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The Safe and Effective Use of Estrogen for Women Part 1

A lot of menopausal and postmenopausal ask about the use of estrogen therapy at the Stengler Center for Integrative Medicine. There are several factors that Dr. Angela and I take into consideration when prescribing estrogen. However, it is true that low estrogen levels can imply problematic menopause with intense hot flashes, night sweats, vaginal dryness, depression, cognitive problems, and other symptoms. a decreased quality of life, and increased risk of major diseases.

The Estrogen and Aging Link

One mainstream medical journal noted that estrogen deficiency, as observed with menopausal women, accelerates aging! The same study notes that dropping estrogen levels with menopause is linked to cardiovascular disease, osteoporosis, urogenital atrophy [breakdown of the urinary tract and genitals], dermal [skin] aging, increased risk of colon cancer, more deadly breast cancer types, loss of neurons from the brain that causes cognitive decline and earlier expression of Alzheimer's disease, macular degeneration, and cataract formation.

In addition, a study released in the American Journal of Public Health estimated that the avoidance of estrogen therapy in women ages 50 to 59 years who had a hysterectomy died prematurely! It is estimated that 91,610 postmenopausal women died prematurely over a ten-year period due to avoiding estrogen therapy.

And if you are a woman who experiences premature menopause, say under the age of 40, the effect of reduced estrogen is so substantial that you are at greater risk of "of premature death, neurological conditions, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease, and infertility."

There are roles for estrogen in postmenopausal women also. For example, reduced estrogen production in postmenopausal women raises the risk of bone fracture, heart disease, and Alzheimer's disease.

A Much Needed Hormone

Remarkably, estrogen has around 400 functions in the body! Since many body cells have estrogen receptors, you can see why it has a lot of functions. Here is a recap of some of the highlights:

  • Improves metabolic rate
  • Improves insulin sensitivity
  • Improves sleep
  • Stimulates an enzyme in the brain that produces acetylcholine (memory and Alzheimer's prevention)
  • Maintains muscle mass
  • Lowers cataract and glaucoma likelihood
  • Improves blood circulation
  • Decreases plaque accumulation in arteries
  • Maintains collagen in the skin and raises the water content of skin for softness and thickness
  • Reduces wrinkles
  • Reduces blood pressure
  • Lowers LDL cholesterol levels and LDL oxidation
  • Protects against muscle damage
  • Acts as an antioxidant
  • Manages carb and fat metabolism
  • Normal sexual and reproductive function
  • Regulates bone mass and strength
  • Lowers risk of colon cancer
  • Protects against tooth loss
  • Alleviates hot flashes
  • Treats vulvo-vaginal atrophy
  • Treats vaginal dryness and pain with intercourse related to vaginal atrophy
  • Treats urinary symptoms like urgency, pain, and recurring urinary tract infections
  • Reduces joint pain
  • Used in the formation of neurotransmitters in the brain such as serotonin to lower depression, irritability, anxiety, and sensitivity to pain

It All Starts With Cholesterol

The first building block of estrogen is cholesterol! So, you can picture what happens to your estrogen production if you get on a cholesterol-lowering medication. The ovaries make most estrogen in premenopausal women. But, it is also produced by peripheral tissues (fat tissue), especially in postmenopausal women, from steroid precursors like pregnenolone and dehydroepiandrosterone (DHEA), conversion from testosterone into estrogen. Estrogen is also produced in the brain, bone tissues, vascular endothelium (inside lining of blood vessels).

Types of Estrogen

It is important to know that the term estrogen is a plural term. There are many different forms of naturally made estrogen in women. There are three primary natural estrogens. The first is known as estrone (E1). E1is the primary estrogen made by the body after menopause. Next is estradiol (E2). E2 is the main form of estrogen during childbearing and premenopausal years. It is also the most potent form of estrogen. The third is estriol (E3). E3 is the primary estrogen made during pregnancy but is also found in all women. Estriol is a lot weaker than estradiol and might have defensive effects against breast cancer by blocking breast estrogen receptors. Therefore, holistic doctors include it in natural estrogen solutions combined with estradiol, whereas conventional doctors usually prescribe estradiol without estriol.

After estrogen has engaged with cell receptors throughout the body, they are metabolized by enzymes in cells, especially in the liver. There are a number of known estrogen metabolites. These estrogen metabolites appear to be important in regards to breast cancer risk. For instance, estradiol and estrone are inactivated by an enzyme in cells called catechol-o-methyltransferase (COMT). Estrogen is acted upon in the liver by a process known as conjugation, where they are made more soluble to be removed mostly in the urine.

Research is showing that one of the good estrogen metabolites is 2-hydroxyestrone (2 -OHE1). This metabolite of estrone is considered to be protective against cancer. The development of the good 2-OHE1 depends on a process called methylation. Some people have genetic problems with methylation activity in their cells. This methylation activity can be tested indirectly with blood homocysteine levels. An elevated level suggests you have problems with methylation. However, you can have your genes tested directly with genetic testing, like the MTHFR and COMT genes. If you inherited problems with these genes, you could improve methylation with supplements like methylated B vitamins, especially B2, folate, B6, and B12, in addition to magnesium. You can also increase the good 2-OHE1 with exercise, cruciferous vegetables, flaxseeds, and supplements such as indole-3-carbinol (I3C) and diindolylmethane (DIM), omega 3 fatty acids, rosemary, turmeric, and by losing weight.

An estrogen metabolite that is cancer causing is 4-hydroxyestrone (4-OHE1). It can damage cell DNA and is one of the metabolites of the synthetic estrogen replacement that used to be popular with standard doctors known as Premarin.

Estrogen Metabolite Testing Available

I commonly test these estrogen metabolites with a urine test to see if a woman has high levels of harmful estrogens. This test can be performed whether a woman is on hormone replacement or not.