Holistic Functional & Integrative Medicine
Bioidentical Hormone Therapy with Sex (Gonadal) Steroid Hormones
Estrone (E1), Estradiol (E2), and Estriol (E3):
Categorized as 'the estrogens', each of these ovarian hormones has its particular functions. Estradiol, the most potent estrogen, primarily aids in the cyclic release of eggs from the ovaries for potential fertilization and preparation of the uterus for pregnancy. In addition to its role in cycling and pregnancy, estradiol also has powerful beneficial effects on heart, bone, brain and colon. It is the reduction in the level of estradiol that causes common menopausal symptoms such as hot flashes and night sweats. Estriol is produced in large quantities during pregnancy and is considered by some to be the 'gentle' estrogen providing some of the protection without exposure to the risks associated with stronger estrogens. Estrone, which can be converted to estradiol in some women, is the primary estrogen in postmenopausal women and is generated in fat cells. Metabolism of estrogens to 2-OH- and 4-OH-estrogens can be dangerous and cancer causing. Methylation of these "bad" hormones with an intact methylation pathway will assure a reduction in risk of cancer with HRT.
Produced cyclically by the ovaries, progesterone maintains the uterine endometrium to nurture a fertilized egg and allows for fetal development throughout a pregnancy. Progesterone has been labeled the body's anti-estrogen, partnering with estradiol to maintain the delicate balance required between a woman's reproductive hormones. A woman's progesterone level diminishes, along with that of estradiol, as she approaches and enters menopause and, in most women, drops to low postmenopausal values.
As a woman ages (in her 40’s or 50’s) there is the slow decline of ovarian hormone production beginning with the irregular cycling of perimenopause which can last several years followed by menopause which is defined as not having cycled for twelve consecutive months. Though menopause brings with it a variety of desirable changes in a woman's life such as no more menstrual cycles, contraception or PMS, there can be many undesirable symptoms.
- Hot flashes, night sweats
- Vaginal dryness and atrophy
- Dryness and thinning of skin, nails, hair
- Bone loss
- Mood swings
- Decrease in libido (sex drive)
- Memory and cognitive impairment
- Increase risk in Cardiovascular events (heart attack)
- Increase risk for some cancers
- In addition to the decline in estradiol and progesterone levels, a woman's testosterone and DHEA levels continue to drop throughout her lifetime and are responsible for some menopausal symptoms. When replacing hormones it is important to maintain a youthful balance of estrogens, progesterone and testosterone.
The "male" hormone, also enjoys a part to play in the female body. Nano-gram for nano-gram there is more circulating testosterone in a woman than estrogen at times. Testosterone in men needs no elaboration, as we see altered and depressed mood, sarcopenia (loss of muscle), lack of libido, decreased energy, thinning of bone, and cognitive decline when a man's testosterone levels fall. HRT for men is as important for age-management as it is for women. Careful management with attention to details is of paramount importance in the proper management of men's testosterone therapy.
Surgically Induced Menopause:
Removal of a woman's ovaries will result in immediate menopause creating a series of rapid and intense symptoms that can be debilitating and can be addressed successfully with the appropriate form of hormonal intervention.
Diseases Associated with Hormones and the Aging Process:
- Heart disease is the number-one killer in America and the leading cause of death in women over age 65. As a woman's estradiol level decreases, her risk of heart disease increases. Older women are ten-times more likely to die from heart disease than breast cancer.
- Osteoporosis, a disease that occurs when bone is breaking down faster than it is being rebuilt, makes bones more fragile and susceptible to fracture. Estrogen and Testosterone has also been shown to help protect against osteoporosis.
- Alzheimer's Disease affects more than four-million Americans a year with women at greater risk than men. Women taking estrogen therapy have a significantly lower risk of the dementia. In addition, recent animal studies indicate that testosterone may also have a protective effect against Alzheimer's Disease.
- Colon cancer is the second leading cause of cancer death in the United States with women at greater risk than men. Estradiol is now being studied as providing protection against this disease though the mechanism is still unclear.
What is Hormone Replacement Therapy?
HRT is the administration of steroid hormones (either natural, synthetic or animal-derived) to make up for the decline in those hormones (that drop naturally with age). Natural HRT refers to a regimen of hormones that is bio-identical in structure and physiological activity to what the body produces. For example Natural progesterone is derived from Mexican Wild Yam, but must be manipulated in the lab. The wild yam is only active in humans once pharmaceutical conversion has taken place. But what is really meant by Natural is the fact that the chemical/molecular structure is identical to that of what our organs produce.
Natural HRT brings with it the following benefits:
- Better tolerance (less unwanted side effects)
- Better therapeutic profile
- Improved long term patient acceptance
- No longer a one-size-fits-all philosophy
Currently, more and more women and men are opting for natural HRT. Given both the short and long term health benefits, HRT is now considered by many healthcare providers as the preventive medicine of the 21st century for women and men in the second half of life. On the average, a female HRT user can expect to live up to three years longer than a non-user.