Life Extension Magazine

Life Extension Magazine November 2013

As We See It

Surprise Findings in Estrogen Debate

By William Faloon

William Faloon
William Faloon

A dispute has raged for 70 years as to whether or not maturing women should replace their sex hormones. The age-reversal impact of hormone replacement is quite noticeable. As a result, many women want to stay on their hormones for life.

By year 2002, doctors were liberally prescribing estrogens and synthetic progestin to females with menopausal symptoms.

When the Women’s Health Initiative study showed these drugs increased risk of breast cancer and vascular disease, a stampede to halt their use ensued.1

For the past decade, mainstream medicine struggled to accurately interpret and understand the results of the Women’s Health Initiative data. They also largely ignored the potential benefits of individualized dosing using natural human estrogens and progesterone.

Life Extension® long ago analyzed the underlying data. We built a strong case against the use of synthetic progestin in favor of natural progesterone.2-9 We also argued that if aging women did not maintain youthful hormone balance, tragic impacts on quality of life and longevity would result.10

In 2013, a published analysis emanating from Yale School of Medicine provided further evidence that synthetic progestin was the villain that caused female sex hormones to be abandoned beginning between 2002-2004.11

Even more compelling, these researchers estimated that over the past decade, anywhere from 18,600 to 91,600 postmenopausal women ages 50-59 years who had undergone a hysterectomy may have died prematurely because they did not take estrogen drugs.11

The 2013 Yale report is not an aberration. A combined analysis from 27 published studies reveals a 28% reduction in mortality in menopausal women under age 60 who replace their sex hormones.12 The studies also show profound quality of life improvements in hormone-replenished women.12

These findings do not mean that women should rush out and seek conventional treatment. Even though some doctors today prescribe natural human hormones, most don’t optimally adjust individual dosing, and almost all fail to recommend protocols designed to protect women against carcinogenic and vascular risks.

This article updates women on the benefits of restoring natural sex hormone balance based on the latest scientific evidence.

Surprise Findings in Estrogen Debate  

Estrogen is required for youthful cellular function. A deficiency of estrogen is associated with the onset of age-related disease.13,14

As women enter their perimenopausal years, their bodies’ production of estradiol (an important estrogen) and progesterone declines.13 Yet these hormones are needed to maintain youthful vitality.

While symptoms of menopause vary depending upon individual hormone balance, most women suffer because their bodies no longer produce enough estrogen and progesterone. Depression, irritability, and short-term memory lapses are common menopausal complaints, along with hot flashes, night sweats, sleep difficulties, and weight gain.15

In the absence of rational hormone replacement, health issues encountered during menopause may adversely impact a woman for the rest of her lifetime.

Surprise Findings in Estrogen Debate

Starting between the years 2002-2004, women were told by their doctors to limit prolonged use of hormone drugs. Doctors were so concerned that they prescribed hormones only long enough to obtain relief from menopausal symptoms and then no more.

In depriving women of their sex hormones, doctors failed to recognize that estrogen and progesterone are involved in critical life processes. Disorders relating to estrogen deficit include glaucoma, dementia, osteoporosis, heart failure, fragility, genital atrophy, loss of muscle mass and strength, and thinning of the skin.16-33

Estrogen deficiency may thus be characterized as a state of accelerated aging.14 Today’s women are suffering because the mainstream did not bother to embrace alternatives to synthetic progestin and inappropriate estrogen prescribing.

What Drug Was Causing the Problems?

In their panic to “do no harm,” conventional doctors minimized all sex hormone prescribing. Yet the two drugs specifically linked to increase cancer and vascular risks in the Women’s Health Initiative trial data were PremPro® and Premarin®.1,34

Premarin® is a horse urine-derived drug that contains some estrogens that are unnatural to the human body.34 It is avoided by enlightened women and some doctors today, but is still the most frequently prescribed oral estrogen drug.34

PremPro® is a combination of Premarin® and a synthetic progestin.1 This progestin, called medroxyprogestereone, is not the same compound as the natural progesterone it was supposed to function as.35,36

A review of the published literature reveals that progestin is a major culprit behind the higher rates of vascular disease and cancer that caused doctors to abandon all female hormone drugs beginning in 2002-2004.11

Prescribing Errors

Premarin® (horse urine-derived estrogens), Provera® (progestin), and Prempro® (horse urine-derived estrogens and progestin) were heavily marketed to doctors as simple solutions for menopausal complaints.

Doctors often prescribed the same oral dose of these drugs to all their menopausal patients, which might explain why a 2004 analysis showed higher incidences of stroke in Premarin®-prescribed females.34

What was overlooked was the adverse impact on arterial blood clotting based on the route of estrogen administration. This is important because increased blood clotting mechanisms are observed more often after oral rather than trasdermal estrogen.47,48 This emphasizes the importance of women using natural estrogen (and progesterone) as a topical cream and not taking oral estrogen drug pills.

One of estrogen’s benefits in vascular health is to protect against endothelial dysfunction by increasing endothelial nitric oxide.24 Data shows that the effect of equine (horse urine-derived) estrogens markedly decreased gene transcription of a crucial enzyme (nitric oxide synthase) involved in the production of nitric oxide in endothelial cells. Compared to natural human estrogens, gene transcription of endothelial nitric oxide synthase was 30 to 50% lower in response to equine estrogens.49

Several studies have shown that the cardio-protective effects of estrogen are largely negated following the addition of synthetic progestin as was used in the Women’s Health Initiative trials. For example, estradiol has been associated with beneficial effects on endothelial function, as assessed by brachial artery flow-mediated vasodilation, but the effect was negated by the addition of progestin.50

Other study data shows that progestin, but not natural progesterone, increases the risk of coronary vasospasm.51

If physicians carefully monitored their patients’ symptoms as well as checked their menopausal patients’ blood levels in response to hormone restoration with natural estrogen and progesterone creams (not pills), they could have individualized the dose to potentially maximize benefit and ideally minimize risk.

Fortunately, women today have access to low-cost natural estrogens and progesterone. They don’t have to rely on antiquated drugs (Premarin®/Prempro®/Provera®) that Big Pharma continues to promote to hurried physicians.

What Are “Natural” Hormones?

When you see the term “natural” before a hormone, such as “natural estrogen” that does not mean it was derived from natural sources.

What it means is that the estrogen is made in a laboratory to be natural to the human body.

Health-conscious people sometimes erroneously believe that a “natural” source of something is safer. An example of why this may not be the case is the drug Premarin®, which is derived from “natural horse urine.” It contains hormones natural to humans (e.g. estrone) and hormones natural to horses (e.g. equilin, equilenin).37

Natural bioidentical estrogen drugs, on the other hand, contain only natural-to-the-human-body estrogens. In order to obtain these 100% natural human estrogens, bioidentical to those produced in the human body, they have to be synthesized in a laboratory setting.

A phytoestrogen (plant estrogen) called diosgenin found in wild yams can be converted in a laboratory into progesterone.38 Diosgenin cannot be converted by the human body into progesterone. Wild yam does not contain progesterone.38 So to obtain natural progesterone, it also has to be made in a laboratory to ensure it is 100% natural-to-the- human-body progesterone.

Progestins are patented, synthetic drugs that protect against estrogen-induced endometrial cancer.36 Progestins are not “ natural-to-the-human-body” as is natural progesterone.

Progestins are meant to function like natural progesterone, but a huge body of data indicates potential for adverse side effects. For example, some data suggests natural progesterone may confer a protective effect against breast cancer,39-42 whereas progestins have been linked with increased risk.41-45

So while both progestin and progesterone are made in a laboratory, progestin is a foreign compound that is never naturally produced inside a woman’s body.

Progesterone is the bioidentical natural-to-the-human-body hormone that provides many health benefits.

As it relates to “bioidentical” terminology, here is where the various hormone drugs stand:

Bioidentical

Non-Bioidentical 1,34,35,37

Natural estrogen Premarin® (horse urine derived)
Natural Progesterone Provera® (progestin)
  Prempro® (Premarin® + progestin)

Life Extension recommends bioidentical natural estrogen and progesterone to be used in topically applied creams to avoid degradation in the liver.46

What Are “Natural” Hormones?