Essential Pharmacy

Estrogen

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Estrogen is not just a single hormone, but rather a group of related hormones produced by your body. The three most important of this group are Estrone, Estradiol and Estriol. Estrogen is manufactured primary in the ovaries, but can also be made in fat cells, muscles cell and the skin. The main function of estrogen in women is to regulate menstrual cycles, promote the growth of female development during puberty and to ensure fetal survival. Let’s look more closely at each of these.

Estrogen has 400 functions in the Body

- Stimulates the production of choline acetyltransferase, an enzyme which prevents Alzheimer’s disease
-Increases metabolic rate
-Improves insulin sensitivity
-Regulates body temperature
-Helps prevent muscle damage
-Helps maintain muscle
-Improves sleep
- Reduces risk of cataracts
-Helps maintain the elasticity of arteries
-Dilates small arteries
-Increases blood flow
-Inhibits platelet stickiness
-Decreases the accumulation of plaque on arteries
-Enhances magnesium uptake and utilization
-Maintains the amount of collagen in the skin
- Decreases blood pressure
-Decreases LDL and prevents its oxidation
-Helps maintain memory
-Increases reasoning and new ideas
-Helps with fine motor skills
-Increases the water content of skin and is responsible for its thickness and softness
-Enhances the production of nerve-growth factor
- Increases HDL by 10 to 15%
-Reduces the overall risk of heart disease by 40 to 50%
-Decreases lipoprotein(a)
-Acts as a natural calcium channel blocker to keep arteries open
-Enhances energy
-Improves mood
-Increases concentration
-Maintains bone density
- Increases sexual interest
-Reduces homocysteine
-Decreases wrinkles
-Protects against macular degeneration
-Decreases risk of colon cancer
-Helps prevent tooth loss
-Aids in the formation of neurotransmitters in the brain such as serotonin which decreases
depression, irritability, anxiety, and pain sensitivity

Bio-Identical Estrogens

E1 called Estrone E2 called Estradiol E3 called estriol

Estriol (E3)

This is the most abundant of all the estrogens. It makes up approximately 80 percent of the estrogen present in the system and is produced by the ovaries. It is made in large amounts during pregnancy and is necessary for a carrying to full term. It also works on protecting the bones from losing density, protects the urogential health of a woman and has many valuable antioxidant properties. It is generally considered to be the weakest of the estrogens in terms of stimulating tissue growth and many see it as the safest form of all. It works well to combat vaginal dryness and vaginal atrophy as well

- Considerable evidence exists to show that it protects against breast cancer
- Is used in Europe to treat breast cancer instead of Tamoxifen
- It does not have the bone, heart, or brain protection of estradiol

Estradiol (E2)

This estrogen is considered to be the most active of all the estrogens. Estradiol makes up 10 percent of the body’s estrogen supply. It is a powerful hormone and is used most widely for controlling hot flashes and general menopausal symptoms. It may offer bone protection, improve lipid profile, enhance blood clotting, improve memory and clarity, increase serotonin and endorphin levels, enhance intestinal absorption of vital nutrients and is associated with eye lens health.

- Increases HDL
- Decreases LDL and total cholesterol
- Decreases triglycerides
- Helps maintain bone structure
- Increases serotonin
- Decreases fatigue
- Works as an antioxidant
- Helps maintain memory
- Helps absorption of calcium, magnesium, zinc

Estrone (E1)

Is the main estrogen the body makes post menopausally. High levels many researchers believe may increase a women’s risk of breast cancer

- Estrone has very similar properties as Estradiol.
- It composes the last 10 percent of estrogen present in the body.
- It is usually converted from body fat.

Symptoms of Estrogen Deficiency Menopause

Each woman may experience her own set of symptoms that let her know that her hormones are changing. Many of these symptoms become quality of life concerns if left untreated. By restoring the natural levels of estrogen there is an obvious relief of symptoms.

- Hot flashes
- Night sweats
- Vaginal dryness
- Anxiety
- Mood swings
- Irritability
- Insomnia
- Depression
- Loss of sexual interest
- Hair growth on face
- Painful intercourse
- Panic attacks
- Weird dreams
- Urinary tract infections
- Vaginal itching
- Lower back pain
- Bloating

Estrogen dominance.

This is a phrase used to describe what can happen when estrogen and progesterone get out of balance. It is a relative excess of estrogen… it doesn’t mean there is too much estrogen, but that there is too much estrogen relative to the level of progesterone. As a woman reaches the age of menopause, her body continues to produce estrogen in her muscle and fat cells. She may typically produce 40-60 percent of the estrogen made before menopause, but only 1/120 of the progesterone. This creates estrogen dominance…there is not progesterone in the system to counter the effects of estrogen that is still being produces. Adding more estrogen at this point is not helpful… rather raising the progesterone levels is the more appropriate therapy.

Symptoms of Estrogen Excess

-Cervical dysplasia
-Depression with anxiety or agitation
-Increased risk of uterine cancer
-Weight gain (abdomen, hips, thighs)
-Water retention
-Headaches
-Poor sleep
-Panic attacks
-Swollen breasts
-Heavy periods
-Increased risk of breast cancer
-Increased risk of auto-immune diseases
-Hypothyroidism
-Fatigue
-Irritability/mood swings
-Uterine fibroids
-Bloating

Causes of Excess Estrogen in the Body

- Taking too much estrogen
- Impaired elimination of estrogen
- Lack of exercise
- Diet low in grains and fiber
- Environmental estrogens
- Elevation of 16-OH Estrone

Estrogen Metabolism

After menopause, the metabolism of estrogen can change. Consequently a
women may respond differently to estrogen replacement

Two major competing pathways: 2-OH Estrogen 16-OH Estrogen

• 2-OH estrone
- Good estrogen
- It does not stimulate the cell growth.
- Blocks action of stronger estrogen products that may be carcinogenic

How Can You Raise 2-OH Estrone- Moderate exercise
- Cruciferous vegetables
- Flax
- Soy
- Kudzu
- Indole-3-carbinol taken as a supplement. Daily doses 200 to 300 mg.
- High protein diet
- Omega-3-fatty acids
- B6, B12, and folate

Obesity
- Decreases 2-OH estrone and increases 16-OH estrone.

• 16-OH estrone
- Has significant strong estrogenic activity
- Studies show it may be associated with an increased risk of breast cancer

One minor pathway
• 4-OH estrone

- Equine estrogens, such as Premarin increase metabolism into 4-OH estrones.
- Studies show it may directly damage DNA and cause mutations
- Therefore, it is proposed to enhance cancer development.

Progesterone

Progesterone is another hormone of the reproductive system. This hormone prepares the lining of the uterus for implantation of the fertilized egg and helps to maintain the pregnancy. Progesterone is also a precursor hormone, meaning it transforms itself to create other hormones…estrogen and testosterone especially. Another very important function of progesterone is to “oppose” estrogen. It is made by nature to work synergistically with estrogen and together they balance each other in the body. When estrogen is present without natural progesterone, the estrogen properties we explored earlier are not kept in check and may eventually lead to conditions associated with too much estrogen in the body. It is therefore, critical to balance estrogen with progesterone to maximize the health benefits of each hormone.
Progesterone is often confused with its synthetic counterpart Progestin. Progestin’s are made and do not have the same properties as naturally occurring Progesterone. In fact, Progestin’s have been associated with an increase in the symptoms of hormone imbalance and deficiency. Remember, only Bio-Identical Progesterone has the properties necessary to appropriately balance the Estrogen properties. Always make certain this combination is in place in your hormone therapies that include any Estrogen replacement. By bringing the progesterone levels into balance it will act as a natural antidepressant, help to normalize the thyroid, improve cholesterol, build bone, restore libido, decrease menstrual cramping and help the body to use fat for energy.

Symptoms of Progesterone Loss

- Anxiety
- Depression
- Irritability
- Mood swings
- Insomnia
- Pain and inflammation
- Osteoporosis
- Decreased HDL
- Excessive menstruation

Causes of Low Progesterone

- Impaired production
- Low LH
- Increased prolactin production
- Stress
- Antidepressants
- Excessive arginine consumption
- Sugar
- Saturated fat
- Deficiency of vitamins A, B6, C, zinc
- Decreased thyroid hormone

Natural Progesterone Affects Not Seen with Progestin’s

- Helps balance estrogen
- Leaves the body quickly
- Improves sleep
- Natural calming effect
- Lowers high blood pressure
- Helps the body use and eliminate fats
- Lowers cholesterol
- May protect against breast cancer
- Increases scalp hair
- Helps balance fluids in the cells
- Increases the beneficial effects of estrogen
- on BV
- Increases metabolic rate
- Natural diuretic
- Natural antidepressant

Treatment

- Compounded progesterone as a cream or as a capsule / troche
- If the patient has insomnia as symptom then choose P.O. which affects the
GABA receptors

Testosterone

Testosterone is the hormone that is most commonly associated with male sex characteristic. Many women I work with are initially fearful at the mention of this word. However, once they understand that testosterone is responsible in part for sex drive and energy levels, they change their minds. Women produce far less testosterone than men- about 90 percent less.

Testosterone Can:

o Increases sexual interest
o Increases sense of emotional well-being
o Increases muscle mass and strength
o Helps maintain memory
o Helps skin from sagging
o Decreases excess body fat
o Helps maintain bone strength
o Elevates norepinephrine in the brain (tricyclic affect)

Symptoms of Testosterone Loss

• Muscle wasting
• Weight gain
• Fatigue
• Low self-esteem
• Decreased HDL
• Dry, thin skin, with poor elasticity
• Thinning and dry hair
• Droopy eyelids
• Sagging cheeks
• Thin lips
• Anxiety

Symptoms of Increased Testosterone

• Anxiety
• Depression
• Fatigue
• Hypoglycemia
• Salt and sugar cravings
• Agitation and anger
• Facial hair
• Acne
• Insulin resistance
• Weight gain
• Hair loss or unwanted hair growth
• Increased risk of heart disease

Treatment

• Testosterone replacement sublingual or transdermally
• If used transdermally must rotate sites.
• In order for testosterone to work well, estradiol must also be optimized.
• Without enough estrogen, testosterone cannot attach to brain receptors.
• If testosterone is given alone it can increase plaque formation.
• Elevated testosterone can be treated with saw palmetto or glucophage.

Causes of Low Testosterone

• Menopause
• -Childbirth
• -Chemotherapy
• -Adrenal stress or burnout
• -Endometriosis
• -Depression
• -Psychological trauma
• -Birth control pills
• -HMG-CoA-reductase inhibitors

DHEA

This is another hormone to consider. DHEA is a hormone produced in the adrenal glands and is the most prolific hormone in the body. It is called the “Mother Hormone” because it has unique properties that allow it to help to balance the entire endocrine system. This enhances the effectiveness of hormone functioning and replacement and is a perfect complement to basic hormone replacement therapy. Boosting DHEA levels may naturally raise Testosterone levels and may be used alone or in conjunction with that hormone. It is commonly believed that DHEA levels may decrease up to 50% by age 40.
DHEA is associated with anti-aging, weight loss and management, strengthening of immune function, balancing thyroid function, improving memory, improvement of moods, increasing muscle mass, boosting of energy and fighting allergic reactions.
Again, as with the other hormones we have discussed, testing levels is critical. If a deficiency is found, supplementation can be invaluable for men and women.