Estrogens

• Estrone(E1), Estradiol (E2), and Estriol (E3) are often prescribed in combination to re-establish a normal physiologic balance
• Relieve menopausal symptoms, including vaginal thinning and dryness
• May increase HDL “good” cholesterol and decrease LDL “bad” cholesterol
• Help to decrease blood pressure and reduce plaque formation on the arterial walls
• Reduce the risk of colorectal cancer
• May improve mood, energy levels, and sleep patterns
• May reduce the risk of developing or the severity of type 2 diabetes
• May improve memory and cognitive function
• Reduce bone loss
The term “estrogen” actually refers to a group of related hormones, each with a unique profile of activity. The three principle estrogens in humans are Estriol (E3), Estradiol (E2) and Estrone (E1). The use of one or more of these hormones is referred to as Estrogen Replacement Therapy (ERT). These hormones are often prescribed in combination to reestablish a normal physiologic balance.

Estriol has been shown to be clinically effective for the treatment of menopausal symptoms as well as postmenopausal problems including vaginal atrophy, dryness, vaginal infections, painful intercourse, and various condition of the urinary tract. Estriol is produced in very large amounts during pregnancy and may be protective against breast cancer. High levels of Estriol are found in vegetarians and Asian women, who have a much lower incidence of breast cancer.

Estradiol is the primary estrogen of ovarian origin and the major form of estrogen in Pre-menopausal women. Estrogen (made from the conversion of Estradiol and Androstenedione)is the primary estrogen in postmenopausal women.

Despite studies reporting the risks associated with synthetic hormones, conjugated equine estrogens remain the most frequently prescribed form of ERT. Metabolites (breakdown products) of these synthetic estrogens have been linked to the devolvement of breast cancer.

In addition to treating menopausal symptoms, ERT has been shown to be effective in decreasing the risk of Alzheimer’s Disease and colorectal cancer. ERT also show potential for treating patients with Multiple Sclerosis and arthritis.

Progesterone

• Is commonly prescribed for peri-menopausal women to counteract "estrogen dominance".
• Alone, or combined with estrogen, may improve Bone Mineral Density.
• Minimizes the risk of endometrial cancer in women who are receiving estrogen
• Is preferred by women who had previously by women who had previously taken synthetic progestins, according to one Mayo Clinic study.
• Is preferred by women who had previously by women who had previously taken synthetic progestins, according to one Mayo Clinic study.

According to Katharina Dalton, M.D., approximately one in ten new mothers suffers from postpartum depression, or postnatal illness (PNI). “Unfortunately, women who have had PMS are prone to develop postnatal illness, but good news is that PNI can be prevented by receiving progesterone” immediately after delivery. Women who have had postpartum depression once have about 68% chance of having it again after another pregnancy, but trials of prophylactic progesterone worldwide have shown that it is possible to reduce this recurrence rate to 7%.

Natural bio-identical progesterone is commonly prescribed for perimenopausal women to counteract the condition know as “estrogen” dominance. Perimenopause is the time between the onset of changes in hormonal secretions and menopause, and is characterized by fluctuating hormones. Estrogen dominance occurs when a woman produces smaller amounts of progesterone than normal relative to estrogen levels.

Jerilynn Prior, M.D., of the University of British Columbia in Vancouver, has presented evidence that progesterone can stimulate new bone formation in women with osteoporosis. This may indicate a role for progesterone use, alone or combined with estrogen which reduces bone loss, in improving Bone Mineral Density.

The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, a 3-year multicenter, randomized, double-blind, placebo-controlled study of 875 healthy postmenopausal women, confirmed that synthetic progestins partially negate the beneficial effects on cholesterol levels that result from taking estrogen. Natural progesterone, on the other hand, maintains the benefits of estrogens on cholesterol while minimizing the side effects associated with synthetic progestins such as medroxyproesterone acetate.

Mayo Clinic researchers surveyed 176 women taking natural micronized progesterone who had previously taken synthetic progestins to see if natural progesterone, when compared to synthetics, made a difference in the women’s overall quality of life, menopausal symptoms, and satisfaction with HRT. After one to six months, the women reported an overall 34% increase in satisfaction on micronized progesterone compared to their previous HRT, reporting these improvements: 50% in hot flashes, 42% in depression, and 47% in anxiety. Micronized progesterone was also more effective in controlling breakthrough bleeding. Miyagawa and Frank of Oregon Health Sciences University and USC School of Medicine compared medroxprogesterone actetate (MPA) with natural progesterone as the progestin in HRT and studied the corresponding effect on coronary artery vasospasm. This research showed that progesterone plus estrodiol protected against vasospasm, but MPA plus estrodiol did not. In the past, the choice of MPA over progesterone has been based on familiarity and convince. Based on the results presented here, formulations of natural progesterone would appear to offer the wiser alternative.

Androgens, such as testosterone

• Enhance libido
• Provide cardiovascular protection (lower cholesterol)
• Enhance bone building (increase claim retention)
• Improve energy levels and mental alertness

Recently, attention has turned to the addition of the androgens testosterone and dehydroepiandrosterone (DHEA) to ERT in order to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes. ERT may represent incomplete preventive hormonal treatment in postmenopausal women because it does not directly address the declines in serum testosterone associated with hysterectomies and age-related gender independent decline in DHEA and DHES-sulfate. Additionally, ERT may cause relative ovarian and adrenal androgen replacement.

Every woman is unique. Therefore, it is sensible approach for the patient to work together with health care professionals to customize hormone replacement therapy. Bio-identical HRT can be compounded in the needed strength and dosage form and administered via the most appropriate route to meet each woman’s needs.