Hey there, this is Doctor Madison Fandel. I wanted to talk about estrogen.The conversation surrounding estorgen has become confusing to some people. The topic of hormone replacement therapy in particular, has almost become controversial. Some worry estrogen replacement therapy can lead to breast cancer. I’m writing this blog post today to try and clear up some of the confusion.
The truth of the matter is, there is always a risk of developing breast cancer with hormone replacement. However, not all hormone replacement is created equal. There are ways to mitigate the risks, and bio-identical hormone replacement therapy is one.
BHRT’s use compounds that are made from soy or yams that look identical to the hormones you produce, so your body knows what to do with them. Synthetic hormone replacement, most notably birth control pills, and Premarin (pregnant mare’s urine), contain hormones that look like your hormones, but are not an exact match. Premarin for example, contains 39 different types of estrogen and when metabolizing these conjugated estrogens, they are more likely to go down a deleterious pathway.
We cannot talk estrogen without also addressing the importance of progesterone. There are progesterone receptor sites in the uterus, breasts, vagina, blood vessels, and brain. Progesterone is protective against breast cancer, cardiovascular disease, and it moderates the side effects of excess estrogen, which could be fluid retention, bloating, headaches, bleeding, or fibroids. However there are also synthetic replacements for progesterone, which should be avoided by all women.
Progestins, (medroxyprogesterone acetate), the synthetic version of progesterone, has some awful side effects including: depression, breast swelling and tenderness, irregular bleeding, weight gain, fluid retention, increased breast cancer risk, increased cardiovascular disease, and stimulates estrogen receptor sites. So make no mistake, progestin is NOT the same as progesterone.
When looking at the data from The Women’s Health Initiative, started in 1991, it was a 15 year research program designed to address the most common causes of death, disability, and poor quality of life in postmenopausal women. They were cardiovascular disease, cancer, and osteoporosis. It involved 161,808 generally healthy postmenopausal women.
The hormone trial had 2 studies: The estrogen plus progestin study in women with uterus, and estrogen alone in women without a uterus. The hormone component of the study was to see if estrogen therapy would result in a decrease in coronary heart disease, and osteoporosis related fractures. The study was cut short though, because the estrogen plus progestin treatment group had an increase risk of cancer, coronary artery disease, storke and pulmonary embolism. This didn’t look good for hormone replacement therapy.
But let’s clear some things up. The study was using animal derived and synthetic hormones. This type of estrogen used is known as conugated equine estrogen, Premarin, pregnant mare urine, and progestins. However, in the other arm of the study where women were only given conjugated estrogens alone, they didn’t have the increased risk of breast cancer. It was the addition of progestins that increased the risk. Alternately, bio-identical progesterone decreases the risk of breast cancer. This is because the progestin causes vaso constriction, whereas the progesterone causes vaso relaxation.
Hormone replacement is typically thought of for women in menopause, but it can be beneficial for other age groups as well. There are other circumstances in which hormone replacement at an earlier age could be wise, and it may help reduce risks of multiple health conditions such as osteoporosis, cognitive decline, diabetes, or coronary heart disease.
There are a variety of ways younger women may become estrogen deficient. This could be from surgically induced menopause, having a total hysterectomy where the ovaries were removed, or sometimes a partial hysterectomy leaving the ovaries can trigger ovarian failure. Some medications can trigger ovarian failure such as chemo and radiation. Also genetic disorders, autoimmune diseases, metabolic disorders, and toxins can cause ovarian failure. Stress can lead to a dysregulation of hormones too, or lack of calories, and over exercise can both lead to lowered hormone levels. Thyroid disorders can also lead to disregulation in your cycle, and in your hormones.
Common signs and symptoms of low estrogen levels include: hot flashes, night sweats, irritability, poor concentration, vaginal dryness, decreased sex drive, and pain during intercourse.
So what are the take-aways from this post? For one, you have to decide if hormone replacement is an acceptable risk for you? The benefits to using bio-identical hormone replacement therapy, (BHRT) are great for many women. The other take-away is, not all hormone replacements are the same, so talk with your doctor.
I would love to help answer any questions you may have. Make an appointment with me for a consultation, and together, we can decide if hormone replacement is right for you. The truth of the matter is, if you are miserable from low estrogen, there is no reason to suffer unnecessarliy.
So don’t wait any longer.
Your tomorrow starts today.