A Women’s Hormonal Symphony

Pamela W. Smith, M.D., MPH

Center For Healthy Living
Copyright 2006
 Menopause
„ Hormone response is as unique to each
person as their own fingerprints.
„ Hormone replacement should not be
considered without a thorough
understanding of how all of the body’s
hormones interact with each other.
„ References can be found in:
„ Smith, P. “HRT: The Answers” 2003.
Menopause
„ The normal age to go through
menopause ranges from 35 to 55.
„ Therefore, a woman may live one half
of her life without a menstrual cycle.
„ Cycling after the age of 55 increases a
women’s risk of breast cancer.
Women’s Health Initiative
Program
„ The study was conducted on 16,000 women
who had not had a hysterectomy.
„ This government sponsored program halted
its study on estrogen plus progestin on July
9, 2002.
„ This was three years early because of an
increased risk of breast cancer in women
taking these hormones.
„ Analysis of the study also revealed that heart
attack risk began increasing in the progestin
group early in the study.
Results of Women’s Health
Initiative Program
„ The stroke rate was 41% higher in
women taking Prempro.
„ Women on Prempro had double the
rate of blood clots.
„ Women on Prempro had an increase in
breast cancer of 26%.
„ Women on Prempro had a 37%
decrease in colorectal cancer.
Results of Women’s Health
Initiative Program (Continued)
„ Women on Prempro had a decrease in
fracture rate of the hip of 33%.
„ Women on Prempro had a decrease in
total fracture rate of 24%.
HERS II
„ The results of the Heart and
Estrogen/Progestin Replacement Study
Follow-up (HERS II), agree with the
findings of the Women’s Health
Initiative Trial.
Synthetic HRT: Other
Problems
„ It is estimated that one-half of women quit
taking their synthetic hormone replacement
therapy after one year because they are
unable to tolerate the side effects.
„ Synthetic hormones waste energy by giving
incomplete messages to cells which then fail
to produce a balanced hormonal response.
Why Consider HRT

„ Relief of symptoms
„ Prevention of memory loss
„ Heart health
„ Bone production
„ Growth and repair
Hormones That Regulate
Growth and Repair
„ Insulin
„ Growth hormone
„ Testosterone
„ Estrogens
„ DHEA
Symptoms of Menopause

„ Hot flashes
„ Night sweats
„ Vaginal dryness
„ Anxiety
„ Mood swings
„ Irritability
„ Insomnia
„ Depression
Symptoms of Menopause
(Continued)
„ Loss of sexual interest
„ Hair growth on face
„ Painful intercourse
„ Panic attacks
„ Weird dreams
„ Urinary tract infections
„ Vaginal itching
„ Lower back pain
„ Bloating
Symptoms of Menopause
(Continued)
„ Flatulence
„ Indigestion
„ Osteoporosis
„ Aching ankles, knees, wrists, shoulders, heels
„ Hair loss
„ Frequent urination
„ Snoring
„ Sore breasts
Symptoms of Menopause
(Continued)
„ Palpitations
„ Varicose veins
„ Urinary leakage
„ Dizzy spells
„ Panic attacks
„ Skin feeling crawly
„ Migraine headaches
„ Memory lapses
Estrogen
„ Estrogen has 400 functions in the body,
including the following:
Functions of Estrogen
„ 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
Functions of Estrogen
(Continued)
„ 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
Functions of Estrogen
(Continued)
„ 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
Functions of Estrogen
(Continued)
„ 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
Functions of Estrogen
(Continued)
„ 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
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
Symptoms of Estrogen Excess
(Continued)
„ 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
Synthetic Estrogen (Premarin)
„ Estrone
„ Sodium equilin sulfate
„ Concomitant components
„ 17 alpha-dihydroequilin
„ 17 alpha-estradiol
„ 17 beta-dihydroequilin
Natural Estrogens
„ E1 called estrone
„ E2 called estradiol
„ E3 called estriol
Estrone (E1)
„ Is the main estrogen the body makes
postmenopausally
„ High levels many researchers believe
may increase a women’s risk of breast
cancer
Estradiol (E2)
„ 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
Estriol (E3)
„ 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.
Estrogen Metabolism
„ After menopause, the metabolism of
estrogen can change. Consequently a
women may respond differently to
estrogen replacement.
Estrogen Metabolism
„ Two major competing pathways
„ 2-OH estrone
„ 16-OH estrone
Estrogen Metabolism
„ One minor pathway
„ 4-OH estrone
2-OH Estrone
„ Good estrogen. It does not stimulate
the cell growth.
„ Blocks action of stronger estrogen
products that may be carcinogenic.
16-OH Estrone
„ Has significant strong estrogenic activity
and studies show it may be associated
with an increased risk of breast cancer.
4-OH Estrone
„ Studies show it may directly damage
DNA and cause mutations. Therefore,
it is proposed to enhance cancer
development.
„ Equine estrogens, such as Premarin,
increase metabolism into 4-OH
estrones.
How Can You Raise 2-OH
Estrone?
„ Moderate exercise
„ Cruciferous vegetables
„ Flax
„ Soy
„ Kudzu
„ Indole-3-carbinol taken as a supplement. Daily dose
is 200 to 300 mg.
„ High protein diet
„ Omega-3-fatty acids
„ B6, B12, and folate
There are two other factors that
affect estrogen metabolism
Obesity
„ Decreases 2-OH estrone and increases
16-OH estrone.
Xenoestrogens
„ There are 50 chemicals that imitate
estrogen that are toxic to your body.
„ Pesticides
„ Synthetic hormones fed to animals
„ Plastics
„ Cosmetics
Estrogen and the Brain
„ Increases blood flow
„ Increases glucose and oxygen to the neurons
„ Protects neurons
„ Increases neurotransmitters
„ Keeps the blood-brain barrier working
„ Increases sensitivity to nerve growth factor
„ Decreases neuronal generation of Alzheimer’s
beta amyloid peptides
Estrogen Replacement
„ Give transdermally
Estrogen Given By Mouth Can:
„ Increase blood pressure
„ Increase triglycerides
„ Increase estrone
„ Cause gallstones
„ Elevate liver enzymes
„ Decrease growth hormone
„ Increase carbohydrate cravings
„ Increase SHBG (decreases testosterone)
„ Interrupt tyrptophan metabolism and consequently
serotonin metabolism
SERMS
„ Tamoxifen (Nolvadex) and Evista
(Raloxifene)
„ Do not have the positive affects on the
brain as natural hormone replacement
does
Treatment
„ Compounded by a pharmacy
„ Dose is individualized
„ Physician can use any mix of biest (E2 and
E3).
„ Only method of obtaining E3
Progesterone
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
Synthetic Progesterone
„ Called progestins
„ Progestins do not reproduce the same
actions of natural progesterone
Side Effects of Progestins
„ Increases appetite
„ Weight gain
„ Fluid retention
„ Irritability
„ Depression
„ Headache
„ Decreases energy
„ Bloating
„ Breast tenderness
„ Decreases sexual interest
Side Effects of Progestins
(Continued)
„ Acne
„ Hair loss
„ Nausea
„ Insomnia
„ Interferes with the body’s own production of
progesterone
„ Does not help balance estrogen
„ Remains in the body longer
„ Can cause spasm of coronary arteries
Side Effects of Progestins
(Continued)
„ Stops the protective affects estrogen has on
the heart
„ May make the symptoms of progesterone loss
worse
„ Increases LDL
„ Decreases HDL
„ Protects only the uterus from cancer
„ Counteracts many of the positive effects of
estrogen on serotonin
Natural Progesterone Affects
Not Seen with Progestins
„ 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
Natural Progesterone
(Continued)
„ 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
Estrogen/Progesterone Ratio
Prolonged Use of Progesterone
Without Adequate Estrogen
„ Increases weight gain
„ Increases total cholesterol
„ Decreases HDL
„ Increases LDL
„ Increase triglycerides
„ Causes depression
„ Causes fatigue
„ Decreases libido
„ Increases insulin resistance
Treatment
„ Compounded progesterone as a cream
or as a capsule
„ If the patient has insomnia as symptom
then choose P.O. which affects the
GABA receptors
„ Prometrium-- advantages and
disadvantages
Testosterone
„ Increases sexual interest
„ Increases sense of emotional well-being
„ Increases muscle mass and strength
„ Helps maintain memory
„ Helps skin from sagging
„ Decreases excess body fat
„ Helps maintain bone strength
„ 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
Testosterone
„ Increases sexual interest
„ Increases sense of emotional well-being
„ Increases muscle mass and strength
„ Helps maintain memory
„ Helps skin from sagging
„ Decreases excess body fat
„ Helps maintain bone strength
„ 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
Causes of Low Testosterone

„ Menopause
„ Childbirth
„ Chemotherapy
„ Adrenal stress or burnout
„ Endometriosis
„ Depression
„ Psychological trauma
„ Birth control pills
„ HMG-CoA-reductase inhibitors
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 P.O. 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 metformin.
DHEA
„ Is a hormone made by the adrenal glands.
„ A small amount is also made in the brain and
skin.
„ DHEA production declines with age starting in
the late twenties.
„ By the age of 70 the body may only make ¼
of the amount of DHEA it made earlier.
„ DHEA makes estrogen, progesterone, and
testosterone in both women and men.
Functions of DHEA
„ Decreases cholesterol
„ Decreases formation of fatty deposits
„ Prevents blood clots
„ Increases bone growth
„ Promotes weight loss
„ Increases brain function
Functions of DHEA
(Continued)
„ Increases sense of well being
„ Helps one deal with stress
„ Supports the immune system
„ Helps the body repair itself and
maintain tissues
„ Decreases allergic reactions
Low DHEA can be due to:
„ Menopause/andropause
„ Decreased production
„ Stress
„ Aging
„ Smoking (nicotine inhibits the
production of 11-beta-hydroxylase
which is needed to make DHEA)
Replacement of DHEA can:
„ Increase muscle strength and lean body mass
„ Activate immune function
„ Increase quality of life
„ Improve sleep
„ Increase feeling of wellness
„ Decrease joint soreness
„ Increase sensitivity of insulin
„ Decrease triglycerides
„ Stop the damaging effects of stress
Dosage
„ Women are more sensitive to the
affects of DHEA and need less DHEA
than men.
Symptoms of DHEA Excess
„ Fatigue
„ Anger
„ Depression
„ Deepening of voice
„ Insomnia
„ Mood changes
„ Weight gain
„ Facial hair
„ Acne
„ Sugar cravings
„ Restless sleep
„ Irritability
Cortisol
„ Is the only hormone in the body that
increase with age.
„ Is made by the adrenal glands.
Functions of Cortisol
„ Balances blood sugar
„ Weight control
„ Immune system response
„ Bone turnover rate
„ Stress reaction
„ Sleep
„ Protein synthesis
Functions of Cortisol
(Continued)
„ Mood and thoughts
„ Influences testosterone/estrogen ratio
„ Influences DHEA/insulin ratio
„ Affects pituitary/thyroid/adrenal system
What Elevates Cortisol
„ Stress
„ Depression
„ High progestin intake
Consequences of Elevated
Cortisol
„ Decreased immune system
„ Increased osteoporosis risk
„ Fatigue
„ Irritability
„ Sugar cravings
„ Shakiness between meals
„ Confusion
Consequences of Elevated
Cortisol (Continued)
„ Low energy
„ Night sweats
„ Binge eating
„ Increased blood pressure
„ Increased cholesterol
„ Increased triglycerides
„ Increased blood sugar
Consequences of Elevated
Cortisol (Continued)
„ Increased insulin/insulin resistance
„ Increased infections
„ Thin skin
„ Easy bruising
„ Muscle weakness
„ Weight gain
„ Sleep disturbances
Abnormal Cortisol Levels Are
Associated With
„ Menopause
„ CFS
„ Fibromyalgia
„ Depression
„ Impotence
„ Anorexia nervosa
Abnormal Cortisol Levels Are
Associated With (Continued)
„ Panic disorders
„ PMS
„ Infertility
„ Sleep disorders
„ Osteoporosis
„ Heart disease
Adrenal Burnout
„ Cortisol and DHEA levels decline
Symptoms of Adrenal Burnout
„ Fatigue
„ Low blood pressure
„ Sensitivity to light
„ Insomnia
„ Digestive problems
„ Emotional imbalances
„ Hypoglycemia
„ Decreased sexual interest
Measurement of Hormones
„ Blood
„ Saliva
„ Urine
Summary
„ All of the hormones in the body are designed
to work together.
„ If one is altered, or deficient, it will affect the
actions of all of the other hormones.
„ Consequently, bio-identical, compounded,
customized hormone replacement is the only
way to achieve this balance.
„ One size does not fit all.