Your body produces 3 different estrogens: estrone, estradiol and estriol. Estriol (also known as E3) is the weakest of the 3 natural estrogens and was originally thought to have little significance. It has been virtually ignored by the mainstream medical community because it doesn’t have the quick, recognizable effects on the body that the stronger estrogens do. While estradiol (E2) will stop hot flashes within hours after applying to the skin, estriol takes much longer to affect you. However, current research has found that estriol offers a wealth of benefits without the dangers that sometimes accompany the stronger estrogens or the synthetic estrogens (such as Premarin).  Estriol can help relieve menopausal symptoms, protect your bones, rejuvinate vaginal tissue, benefit urinary tract health and correct vaginal dryness. It may also reduce cardiovascular risk and shows great promise in reducing brain lesions in multiple sclerosis patients.Estriol is the estrogen most commonly associated with pregnancy. In fact, during pregnancy levels of estriol are up to 1,000 times higher than normal when compared to non-pregnant levels. Women suffering from multiple sclerosis often see their symptoms get considerably better during pregnancy.But what about the risk of breast cancer? There have been lots of opinions and articles in the media relating estrogen use to increased risk of breast cancer. What they fail to tell  you is the type of estrogen studied. In a study funded by the U.S. Army and performed at the Public Health Institute in Berkeley, CA, researchers compared estriol levels during pregnancy with breast cancer incidence 40 years later. Results of the study showed that of the 15,000 women involved, those with the highest levels of estriol during pregnancy had the lowest incidence of breast cancer later on. Asian and Hispanic women typically have higher levels of estriol than other racial groups and interestingly have the lowest breast cancer rates.Estrogen has also been linked to endometrial cancer in the media. In one investigation, postmenopausal women were given oral estriol with no progesterone for 6 months. Oral estrone or estradiol are not advised because they can increase the risk of blood clots. Giving them unopposed (without progesterone) is not advised because it can increase the risk of endometrial hyperplasia (overgrowth…which can lead to cancer). However, all the study participants showed an improvement of symptoms; there were no strokes or blood clots and no endometrial hyperplasia (confirmed by endometrial biopsy). There were also no breast changes that would indicate a higher risk for breast cancer.Estriol has been shown to be the safest estrogen we can use to replace our body’s natural estrogens; it gives the most benefits with the lowest amount of risk. Ask your physician if estriol may be the right choice for you.

It’s long been thought that higher levels of testosterone in men would lead to an increased risk of prostate cancer. This belief has led many men to accept the side effects of testosterone deficiency as an inevitable part of aging: weight gain, loss of muscle tone, lack of energy, and a decrease in sexual enjoyment. However, recent studies have shown that testosterone therapy is not associated with increases in prostate cancers or any other prostate illnesses.

Many studies have shown that severely limiting testosterone can cause prostate cancer to shrink temporarily. From that, physicians have concluded that raising testosterone levels would make prostate cancer grow. However, no evidence has been found that links testosterone treatment with prostate cancer. In fact, prostate cancer becomes most prevalent at the time in a man’s life when natural testosterone levels decline. In 2002, a study published in the International Journal of Andrology found that men who received testosterone therapy had decreased prostate size, lower PSA numbers and an improvement in urinary symptoms.

Per Dr. Eugene Shippen, author of The Testosterone Syndrome, “All organs of the male reproductive system, including the prostate, tend to stay healthy in the presence of adequate levels of key hormones, including testosterone. Normal concentrations of testosterone and its more powerful derivative may well be harbingers of prostatic health, not illness.”

Make sure you are doing your part to maintain good prostate health- have a digital rectal exam every year, have a blood test called the PSA yearly, and ask your doctor about testosterone therapy to alleviate symptoms of deficiency.

A German study has been published that shows previous hormone therapy use appears to be a factor increasing survival in women with breast cancer. It’s speculated that hormone therapy prevents bone metastases (the spread of disease from one organ to another). The 1072 breast cancer patients who were studied were divided into 3 groups; premenopausal, post-menopausal with previous hormone therapy use, and post-menopausal with no hormone therapy use. The authors of the study found that previous hormone therapy users had significantly higher rates of survival after breast cancer than nonusers-the 5 year survival rate for previous HRT patients was 92.8% versus 82.2% for non-HRT users.

It’s important to keep up-to-date on the latest research-your health may depend on it. Ask your physician what the latest findings mean to you.

DHEA is a hormone that most people aren’t even aware of. It’s name doesn’t translate well in the news stories (dehydroepiandrosterone) and it’s a little more complicated than estrogen or testosterone. However, it is a vitally important hormone that protects the body against the ravages of aging.

DHEA is a precursory building block that allows our bodies to create various sex hormones such as estrogen and testosterone. A deficiency of DHEA has been linked to:

• Chronic inflammation
• immune dysfunction
• Depression
• Rheumatoid arthritis
• Type II diabetic complications
• A greater risk for certain cancers
• Excess body fat
• Cognitive decline
• Heart disease in men
• Osteoporosis

DHEA levels begin to decline from 25 years of age and may have dropped 95% by the age of 85. Many of the common complaints of aging can be alleviated by DHEA replacement therapy. In the proper dosing, DHEA replacement can produce great results. A few benefits to consider:

1. It suppresses inflammatory cytokines which cause or contribute to Rheumatoid arthritis.
2. It fights viruses and infection by preventing activation of the virus and dropping cortisol levels.
3. It improves neurological function, elevates IGF-1 (insulin growth factor), protects against heart disease and atherosclerosis.
4. It has been known since the 1950’s to be an effective anti-depressant. Since it converts to estrogen and testosterone in the body, DHEA can be an effective tool in regulating mood.
5. DHEA may be effective in preventing and treating certain cancers. It has been shown to inhibit tumor proliferation and block the binding of carcinogens to the cells.
6. It protects your brain against age-associated atrophy.
7. It protects your skin from everyday damage and helps it heal from injury.
8. DHEA maintains your immune system

Maintaining optimal levels of DHEA can help restore your health to strong, youthful levels and prevent many long-term problems associated with aging. However, DHEA is a powerful hormone and shouldn’t be taken without your physician’s advice. Your doctor can check your DHEA-S levels in your blood and determine if you would benefit from DHEA and if so, how much would be appropriate for you.

Endometriosis is a painful condition that can lead to infertility. There is no cure except a total hysterectomy, but hormones can help considerably with the pain and to prevent it from getting worse.

What is endometriosis? The endometrium is the tissue that lines the uterus. During each menstrual cycle the endometrium thickens, getting ready for possible pregnancy. If you don’t become pregnant, the endometrium is shed, which causes your menstrual period. Endometriosis is endometrial tissue that flows the wrong way out through the fallopian tubes and grows on the ovaries, fallopian tubes, the outer surface of the uterus, bowels or other abdominal organs. The growths are called implants. These implants grow, bleed, and break down with each menstrual cycle, just like the endometrium does. This can cause pain, infertility, and in some cases, scar tissue that interferes with an organ’s normal function. Women who suffer from endometriosis will often feel less pain during pregnancy and have no symptoms at all after menopause.

What can hormones do to help? Hormone therapy can reduce the estrogen levels in your body.  Estrogen is the hormone that “feeds” endometriosis growth. Using progesterone, a Mirena IUD or birth control pills (a estrogen/progestin combo) can slow or halt growth of implants. Let’s take a closer look at each option:

1. progesterone-Using progesterone lowers estrogen levels. This causes the implants to shrink thereby reducing pain as well. Using bioidentical progesterone can be an effective long-term treatment as it helps prevent bloating, protects bones and protects you from breast and uterine cancer. Progesterone has the smallest amount of side affects of any hormone treatment for endometriosis. Does not prevent pregnancy.
2. Mirena IUD- This is a device that releases low levels of progestin constantly into the body and only needs to be changed every 5 years. This is a good option for those who don’t want to think about using a medication daily. Prevents pregnancy. Is a synthetic progestin, but at a very low dose. Side effects can include minor weight gain.
3. Birth control pills-estrogen/progestin combination pills that stop ovulation and endometrial growth. Birth control pills cause implants to shrink and protect against pregnancy.  Lower ovarian cancer risk (which is higher with endometriosis) and can be used long-term.

Hormone therapies are effective for 80-90% of women with endometriosis. While one may work for you, it may not work for someone else. Ultimately, if you are done with childbearing the only definitive cure for endometriosis is hysterectomy with removal of the ovaries that secrete estrogen and feed the implants. This is a last resort for severe pelvic pain. Your physician can help you decide which treatment is right for you.

A study done by Mayo Clinic researchers found that women who had both of their ovaries surgically removed had twice the risk of developing Parkinson’s disease later in life. The risk doesn’t come from the surgery itself, but from the decreased levels of estrogen.

There is evidence from animal studies that estrogen protects the part of the brain involved in controlling movement. Damage to this part of the brain can result in Parkinson’s disease. A newer study involving nearly 5000 women shows a similar protective property of estrogen in humans. About 1/4 of the women had one ovary removed, 1/4 had both ovaries removed and the remaining 1/2 had not undergone surgery. Women who had both ovaries removed had twice the risk of developing Parkinson’s disease as women who still had both ovaries. Those retaining one ovary had only a slight increase in risk.

Women considering having their ovaries removed as a preventative measure or with a hysterectomy should weigh their options carefully. If you have ovarian cancer, obviously you should have your ovaries removed. For many other conditions, having a hysterectomy while keeping your ovaries may be a good option. Keeping your ovaries will allow them to continue to make estrogen, thereby protecting your bones from osteoporosis, your heart from cardiovascular disease and your brain from Parkinson’s disease.

Estrogen can help lower cardiovascular risks, if it is given at the right time. An 8 year study called the WHI-CACS trial showed that estrogen is cardioprotective in younger post-menopausal women. Women who started hormone therapy in their 50’s, typically before advanced atherosclerosis develops, were 61% less likely to have high levels of coronary calcification (hardened plaque build-up in the coronary arteries) than those women who had not taken hormones.

Starting hormone therapy when a women is older, say 10-15 years post-menopausal and more likely to have advanced atherosclerosis, is not cardioprotective. In fact, it could increase cardiovascular risk due to thrombosis (formation of a clot in your artery or vein) and plaque rupture, which can close an artery within hours (as opposed to closure by atherosclerosis, which can take months or years) resulting in a heart attack.

Hormone therapy has many benefits other than relief from hot flashes, but it is important to work with a knowledgeable physician to decide which hormones are right for you and how long you should take them. Relief from the symptoms of menopause, which are quality of life issues, can go hand-in-hand with preventive medicine such as cardioprotection and protection from osteoporosis.

Several years ago, women were told that estrogen was dangerous and contributed to heart attacks and strokes. All women were advised to discontinue hormone therapy until further notice. That notice has been given. After continuing to analyze data from the original studies…scientists have determined that women starting hormones shortly after menopause actually have a lower risk of heart disease. Specifically, taking estrogen for 7 years or more after menopause reduces calcification of the arteries by as much as 60%. Calcification of the arteries is a predictor of increased risk of heart attack. The only women found to be at risk were those who started hormone therapy at least 10 years after menopause.

The original studies (such as the Women’s Health Initiative study) included a number of older women who are rarely considered candidates for hormone replacement therapy. This unfortunate selection of subjects caused skewed results that don’t apply to the average menopausal women seeking relief from hot flashes and night sweats. As Dr. Robert W. Rebar, executive director of the American Society for Reproductive Medicine, states: “We are clearly learning that the benefits of estrogen in young, healthy, symptomatic post-menopausal women outweigh the risks.”

Estrogen, like any other medication or hormone, should be given in doses appropriate for you and monitored regularly. Hormones can help ease your transition through menopause.

There are several different types of progesterone used in hormone replacement therapy. Many are synthetic, such as levonorgestrel, medroxyprogesterone acetate (MPA), and norethindrone acetate. Currently, there are only two bio-identical progesterones known as micronized progesterone and prometrium. Synthetic progesterone-like compounds (progestins) were created because progesterone couldn’t be absorbed orally. Once progesterone was micronized (made into tiny crystals), it could be easily absorbed orally so synthetic compounds are no longer needed.  However, many physicians became used to prescribing synthetic compounds, so are continuing to use them.

Are the synthetics safe? Two major studies, the Women’s Health Initiative study and the Million Women study, have linked hormone therapy to breast cancer. Both of these studies used synthetic hormones. Their findings are echoed by a more recent study in France that showed a higher risk of breast cancer with progestin use, a small risk of breast cancer when using estrogen only (but an increased risk of endometrial hyperplasia-the thickening of the lining of the uterus which can turn into endometrial cancer) and no risk of breast cancer when using micronized progesterone. Two major studies, the Women’s Health Initiative study and the Million Women study, have linked hormone therapy to breast cancer. Both of these studies used synthetic hormones; their findings are echoed by the more recent findings in France.

So what does this mean to you? If you have a uterus, don’t use estrogen without progesterone to prevent endometrial hyperplasia and in turn endometrial cancer. When you use progesterone, make sure you are using micronized progesterone, not progestins. How can you tell if you are using progestins or progesterone? If your prescription says “progesterone” or “prometrium” it is bio-identical. If your prescription says  “progestin”, “prempro”, “provera”, “Medroxyprogesterone acetate ” or some other chemical name, it is not bioidentical. The progestin found in birth control pills is not bio-identical, but sometimes the benefits of a medication outweigh the risks. Talk to your provider for more information.

Many women have come to our clinic on estrogen pills and are dismayed when we switch them to creams. “I like the convenience of a pill” and “Pills travel better” are common complaints we hear. What’s wrong with oral estrogen anyway?

A study published in the journal of the American Heart Association found that women taking oral estrogen had four times the risk of developing a serious blood clots than those using patches, gels, or creams. Women using transdermal (through the skin) estrogen, on the other hand, were at no higher risk of developing clots than those who weren’t even using estrogen. When using transdermal estrogen, the hormone bypasses the liver and enters the bloodstream directly, as your natural hormones do. This cuts down on side affects and is a more effective treatment.

Patches travel well and there are many different bases for cremes and gels. Ask your provider about your options. Safety and convenience…you can have it all!