Wednesday, February 4, 2015

The Estrogen Dilemma

To replace or not to replace…that is the question. The answer is confusing. Most of the available information seems contradictory at best and frightening at the worst. To truly answer the question, we need to start with the definition of estrogen and the role it plays in the body. Estrogen is a term for a group of chemically similar hormones: estradiol and estrone, produced primarily by the ovaries, and estriol, primarily produced by the placenta during pregnancy.

Estradiol is the most potent form of estrogen in the body and estradiol is the form of estrogen that women lose at menopause. Estradiol is the bio-identical hormone replacement used in most patches or creams.

Estrone is the weakest of the naturally occurring estrogens and its only known function is to serve as a storage unit for functional estrogen. Estrone is produced in small amounts by fatty tissue and by the liver and adrenal glands and is increased by routine alcohol use. High levels of estrone can stimulate breast and uterine tissue, possibly increasing cancer risk. This could explain the increased cancer risk associated with excess alcohol use and high fat diets.

Estriol is interesting because it does not promote breast cancer. It also does not have the bone, heart, or brain protection of estradiol, but it can help lower cholesterol. Estriol has been used widely in Europe and Scandinavia. A combination of estriol and estradiol cream seems to maximize the relief of menopausal symptoms while minimizing cancer risk and this combination seems to hold the most promise for future research. There is no estriol /estradiol cream commercially available and this can only be obtained by prescription and through a compounding pharmacy.

Cancer risk is the dilemma with hormone replacement therapy. The initial studies with estrogen in women found that women taking estrogen only had an increased risk of uterine cancer. Women taking estrogen and progesterone did not have an increased risk, so the standard of practice is that a woman on estrogen replacement therapy must also use progesterone (next week’s topic) if she still has her uterus. Women using vaginal cream only generally do not need progesterone. Estrogen alone can increase the risk of estrogen dependent breast cancer; however, this risk is reduced by using topical estrogen and can be further reduced by using the estriol/estradiol combination.

Bottom line: Hormone replacement therapy has both risks and benefits associated. For myself, I had to evaluate the benefit of how much better I felt overall and the cariodprotective/bone-protective/neuroprotective benefits versus the risk. I had extensive discussions with my gynecologist to reach the decision that was right for me including a review of family history for cancer and cardiac risk and a commitment to a healthy lifestyle --more on that in future topics!

Making healthy choices for life at John Hollis Pharmacy!

Important note: estrogen levels are lower in smokers. Smokers often have more menopausal symptoms than non-smokers. Smokers have more wrinkles than non-smokers. There are nicotinic receptors in the bladder that lock on to the nicotine in cigarettes. This is why smokers also have to deal with incontinence at an earlier point in time. Bottom line: Don’t smoke! It wrecks your body!

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