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Particular hormone tests are available to help you deal with menopausal challenges. Using the results of those tests, you can decide which type of hormone supplementation is right for your menopause symptoms.
Testing for sex hormones
When asking your doctor to check your sex hormone levels, you can expect to get a baseline blood test for:
- Estradiol, estriol and estrone. (Ask for 4-hydroxyestrone and 16 alpha hydroxyestrone levels, which increase cancer risk.)
- DHEA-S (dehydroepiandrosterone sulfate).
- SHBG (sex hormone binding globulin).
- Pregnenolone (precursor to estrogens, progesterone, testosterone, DHEA).
Your blood may also be tested for the precursor hormones of the hypothalamus and pituitary gland (in your brain). These precursor hormones communicate “downstream” to stimulate your adrenals and ovaries to produce your sex steroid hormones:
- FSH (follicle-stimulating hormone).
- LH (luteinizing hormone).
- ACTH (adrenocorticotropic hormone).
Blood tests for these are a good beginning, but soon you may need saliva testing to monitor your transdermal estrogen. Why? Because you should never be taking oral estrogen (it can lead to dangerous metabolites as it passes through your liver); and the only reliable test to monitor transdermal hormones is via the saliva, which most closely represents tissue levels of free hormones. The same goes for transdermal progesterone and testosterone.
While you are at it, consider getting your cortisol and melatonin levels measured with saliva testing. No blood draw is needed; a kit can be sent to your home for this.
Estrone, Estradiol and Estriol
Estrogen has three main components: estrone, estradiol and estriol. Bio-identical hormone prescription creams contain estradiol and estriol (called “biest”). But estrone has varying components that can be metabolized further into breast cancer-promoting forms (4-hydroxyestrone and 16-alphahydroxyestrone). It can also be metabolized into a breast cancer-protecting form (2-hydroxyestrone).
Fortunately, you can actively promote metabolism to the cancer-protecting estrone (2-hydroxyestrone) by consuming broccoli, soy isoflavones, flaxseed lignans and/or omega-3 oils. Other ways to promote healthy estrone metabolism are by consuming adequate amounts of B vitamins, vitamin D, SAMe (methionine), magnesium, N-acetyl cysteine (NAC), glutamine, glycine, and the herbs rosemary, turmeric or chrysin. Remember also to consistently exercise, control your weight and not smoke.
Estriol, on the other hand, protects against breast cancer, according to a number of studies. When given with estradiol or with progestin, estriol showed breast cancer-protecting effects. 1 In a large study of 30,000 women reported in 2004, those who used estriol only had no increased rate of breast cancer, while those who used “estrogen” only did have an increased rate of breast cancer. 2 In a large case-control study of 3,345 women, the risk for breast cancer among estriol users was the same as nonusers. 3
Lifestyle and non-prescription treatments
Fill your diet with nutrient-rich, low-calorie, high-fiber foods such as vegetables, low-glycemic fruits, sprouted grains, seeds, nuts, and legumes whenever possible. Reduce foods high in starches, sugars, unnatural fats and animal protein. They generally lead to obesity and hormone imbalances. Eliminate caffeine because it promotes cortisol production, which competes with progesterone and also promotes belly fat.
Vitamins and nutrients that help reduce menopausal symptoms include soy isoflavones, calcium (500 mg daily) and magnesium (500 mg daily); vitamin A 10,000 IU and E 800 IU twice a week; omega-3 oils daily such as found in cod liver oil (increases bone density, fights heart disease, helps prevent arthritis, lowers high blood pressure, supports normal brain function and reduces depression/mood swings); and vitamin D3 at 10,000 IU twice a week.
Herbs that balance hormones include black cohosh and soy isoflavones (found in Estroven®), chaste tree, kudzu, red clover, wild yam, asparagus racemosus, peony, dong quai, blue cohosh, lady’s mantle, unicorn root, vervain, sage, schisandra, Russian rhubarb, ashwagandha and chayawnprash. Consult an herbalist or naturopathic doctor for specific treatments with these depending on your hormonal imbalances.
The usual dose of estrogen cream for menopausal symptoms is 0.25 mg to 1.0 mg per day of “biest” (estradiol and estriol in a 1:4 ratio or 1:1 ratio). If you are still having periods, you can use it on days 5 to 25 of your cycle. If you no longer have periods, you can use it continuously along with progesterone or take a three-day to five-day break each month. Progesterone protects from symptoms (and long-term risks, such as cancer) of “unopposed estrogen.”
If you are premenopausal and suffering with PMS symptoms, then you can use the daily sustained release or topical cream progesterone on days 14 through 25 of your cycle. If you are having peri-menopausal symptoms (irregular bleeding or other signs of estrogen failure) then you will do best on the same dose of progesterone as for PMS, but start on day 12 of your cycle to control irregular bleeding. Vaginal suppositories also have good absorption similar to skin creams. If progesterone alone does not control your perimenopausal symptoms, then you’ll want to add biest cream, starting at doses of .25 to .5 mg daily.
After you go through menopause, you’ll want to consider using both progesterone and estrogen even if you have no symptoms. Why? Because of the beneficial effects of these hormones on your heart, liver, brain, bones and skin. After menopause, these can be dosed daily or with a break for three to five days per month. You also may need the strengthening and libido-enhancing benefits of a daily low dose of testosterone (.25 to 1 mg) or consider DHEA (a precursor hormone to testosterone), according to your hormone tests.
Patient A, age 52, wondered if she should take hormones for menopause. Her periods had slowed and become irregular over the previous two years. She was experiencing only occasional hot flashes. She wanted her hormone levels checked. Her results showed:
- Estradiol on the low end of the normal range.
- Testosterone on the low end of the normal range.
- Progesterone on the high end of the normal range.
- FSH and LH were on the high end of the range (indicating ovarian failure).
I told her that conventional doctors may consider these to all be in the normal range because they are typical values for a woman moving through menopause. I also told her that she deserves to feel good and to change the course of her inevitable physical and mental deterioration due to dropping hormone levels. After understanding the benefits of natural hormone replacement, she asked for bio-identical hormone replacement therapy (she needed only estrogen and testosterone, with follow-up saliva testing to verify they remain in balance) to improve her sexual health, lower her risk of heart disease, help maintain her bone density and help prevent memory loss.
Patient B, age 80, complained mostly of recurring vasomotor symptoms she recognized from when she went through menopause at age 50. Blood testing for her would certainly show ovarian failure and all hormones to be normal for her age (probably in the normal range, since all women not getting hormone replacement will have almost no hormones). However, she opted or blood testing just to see. Her tests showed “normal” for her age, as expected. Even her thyroid studies were showing normal. However, with low-dose hormones, her symptoms improved dramatically, as did her mood.
Patient C, age 45, had been having hot flashes for more than a year. They were keeping her up at night from sweating so much, which contributed to daytime fatigue and irritability that showed at work and at home. Basically, she was feeling miserable.
I told her that natural hormone replacement would affect much more than just skin and hair; they would influence her overall energy level, help preserve her mental acuity and likely improve her sleep. Blood tests were obtained and, correspondingly, she readily agreed to start on the bio-identical hormones biest (cream), progesterone (cream) and DHEA (pill). She also worked at reducing her stress so her adrenal gland could heal by using stress-reduction techniques. In addition, she used the herb lemon balm and the amino acid l-theanine. She would wait before using adrenal extract. She let me follow her saliva levels for these sex hormones as well as cortisol and melatonin.
Menopause and hormone imbalances can be treated with various natural approaches and should never be treated with synthetic hormones. Natural estrogen and progesterone give the most effective treatment results with a proven safety profile.
Estrogen can be used for menopausal symptom control as I discussed. Estrogen cream (but not taken orally) plus progesterone has long-term health benefits: stronger bones, a healthier heart and improved memory for the later years of a woman’s life.
Progesterone reduces the bothersome symptoms of PMS and of perimenopause. Progesterone improves mood and sleep, lowers risk for heart disease, protects from thinning bones and protects from estrogen’s potential effects of breast and uterine cancer.
To feeling good in life,
Michael Cutler, M.D.
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