Posted by FixAFlash on Mar 02, 2019
1. Is it safe giving unopposed estrogen 2 weeks out of the month?
A healthy, well-functioning fertile woman produces estradiol in a distinct rhythm throughout her menstrual cycle. By its rhythmic production, estradiol up-regulates its own receptors, progesterone receptors, and multiple other hormone receptors including growth hormone receptors. To optimize estrogen’s activity throughout the body and optimize progesterone and other hormone receptor production seems logical and important to reproduce the ovarian rhythm as closely as possible. A small amount of progesterone is normally produced by the adrenal gland throughout the month. A small amount is also thought to be produced by the ovaries or the brain throughout the month.
Adding significantly more progesterone during days 1-13 is not physiological and can be counterproductive. More progesterone than what the receptors can accept can cause excess progesterone to convert to cortisol leading to other concerns. Persistent progesterone can down regulate certain progesterone receptors necessary for normal functions. Women who have healthy adrenals should maintain the natural ovarian cycle and replace progesterone when the cells have been maximally primed for it. There are no long-term studies to compare static dosing vs. rhythmic dosing.
However, until rigorous long-term studies are performed it is logical and scientifically sound to reproduce and replace what the brain and ovaries have produced in their healthiest years. Some women feel well on progesterone throughout the month. These women are likely to have compromised adrenal function. There is more than one way of dealing with stressed adrenals, but as with most such cases in advanced medicine it is better to address the underlying cause.
2. Is it reasonable to keep the blood hormone levels within the reference range levels of healthy fertile women in their late 20’s-early 30’s?
Low dose P4 can’t be accurately measured in serum at this time. The salivary standards currently used were specifically designed by the lab working with Dr. John Lee at the time to justify his dosing premise of “Estrogen dominance” aka, lack of progesterone, in peri and post menopausal patients and not as an accurate baseline in healthy young women. Serum levels of young fertile women have been recorded for decades which are the case for using serum levels to monitor.
On cyclic hormone therapy appropriate labs and a detailed history and review of systems should be measured every three months during the first year to ensure therapeutic symptomatic and physiologic optimums are achieved. Using suboptimal dosing may produce suboptimal results without knowing or experience best results possible. It is important to keep in mind that what is topically applied is not all absorbed. In clinical practice when I have tried to wean women off Premarin and start topical standard pharmaceutical transdermal estrogen, the patients could not tolerate the symptoms and requested to be put back on the Premarin. The topical estrogen was not absorbing well enough, nor a high enough dosage to produce the same effects as the oral premarin.
3. Why only give E2 and not combinations such as Biest and Triest?
The estrogen produced by the human ovaries is estradiol. Some estrone is produced from the conversion of androgens from the adrenal glands and from fat stores for the postmenopausal woman. Estrone is also converted from estradiol. Whatever limited data there is on estrone indicates that estrone is the least favorable estrogen. There is no logic in supplementing it. Estriol is a non-reversible metabolite of both estradiol and estrone. Estriol may have beneficial effects in the urogenital system (bladder and vaginal tissues). Estradiol eventually converts into estriol; so there is no point of supplementing the metabolite.
4. Why is biomimetic or rhythmic dosing better than giving E2+P4 days 1-28 and stop for a few days?
Static, simultaneous dosing is the template of Big Pharma’s synthetic PremPro, which has been proven by the Women’s Health Initiative Study to be very dangerous on many levels. Administering estrogen and progesterone, even bio-identical compounds, in a static non-mimetic dosing schedule is not physiologic in healthy, fertile women. Some physicians recognize the need to have some fluctuation in the course of a month. Until we have the long term studies to show which pattern is most beneficial, it seems most reasonable to stay with nature’s pattern, the one that occurs in the healthiest years. By giving static doses of hormones we are not allowing optimal progesterone receptors to be produced which results in inadequate cell apoptosis and a higher chance of breast cancer initiation and recurrence. There is data showing that chronic administration of progestins will down regulate specific P4 receptors.
5. What about the risk of breast cancer on cyclic hormone therapy?
Julie Taguchi, an Oncologist in Santa Barbara is active with clinical oncology research through UCLA, and is an associate professor of clinical medicine with USC. She has shown, based on a small observational study within her own practice, that women have better quality of life without an apparent significant increase in recurrence or new breast cancers. Long term data with large numbers of patients is not available but is needed to accurately evaluate the risk of breast cancer or recurrence. Unfortunately, this is unlikely to happen in the current medical practice. Many physicians are reluctant to help women based on the lack of data but soon realize that women are less reluctant than their physicians to be on cyclic hormone replacement therapy because it makes sense. Once a woman starts to feel better, she will do anything to continue feeling that way.
6. What are the rates of “compliance” on cyclic hormone therapy?
Great, due to the fact they get results.
7. Women may not like getting a period again?
The uterus is a barometer, indicating how the rest of the body is functioning. A normal menstrual cycle indicates to the brain that the body is fertile, which is an optimum state of health. To have a uterus and be on hormones and not have a period just means lack of optimal function. We really do not know what the long term consequences of this are. Until long-term studies are done it is up to the patient and the physician to decide which approach to take. When women have hormones they have periods. When women are postmenopausal with little or no hormones, there are no periods. Something in between is not physiological or biological and is unknown.
8. Why is it important to maintain the youthful cycle?
During the years a woman’s ovaries are healthy, her body is in balance. Every system in her body is functioning and turning over at an optimal rate. Mind and body are at their best and she is fertile. This state of vitality and health is largely due to the intelligent rhythm that nature created. It is not fool proof, as we see in many women who have suboptimal ovarian function. The state of well being begins to decline as women approach menopause. Cycles become anovulatory, progesterone is deficient, estrogen levels wane and the hormonal rhythm and balance is lost. Several chronic diseases are now being attributed to low estrogen levels (arthritis, osteoporosis, cardiovascular disease, etc). By trying to restore nature’s rhythm we can approach the optimal function that healthy ovaries provide. Again, sex steroids are dose dependent in their results. We can’t really know the optimal amount or serum level of either estradiol or progesterone in a postmenopausal woman….since it is very little in a natural state.