LE Magazine June 2003
The Overlooked Female Hormone
By Melissa L. Block, M.Ed.
Hormone deficiencies can wreak havoc with a woman's health and feeling of well-being.
Mainstream medicine has focused on the drop of estrogen as being the culprit behind menopausal miseries. The scientific literature, however, reveals that an imbalance of several hormones is responsible for many of the discomforts and lethal diseases that women face during most phases of their lives.
Concern about the life-threatening side effects of synthetic drugs has caused many women to be deprived of the benefits of safe natural hormone therapy. When hormones are properly replaced, the risk of contracting degenerative disease is reduced. Attaining optimal hormone balance can also dramatically improve women's emotional and physical spheres of life.
This article introduces a new concept to explain why so many females suffer hormone-related problems and provides a simple solution that has been overlooked by most conventional doctors.
With female life span currently hovering around 80 years, the fact is most women spend a significant percentage of their lives in a state of hormone imbalance that began with the onset of menopause. In the U.S. alone, approximately 36 million women have entered menopause, and many of those women experienced troublesome symptoms both before and during "the change."
It's clear that as long as there has been menopause, there have been women who suffer greatly as a consequence of this transition. Once they've passed through this complex transition, women find themselves at increased risk of heart disease, osteoporosis and cancer.1
Efforts to help those women who suffer from menopausal symptoms and diseases of aging have moved along two paths. Mainstream medicine's path has led to the widespread prescription of conjugated estrogens, most commonly sold today as Premarin, and synthetic progestins. The second path has led to the development and use of natural estrogens and progesterone. While the first path has led to temporary relief for many women, it has done so at great cost. The second path, although given little credence by the medical mainstream, works without the side effects characteristic of conjugated estrogens and progestins, because its goal is to duplicate the hormonal balance that naturally occurs in a healthy young woman's body.
Conventional vs. natural hormone replacement therapies
The primary aim of both types of hormone replacement therapy (HRT) is to relieve menopausal symptoms. Both have proven capable of achieving this end. HRT research has also focused on its ability to reduce risks of age-related diseases such as heart disease, osteoporosis and cancer.
Possible Premenopause Symptoms
•Extremely heavy or extremely painful periods
•Moderate to severe PMS
Conjugated estrogens and progestins effectively relieve menopausal symptoms but at the risk of significant side effects, including breast tenderness, vaginal bleeding and mood changes. Some studies have appeared to support HRT's effectiveness at preventing heart disease, but the overall weight of the research data does not support it as preventive medicine against cardiovascular diseases.2
The most recent large-scale study showed that this combination of synthetic hormones increased the likelihood of strokes (41%), invasive breast cancer (26%) and heart attacks (29%) in women who used it for less than five years. The results of this study, which involved over 16,000 menopausal women, were so alarming that it was halted prematurely.3
Natural estrogens and progesterone, on the other hand, pose little to no risk of adverse effects when they are used properly. Unlike the synthetic progestins and conjugated estrogens, their molecular structure is identical to the hormones made in the human body. When the molecular structure of a hormone is "tweaked" to make it patentable (thus enabling drug companies to charge what they like without fear of competition), it does not function the same as its natural counterpart. This can lead to other actions in the body resulting in unpleasant or dangerous side effects. Natural progesterone and estrogens, which are made from soy or wild yams, are bioidentical - indistinguishable from the real thing, both under a microscope and within the human body.
Bioidentical progesterone and estrogens, when used appropriately, also relieve vasomotor symptoms and help to build bone.4 They pose no increased risk of heart attack, and their physiological effects on the circulatory system are likely to aid in the prevention of cardiovascular disease.5-7 Evidence exists that natural (bioidentical) progesterone is more effective at building bone than synthetic estrogens.8
Natural hormones are also useful for maintaining or reviving libido during "the change." Unlike any type of synthetic HRT, natural hormones - more specifically, natural progesterone - appear to help prevent breast cancer.9-13 An added advantage of natural hormone therapy is that it can be used by women who have yet to pass into menopause. Growing numbers of women in Westernized nations begin to experience premenopause symptoms as early as their 30s and 40s (see a partial list of premenopause symptoms, above).
Most women who experience premenopausal symptoms are not ovulating with each menstrual cycle, and so do not make the progesterone needed to balance out the estrogens that build up the uterine lining. Studies have shown that by the age of 35, approximately 50% of women are having at least some anovulatory cycles.14,15
Constant exposure to estrogen-mimicking chemicals in the environment - found abundantly in everything from plastics to cleaning solutions - further elevates these women's estrogen load. The result is an imbalance that hormone expert and author John Lee, M.D. has named estrogen dominance. Estrogen dominance occurs when the tissue-building properties of estrogen are not adequately countered by the normalizing, balancing effects of progesterone, a hormone that can be physiologically supplemented in a manner that mimics the hormonal cycles of a healthy young woman.
A common age for the initial detection of breast cancer is five or more years before menopause. This indicates that factors in play before the menopausal transition - most likely, estrogen dominance - create an ideal environment for the development of breast tumors. According to Dr. Lee and biochemist David Zava, Ph.D., the authors (along with medical writer Virginia Hopkins) of What Your Doctor May Not Tell You About Breast Cancer (Warner Books, 2002) balancing hormone levels through the proper use of natural progesterone can prevent breast cancer in estrogen dominant women.
Even younger women, including those in their teens and 20s, can suffer from estrogen dominance. Their symptoms may include PMS, weight gain, fibrocystic breasts, bloating, troublesome periods, infertility, endometriosis, depression or repeated miscarriage. Natural progesterone works to relieve symptoms in these younger women as well.
Some menopausal women find that their symptoms are relieved with natural progesterone alone. This is due to two factors: first, estrogens are made in fat cells, which means that heavier (or extremely estrogen dominant) premenopausal women may actually continue to be estrogen dominant well into menopause; and second, natural progesterone supplementation has the effect of "waking up" estrogen receptors, increasing their uptake of available estrogens.
Hazards of Oral Contraceptives
Birth control pills contain the same synthetic hormones that have been linked to serious health risks when used after menopause. They have been found to increase risk of cardiovascular disease (strokes, heart attacks and blood clots that can become lodged in leg vessels or vessels that feed the lungs), as well of the risk of developing cancer of the breast, cervix and liver.
The cardiovascular risks of the Pill use are often underestimated. It's likely that the increasing use of oral contraceptives for the symptoms of premenopause will lead to more cardiovascular adverse events, because women in the premenopausal age bracket already have elevated risk of such problems.
In some women, oral contraceptives cause depression, anxiety and mood swings. These side effects can be severe enough to affect quality of life and the ability to have healthy relationships.
The use of estrogen drugs in women with premenopause symptoms is not helpful. That's because the last thing any estrogen dominant woman needs is more estrogen, and synthetic progestins can't replace the real thing. Many women with premenopause symptoms end up using oral contraceptives to control them, and these drugs have their own hazards. This is no surprise when one considers that they contain the same kinds of synthetic hormones found in conventional HRT (see "The hazards of oral contraceptives," left).
Dr. Lee and other experts have found that natural progesterone is the best treatment for the symptoms of estrogen dominance, and thousands of women have discovered this firsthand.
If natural hormones are superior to synthetic ones, one might ask, where is the research to support this claim? Natural substances cannot be patented, and so the potential for huge profits from their manufacture and sale can't match those of synthetic versions. Because of this fact, it has been impossible to secure the funding necessary for the large-scale trials that could pit natural hormone therapy against the synthetics.
Some studies have been done to show the bioavailability and overall value of natural HRT,4,16,17 but natural hormone researchers have not been able to compete with the enormous, pharmaceutical company-funded studies that have been published on conventional HRT. As a result, most women have been led to believe that conventional hormone replacement therapy was their only option at menopause. The role of synthetic progestins in HRT has been relegated to little more than a preventive measure against uterine cancer. Mainstream medicine has ignored the many important roles natural progesterone plays in reproductive health and in the complete health picture of women in every stage of their life spans.
Natural progesterone, delivered to the body via a skin cream that contains this hormone, is all that many women need to regain and maintain hormone balance. Women who are in or past menopause may also need other hormones, including natural estrogens, testosterone and DHEA.
The many uses of natural progesterone
Progesterone's best-known role is in maintaining a healthy pregnancy. When a woman ovulates, the follicle that has burst to release the ovum becomes the corpus luteum. The corpus luteum secretes anywhere from 4 mg to 28 mg of progesterone per day during the two weeks between ovulation and menstruation, with the average being 22 mg to 25 mg. If pregnancy takes place, the corpus luteum continues to make progesterone throughout the first trimester, playing an indispensable role in maintaining the pregnancy until the placenta can take over the job of providing progesterone. By the third trimester of pregnancy, the placenta is making up to 400 mg a day of this pro-gestational hormone.
Women who suffer from repeated miscarriages may suffer from luteal insufficiency, meaning that their ovaries are not making enough progesterone to protect the pregnancy through the first trimester. It makes sense for women vulnerable to miscarriage to supplement with natural progesterone, starting as soon as they know they are pregnant. A recent study has concluded that injections of a metabolite (breakdown product) of progesterone are highly effective at preventing pre-term births in women who are at risk for them.18 Transdermal progesterone is likely to have the same beneficial effect.
It is important for women who are pregnant or trying to conceive to use a pure progesterone cream-one that contains no estrogens or estrogenic herbs. If you would like to use progesterone cream to prevent miscarriage, enhance fertility or prevent pre-term birth, consult with an obstetrician or other health practitioner knowledgeable in the use of natural hormones, or refer to What Your Doctor May Not Tell You About Premenopause by John Lee, M.D., Jesse Hanley, M.D. and Virginia Hopkins (Warner Books, 1999).
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