Female Hormone Restoration

Beyond Estrogen and Progesterone: The Total Hormone Picture

The final step to total hormone restoration is to look at all the hormone levels. Because the steroid hormones are all related to one another, and because many convert into other hormones, it is very important to strive for balance.

DHEA is a natural steroidal hormone secreted by the adrenal gland, the gonads, and the brain (Williams et al 2001). Although women usually have less DHEA than men, both sexes lose DHEA at about the same rate, suggesting that its decline is age related (Khorram 1996; Wilder 1996). Peak levels are typically reached when women are in their 30s, after which they begin to lose approximately 2 percent per year. Decreased levels of DHEA are associated with cancer, diabetes, lupus, and psychiatric illness (Berkman et al 1993; Salek et al 2002). Low levels of DHEA are also associated with higher levels of insomnia, pain, and disability (Morrison et al 1998).

DHEA has been shown to improve mood, neurological functions, immune system functioning, energy, feelings of well-being, and to maintain muscle and bone mass (Kroboth et al 1999; Proctor et al 1998; Yen et al 1995). A study has demonstrated memory-enhancement effects by DHEA and pregnenolone (Rupprecht et al 1999). DHEA may also improve insulin sensitivity and lower triglyceride levels (Casson et al 1995).

Testosterone levels also gradually decrease with age (Schneider 2003). Loss of testosterone affects libido, bone and muscle mass, vasomotor symptoms, cardiovascular health, mood, and well-being (Burd et al 2001; Watt et al 2003). Testosterone therapy, combined with estrogen therapy, has been shown to improve quality of life, vigor and mood, ability to concentrate, bone mineralization, libido, and sexual satisfaction (Bachmann 1999; Braunstein 2002; Cameron et al 2004; Davis et al 2003; Sarrel 1999). This combination therapy also produces improvements with hot flashes, sleep disturbances, night sweats, and vaginal dryness. Because DHEA converts into testosterone, it may be possible to raise testosterone levels with DHEA supplements (Cameron et al 2004; Schneider 2003).

An observational study suggests that testosterone may protect against breast cancer (Slayden 1998). Studies also demonstrate that testosterone replacement alone may protect against breast cancer (Dimitrakakis et al 2003; Dimitrakakis et al 2004; Zhou et al 2000). In addition, testosterone is effective for the treatment of decreased libido (Davis 1999).

Pregnenolone levels also decline with age. As the primary steroid hormone in the cascade, pregnenolone is the first product of cholesterol. Like other hormones, there is a significant reduction occurring in women at about age 32 (Havlikova et al 2002). Reduced pregnenolone levels result in decreased amounts of all other hormones, and pregnenolone deficiencies have been associated with diminished brain function and dementia (Yao et al 2002; Maurice T et al 1999).

It is very important for women to check blood levels of hormones before beginning therapy, and again one and three months after initiating replacement therapy to ensure safe and adequate levels. If testosterone is still low after DHEA and pregnenolone therapy, talk to your physician about options. Always consult your physician before beginning HRT, especially if you are at high risk or have a family history of hormone-dependent cancer.

Phytoestrogens: A Natural Option

It might seem like a stark choice: face aging and hormonal decline or rely on synthetic hormones that raise the risk of heart attack and breast cancer. Fortunately, there are other options. Progressive physicians throughout the United States, Europe, and Japan have begun to rely on natural bioidentical estrogens, or plant compounds that have estrogenic properties (called phytoestrogens).

Some of the best evidence for phytoestrogens comes from Asia. In Asia, women do not experience many of the diseases and symptoms associated with menopause and the loss of estrogen (Knight et al 1996; Park et al 2005; Sarkar et al 2003). Looking for answers, researchers examined whether there was a genetic difference or another explanation.

Phytoestrogens found in soy and other plant products may help protect aging Asian women (Park et al 2005; Sarkar et al 2003).

Phytoestrogens bind to estrogen receptors (Zittermann 2003). By competing for estrogen receptors, phytoestrogens help prevent the growth and spread of several hormone-dependent cancers (Adlercreutz et al 1992). They have also been shown to decrease the risk of some degenerative diseases, including cardiovascular disease, osteoporosis, and breast and uterine cancer (Badowski et al 2001; Fletcher 2003; Magee et al 2004; Park et al 2005; Valentin-Blasini et al 2003).

Heart Benefits of Phytoestrogens

Unlike conventional HRT, which was shown to raise the risk of heart attack among postmenopausal women, phytoestrogens actually have a positive effect on the heart. In 1999, the US Food and Drug Administration authorized the use of food-label health claims connecting increased soy consumption with reduced risk of coronary artery disease (Vincent et al 2000). One study of more than 400 women demonstrated that phytoestrogens protect against arterial degeneration and atherosclerosis through their effect on the arterial walls, particularly in older women (van der Schouw et al 2002).

A survey of scientific studies on phytoestrogens found they offer the following benefits:

• Decreased blood pressure, LDL cholesterol, total cholesterol, and triglycerides (De Kleijn et al 2002; Ruiz-Larrea et al 2000).
• Increased HDL cholesterol and improved cardiovascular profile (De Kleijn et al 2002).
• Lowered the overall rate of cardiovascular disease among people with higher consumption of phytoestrogens (Ariyo et al 2002). Genistein and daidzein, two of the most extensively studied phytoestrogens, are effective at lowering lipids in people with high cholesterol (Anthony et al 1997; Teede et al 2001; Zittermann 2003). Increased levels of daidzein and genistein inhibit LDL oxidation and help reduce the risk of atherosclerosis (Exner et al 2001).
• A six-month study of more than 180 women confirmed that a soy-rich diet is as effective as conventional HRT for lipid lowering (Park et al 2005).

Furthermore, phytoestrogens have up to almost 3 times the radical scavenging activity of vitamin C and vitamin E and have protective effects on the arterial walls (Ruiz-Larrea et al 2000; van der Schouw et al 2002).

Osteoporosis and Phytoestrogens

Studies have shown that postmenopausal women with a habitually high intake of phytoestrogens have high bone mineral density of the spine and hip (Greendale et al 2002; Hanna et al 2004; Mei et al 2001). A number of studies have been conducted on phytoestrogens and bone homeostatis:

• Genistein, daidzein, and coumestrol increase bone mineralization (Clifton-Bligh et al 2001; Kanno et al 2004).
• Genistein and daidzein decrease bone resorption and inflammatory factors and increase bone-making proteins (Gao et al 1999; Gao et al 1999b; Harkness et al 2004; Jia et al 2003; Rassi et al 2002; Suh et al 2003; Yamaguchi et al 2000; Zhang et al 2004).
• An isoflavone mixture of daidzein, genistein, formononetin, and biochanin demonstrated significant increases in bone mineral density after six months of treatment. Women who took 57 mg/day of isoflavones had a 4 percent increase in bone mineral density (Clifton-Bligh et al 2001).
• A phytoestrogen preparation using daidzein, genistein, formononetin, and biochanin demonstrated protective effects on the lumbar spine (Atkinson et al 2004).
• Dietary supplementation with 54 mg/day of genistein “may be as effective as hormone replacement therapy in attenuating menopause-related bone loss without causing the associated side effects” (Cotter et al 2003).

Genistein: A Powerful Phytoestrogen

Genistein, together with daidzein, is one of the most extensively studied phytoestrogens. It has been shown to have beneficial estrogenic effects in bone, the brain and the cardiovascular system (Bang et al 2004). It is even being considered as an alternative to estrogen for the treatment of Alzheimer’s disease (Bang et al 2004).

Brain protection. Estrogen and estrogen-like compounds protect brain cells from degenerative changes due to aging and oxidative stress (Bhavnani 2003; Linford et al 2002). Genistein is a potential alternative to estrogen in the treatment of Alzheimer’s disease (Bang et al 2004).

Menopause symptoms. Several studies demonstrate that natural estrogens significantly decrease hot flashes and vaginal atrophy (Albert et al 2002; Baird et al 1995; Chiechi et al 2003; Clifton-Bligh et al 2001; Murkies et al 1995). Treatment with 54 mg/day of genistein safely decreases hot flashes up to 30 percent and should be considered as an alternative treatment for postmenopausal conditions (Crisafulli et al 2004).

Cancer. Studies demonstrate a significantly lower incidence of sex hormone–related cancer in Asian countries (Sarkar et al 2003; Vij et al 2004). This difference has been attributed to the traditionally high intake of soy isoflavones in the Asian diet because genistein has been shown to stop the growth and spread of breast cancer cells and significantly delay the progression of prostate cancer (Sarkar et al 2003; xon-Shanies et al 1999).

Daily soy isoflavone consumption is associated with decreased breast cancer risk (Lu et al 2001). A diet containing 113–202 mg/day (depending on body size) of genistein and daidzein can increase the production of the protective 2-hydroxylated estrogen, decrease estradiol and its harmful metabolites, and lower the long-term risk for breast cancer (Lu et al 2000). Genistein and daidzein also have an inhibitory effect on uterine cancer (Lian et al 2001). Most studies indicate that soy isoflavones are safe and effective.

Bioidentical Hormone Replacement

Among younger women, phytoestrogens alone may be enough to correct small deficiencies. Menopausal and postmenopausal women, however, often require HRT with bioidentical estrogens and progesterone. As the name implies, these hormones have exactly the same chemical structure as biological hormones. Bioidentical hormones can be found at special pharmacies that will compound them in the correct ratio to naturally restore hormones to a youthful level. The use of bioidentical estrogens, which is gaining acceptance in the United States, has long been practiced in Europe and Japan (Kano et al 2002).

Estriol is the main component of Life Extension's recommended bioidentical estrogen replacement therapy, representing 90 percent of the content, with smaller proportions of estradiol (7 percent) and estrone (3 percent). Estriol offers many of the benefits of more conventional estrogen-replacement therapies, but without the harsh side effects or long-term dangers often encountered with conventional HRT, which has an unnatural balance of estrogens and contains almost 50 percent horse estrogen (Head 1998). This weak estrogen also slows the progression of atherosclerosis (Kano et al 2002).

Some popular prescription estrogen formulas are BiEst® and TriEst®. BiEst® consists of estradiol and estriol (Taylor 2001), while TriEst® contains all three estrogens in a ratio of 80 percent estriol to 10 percent each of estradiol and estrone (Taylor 2001). For a patient with a prescription, a compounding pharmacy can alter the proportion of each estrogen to achieve Life Extension’s recommended ratio of 90:7:3. For referrals to physicians who are willing to prescribe bioidentical estrogens, or for information on obtaining a Female Hormone Profile, call 1-800-544-4440 or go to www.lef.org.

Bioidentical estrogens will often be prescribed after blood testing shows deficiencies in estrogen and can be part of a comprehensive hormone restoration program that also includes progesterone cream or bioidentical progesterone, DHEA, pregnenolone, and perhaps testosterone.

Women should also discuss hormone cycling with their physicians. During their fertile years, women do not experience stable blood levels of estrogen and progesterone. Rather, estrogen and progesterone levels naturally rise and fall throughout the monthly cycle. Decades of this normal, natural flow of hormones has the effect of conditioning hormone receptors throughout the body to follow a rhythmic pattern.

To mimic nature and get the most benefit from hormone restoration, a woman should take estrogen in the first part of the month and taper the amount toward the end of the month, when her body is conditioned to receive less estrogen. Progesterone, on the other hand, should be taken in the latter half of the month, when her progesterone levels would be rising. Discuss this cycle with your physician because every woman's body and natural cycles are different.