The symptoms of peri-menopause and menopause are due to declining estrogen levels, declining levels of progesterone, testosterone, and DHEA; and a resulting imbalance in these hormones. We recognize that an imbalance occurs between the types of estrogens. Although estradiol levels decline, estrone levels decline much more slowly, resulting in more estrone than estradiol. These hormones are enough to cause concern about the development of breast cancer, the ratio of the hydroxyestrones (Estrogen metabolites) becomes a more important factor during this stage of life. Some hydroxyestrones (4-hydroxy- and 16-alpha-hydroxyestrone) may promote cancer, while
seems to prevent it.
As I mentioned in one previous article, Progesterone declines more rapidly than these estrogens, resulting in a phenomenon called estrogen dominance. This transfer in dominance of estrogen over progesterone that occurs with aging causes a decrease in fertility and the ability to carry a pregnancy to term. Estrogen dominance causes fatigue, depression, thyroid malfunction, fluid retention, and fat storage, resulting in weight gain. The phenomenon of estrogen dominance is aggravated by environmental exposure to pesticides and obesity.
The lack of estrogen is not the only concern during peri-menopause and post-menopause. Balance is key to best possible therapy. The Imbalance between progesterone and the estrogens (E1, E2, and E3) contributes to the symptoms. Declining testosterone, pregnenolone and DHEA may need to be replaced. Laboratory testing of hormone levels is recommended because some women continue to make adequate amounts of certain hormones while deficient in others. For the best management of the menopausal years, a physician well versed on this topic should evaluate the symptoms of the woman and correlate these symptoms with blood, saliva, and/or 24-hour urine levels of the hormones.
These natural hormones are biologically identical to the hormones made in a woman's body rather than to those isolated from pregnant mare urine or synthesized in the laboratory. These hormones are all natural because they occur in the human body. The doses are titrated to an individual's needs, using the minimum amount required to accomplish the treatment goals, using the symptom profile score, blood, saliva, and/or 24-hour urinary excretion levels.
A personalized compounded formula of the hormones is prescribed based on the individual's needs. A re-evaluation should be done in 60-90 days. The compounded formulation can be in a cream, patch, troche, or oral dosage. We have noticed that individual responses to these compounded medications vary from patient to patient and adjustments must be made. That's why these follow-ups are very important. Some of our patients will respond with alleviation of symptoms in weeks, while others may take months. Some individuals may never reach the optimal blood hormone range, but show a relief of menopausal symptoms. Some physicians may choose to use an oral form of estriol, a weak estrogen, and a natural progesterone cream at the onset of menopause because estriol is considered to be the safest form of estrogen. Studies suggest it might help prevent breast and other cancers (Head 1998; Takahashi et al. 2000a,b; Granberg et al. 2002). However, estriol is often not strong enough to prevent osteoporosis on its own and it may not relieve hot flashes.
Prescription cream (or gel) we prepare, can include estrogens and/or testosterone that has been shown to be sufficient. Some estrogen creams contain 100% estriol, while others have varying percentages of the more potent estradiol and estrone forms in addition to estriol. Some popular prescription estrogen formulas are called BiEst or TriEst. BiEst consists of estradiol and estriol. TriEst consists of estradiol, estriol, and estrone in a ratio of 80% estriol to 10% each of estradiol and estrone.
A popular combination is a specially prepared BiEst formula that contains 80% estriol and 20% estradiol. This combination is recommended because fat cells, the liver, and to some extent the adrenal glands continue to make more estrone than estradiol during menopause.
Estrone is less desirable because it is cancer-promoting and tends to be naturally present in higher quantities relative to the other two estrogens during menopause. However, a saliva, blood and/or 24-hour urine test can aid a physician in optimizing your personalized prescription. The goal is to relieve symptoms and prevent bone loss with as little risk as possible.
At S&P; Prescription Compounding Services, Our pharmacists work with the physician in obtaining the appropriate therapy to relieve hormonal deficiencies. We also recommend dietary and lifestyle factors that increase circulating levels of 2-hydroxyestrone include ingestion of cruciferous vegetables or extracts (Auborn et al. 1998), supplemental
(Bradlow et al. 1995a; Rosen et al. 1998), supplemental lignans found in flaxseed (Haggans et al. 1999), isoflavones in enriched soy (Lu et al. 2000), omega-3 and omega-6 fatty acids in fish oils (Osborne et al. 1988), a high-protein diet (Anderson et al. 1984), and an athletic lifestyle. These items are also readily available through our pharmacy.
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