like tamoxifen.

And as if this news weren’t exciting enough on its own, there’s another brand new use for estriol and the EQ, which might give some much-needed hope and relief to people suffering from auto-immune diseases, especially multiple sclerosis.

It is recommended that estriol levels be measured when supplementing with a compounded preparation of bioidentical estrogens (e.g. “Biest” preparations contain estriol and estradiol OR “Triest” preparations containing estriol, estradiol and estrone).

I would strongly urge you to read ‘You’re just 24 hours away from discovering-and reducing-your breast cancer risk‘ by Dr Wright. This informative article gives us the latest update on “good” and “bad” estrogens.