Estrogen

In light of 7/9/02 breaking news re: Hormone Replacement Therapy (HRT) in America, I feel compelled to respond. Premarin (which is pregnant mare's urine-horse estrogen) is too strong and carcinogenic. Integrative medical physicians have known this for years and prescribe differently. And Provera which is synthetic progesterone, not real progesterone, not only causes cancer but most women get bloated and depressed. Usually, we are already there, we do not need to be pushed off the cliff. But the main problem with synthetic Progesterone is that it constricts coronary arteries, and heart disease is the number one cause of death in women.

Medical doctors who are trained by European endocrinologists prescribe differently.  They prescribe In a way that resolves the multitudinous symptoms of hot flashes, night sweats, temperature dysregulation, loss of libido, vaginal dryness, difficulty achieving orgasm or decreased intensity of orgasm, depression, weight gain, mood swings, irritability, memory loss, hair loss, myalgias (muscle pain), fibromyalgia, insomnia with difficulty getting or remaining asleep (or both)...you know the list. Natural HRT is biochemically identical to the hormones you were making in your thirties, given in low doses (not every women needs estrogen, some would rather not live without it), monitored by hormonal testing (blood draw), and tailored.

So what we have is astounding lucid confusion. Women usually expect their gynecologists to be specialists in HRT. Gynecologists are surgeons, and are trained as such. Women intuitively know they need hormones but fear cancer. Let me be the first to tell you that estrogen alone does not cause cancer. However, the type of Estrogen we are trained to prescribe is carcinogenic. The package insert tells us. But, even if you are not taking synthetic estrogen, you are filled with estrogen. Estrogen is stored in the fat cells in the form of estrone. And the environment and our food supply is filled with estrogen and other hormones - some called xenobiotic estrogenic compounds (bad estrogen).

An interesting aside is that we are taught to prescribe 0.625 mg. of Premarin to all women, regardless of their size. And, hormone levels are never drawn. What blood levels are almost always brought to a first consultation is FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone). These levels get real high during perimenopause and menopause.

The minimum blood workup is Estradiol, Estrone, Progesterone, Free Testosterone (yes, you probably need a VERY low dose), DHEA-S, Free T3 , Free T4, reverse T3, TBG (Thyroid Binding Globulin) Antithyroperoxidase Abs, Antithyroglobulin Abs, and SHBG (Sex Hormone Binding Globulin).

When these results arrive, if a woman is perimenopausal (still menstruating, but irregularly), there is often an Estrogen dominance. Progesterone is the first hormone to take a nose dive. FYI, some women are in perimenopause for a decade. Menopause is defined by not menstruating for twelve months, and an elevated FSH and LH.