As a woman ages, she goes through a time in her life when several hormones decline. These include the three types of estrogen: E1 (Estrone), E2 (Estradiol), E3 (Estriol). Progesterone and testosterone also decline. This is called menopause and as the decline occurs, a woman often experiences several types of symptoms – some women have these feelings more than others. The symptoms most described include irritability, irrational behavior, a feeling of living in a fog, sleep problems, loss of libido, vaginal dryness and the infamous hot flashes. At this time of life, women tend to find it difficult to cope with problems and decisions that they used to handle well.

Replacing these hormones in a woman’s body, in a way that resembles nature, means attempting to achieve a balance of the five hormones in a way that is most like what her body was accustomed to at a young age, during the time in her cycle when she felt the best. Before describing how this is done, it is important to understand the following information.

ERT stands for “Estrogen Replacement Therapy.” For years this has been and still to this day, often refers to the use of “Premarin”, a pill first developed in the 1930’s. The name “Premarin” comes from the source of the estrogens in the pill which is the “pregnant mare’s urine.” These are estrogens that only vaguely resemble human estrogens. Many studies have been published using this type of ERT with and without Provera, a type of progestin which only vaguely resembles natural human progesterone. These two drugs were patented and are still sold at high prices. Human estrogen and progesterone (called bioidentical) cannot be patented and are less expensive. The studies with the non-human (horse) hormones showed some positive but also some concerning negative effects. These side effects have been unfortunately linked to all hormone replacement, but as you will read below, the human bioidentical hormones when used topically have lower risks.

One of the effects is increased clotting that can lead to a higher risk of blood clots in the legs and lungs in addition to increased risk of heart attacks and strokes. When any estrogen pill is taken by mouth, it has to go through the liver and in doing so, the blood clotting proteins are affected and the triglyceride levels in the blood rise. Studies have shown that this does not happen when hormones are provided to the body through the skin (topically). Risk of clotting, heart attack and stroke does not increase with topical hormones (creams or patches). It is important to understand that every individual woman has her own baseline risk of these things happening – that is, a blood clot, heart attack or stroke can happen whether you use topical hormones or not, based on one’s own risk but studies have shown that when used on the skin, these hormones do not change that risk.

Another very important concern about using any estrogen, whether it is by mouth or topically is that estrogen will increase the risk of breast cancer. This is a real concern. The studies using Premarin show there is a mild increase in a certain type of breast cancer and breast cancer survivors with receptors positive for estrogen receptors are usually told to take medication that act “against” estrogen. Studies with topical estrogen and their association with breast cancer have not been done and are needed, but it is well known that there are many breast cancer survivors who use bioidentical hormones safely, if used with human progesterone. (See below re progesterone.)

It is important for any woman to know that, in New Jersey, one in eight women get breast cancer whether they use hormones or not. There are many causes of breast cancer – or any cancer for that matter – and the toxins in our environment (including from smoking) are the biggest culprits.

The use of progesterone creams with the estrogen creams also needs to be studied. Women who take estrogen by mouth or use it on the skin may complain of breast growth and tenderness. Fibrocysts may develop or worsen. Just as estrogen stimulates the growth of breast cells, progesterone “modulates” this and limits the growth leading to the natural death of cells helping to prevent this tenderness, growth of fibrocysts and breast cancer. Breast tissue needs this to remain healthy and there are many breast cancer survivors who are doing well on hormone replacement keeping their breasts healthy using estrogen and progesterone together. There are many and varied opinions regarding this issue in the medical community and the literature. Many doctors do not realize that there are many studies regarding the breast cancer preventive effects of progesterone.

There is more agreement on the fact that progesterone is needed for healthy cycling of the uterus when estrogen is used. When a woman still has her uterus, the estrogen builds up the blood lining of the uterus and progesterone leads to the natural death of cells and to the loss of the lining causing uterine bleeding through the vagina. This is a frequent side effect for women with a uterus who take hormones. Many women will tolerate this bleeding, but it can become a problem when it is unexpected and/or heavy. Sometimes the bleeding is rare, occasional and light. This is called spotting or breakthrough bleeding.

Anyone who decides to replace estrogen, testosterone and progesterone (those hormones that are identical to the human hormones that were in her body before menopause) must weigh the above risks and side effects against the benefits.

And so, if there are so many possible side effects, what are the benefits?

Estrogen affects almost every organ and tissue in the body, helping them stay flexible and young. These include the skin, bones, blood vessels, breasts, uterus, urinary tract, liver and even the brain.

The book, Ageless, by Suzanne Somers, says it well:

Hormones have a powerful influence on your body and on how you feel. They are the body’s way of communicating chemically among the cells, effectively telling them what to do. Your hormones affect virtually every function in your body. Without hormones you cannot sleep, you can’t think clearly, your health deteriorates, your weight goes out of control, your sexuality diminishes, your skin gets sallow and dry, your hair loses its luster, your eyesight diminishes, your body temperature becomes impossible to regulate, and on and on and on. Without hormones you slowly die, and the picture is not pretty. As a society, we have accepted sleeplessness at night as part of aging. We have accepted dry skin, thinning hair, wrinkling, bone loss, foggy thinking, heart problems, and cancer as normal when we get older. In essence, hormones affect everything we do. From the minute we are born, our hormones play a major role in how we grow, age, and die.

Bioidentical hormones have many and varied benefits. The frequency and intensity of hot flashes decrease and these symptoms ultimately disappear. Fatigue is replaced with energy. Deep and effective sleep replaces insomnia. The body’s weight normalizes when associated with a healthy low-carbohydrate diet. Sex drive and vaginal moisture returns. Skin tone improves. The memory and mind clears while mood evens out and ability to handle problems and make decisions improves. Progression toward heart disease and osteoporosis (bone loss) stops. The immune system also becomes better able to fight off infections.

The doses of each of these hormones may need to be adjusted depending on each woman’s symptoms and needs.

For an entire program of health and disease avoidance, it is important to understand that bioidentical hormone replacement is only one part of a complete plan of caring for your body. Other parts include:

• Exercise
• Healthy diet, with avoidance of refined and processed foods
• Nutritional supplements, including natural sea salt with minerals
• Probiotics
• Toxin Avoidance, including the toxins – smoke, nicotine and non-nutritive sweeteners
• Stress Management
• Effective Sleep