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Tag Archives: estrogen
June 17, 2017 : looking back hardly a day or two goes by since this year began when a question about medical marijuana or as we call it out here “marijuana” and what is going to happen next July when it becomes real is asked. Last month I was asked by a group of Nurse Practitioners to present on a topic I rarely speak about but fill prescriptions for often – BioIdentical Hormone Replacement Therapy. I like to use the term supplement instead of replacement but it really made me think about the tough upward climb this category has had and continues to have based on a few position statements from such groups as SOGC and NAMS.
Looking at the marijuana issue, never before have we seen a couple of ingredients leap onto the potential healthcare market with the claim to relieve or cure so many, many health issues. Never before have so many N of 1, anecdotal reports driven an entire category of mostly unproven therapies. Granted there are some valuable uses of the drug that have been used for years but many have been very overblown with the main selling point of “no one has died”.
Turning to my upcoming presentation, I started mulling over the studies that have shown for years the benefits and limitations of all types of hormone therapy that I have collected and still continue to collect on the topic. Speaking to the public on a subject is different than talking to medical professionals. I speak to both groups all the time on all topics. To narrow down an hour worth of meaningful, compelling, convincing data that flows easily on a medical treatment that is foreign to a professional group so that you don’t lose them is daunting.
If I present on a topic I have a clear conflict of interest with such as this, I always open with that and some literature from the other side of the argument. There is no problem here with BHRT as lots of naysayers exist. In truth, I have found there are as many cases of overblown promises with BHRT and there are complete opposite downplay of any proven benefits and exaggeration of adverse effects. A segment from Climacteric from just this year was the best I could find that slammed this type of therapy over a dozen sentences. We now see less of an issue with the term BioIdentical, since estrogen and progesterone are both found in the commercial prescription drug industry in Canada more and more in a bioidentical form, especially since the Women’s Health Initiative Study over a decade ago that effectively stopped conjugated equine estrogen and medroxyprogesterone acetate from being dispensed overnight. So at least Big Pharma has caught up with compounding in some ways.
I continue in my talk to disprove the issues just laid out from the climacteric slide: that hormones do pass predictably through human skin and give resultant increases in the body (given the correct fluid is tested), that the stability of the hormone in the right base is predictable, that saliva testing is legitimate and useful in showing levels of active hormones (especially for topically applied hormones), and that all hormone therapies have benefits and risks associated with them, regardless of what hormone therapy that entails.
Given the criticisms the WHI received, one thing we did find from the CEE/MPA regimen was the decrease in fracture risk. With the older average age of the subjects in that study and the lack of topical hormone or actual BHRT used, there is very little to pull from that study for this talk. There are however many studies that can and do show the benefit of BHRT. Most of these are smaller studies than we are used to in the prescription world. One point to take away though is we have seen a top seller in our prescription market fall away to nothing and the public is looking at us and asking how could we be so wrong all these years about something that was so blatantly clear in a study that it cut the study short? Evidence slowly grows on bioidentical hormones but is showing even to our commercial drug industry that it is a safe benefit.
The International Journal of Pharmaceutical Compounding published a three part study on the topic of BHRT. In this small study, surveys were given to women on HRT. The response rate was 70 on BHRT and 53 on synthetic hormone therapy. Each survey consisted of 15 questions that probed such topics as symptom relief, reasons for starting hormone therapy, side effects, age of starting therapy and type of therapy. In the areas of hot flashes, night sweats, sleep quality, dry skin/hair, vaginal dryness, foggy thinking, mood swings and decreased libido, bioidentical therapy outperformed synthetic therapy in all counts. In side effects from therapy, bioidentical was preferred over synthetic for side effects like difficulty sleeping, weight gain, breast tenderness, bloating, upset stomach, breakthrough bleeding, foggy thinking, mood swings and leg pain. Drowsiness occurred more frequently with bioidentical than with synthetic.
A huge concern with bioidentical and compounded hormones is the threat of cancer in hormone therapy. In 2008 a study that looked at over 80,377 post menopausal women, 2354 of them developed invasive breast cancer. Compared to the women that never used HRT, estrogen alone therapy was associated with a 1.29 fold relative risk, 1.69 with estrogen/progestagen and a relative risk of 1 with the estrogen/progesterone women.
In other studies we have seen the benefits from BHRT in areas of insulin resistance, blood pressure, lipids, endothelial function, arteriosclerosis, thrombotic risk, and neuroprotection. More and more we are seeing studies unfolding showing not only is BHRT a healthy and safe option for women of all ages but is also brings quality of life to these patients that they have lost since the Women’s Health Initiative Study came out. Saliva testing for topicals is also shown to be useful as topically applied hormones aren’t reflected in blood draws like oral is. Oral hormone therapy has shown itself to be an unhealthy route for women and topical application has proven itself to be the preferred choice longterm.
So yes, thank you Marijuana, or more correctly CBD:THC. Your very sudden rush to the market has been touted for virtually every medical issue going right now. There are definite benefits in areas such as pain, perhaps PTSD (and a few others) but completely untested and unproven “benefits” in so many other areas. It has shown us that there are areas like BHRT that we’ve been told we had zero proof for but really do have volumes of proof when we compare it to the complete lack of proof in marijuana for many of the areas it is being used for.
Orozco ,P. et al. Salivary Testosterone is associated with higher lumbar bone mass in premenopausal healthy women with normal levels of serum testosterone. European Journal of Epidemiology 16:907-912,2000
Wright, JV. Bio-Identical Steroid Hormone Replacement. Selected Observations from 23 years of Clinical and Laboratory Practice. Ann.N.Y.Acad.Sci. 1057:506-524 (2005)
Hofling, M, MD et al. Testosterone inhibits estrogen/progestogen-induced breast cell proliferation in postmenopausal women. Menopause:The Journal of The North American Menopause Society. Vol 14, No.2, pp 183-190
Holtorf, MD. The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol,Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgraduate Medicine, Volume 121, Issue 1, January 2009
Schwartz, E.T. MD. Hormones in Wellness and Disease Prevention: Common Practices, Current State of the Evidence, and Questions for the Future. Prim Care Clin Office Pract 35(2008) 669-705
Deleruyelle, LJ. Menopausal Symptom and Side Effects Experienced by Women Using Compounded Bioidentical Hormone Replacement Therapy and Synthetic Congugated Equine Estrogen and/or Progestin hormone Replacement Therapy: Part 3 . International Journal of Pharmaceutical Compounding Jan/Feb 2017 pp 6-16
Stephenson, K. MD FAAFP. Salivary Hormone Profile. International Journal of Pharmaceutical Compounding vol 8 no 6 November/December 2004
Wepler, ST. A Review of Bioidentical Hormone Replacement Therapy. International Journal of Pharmaceutical Compounding Vol.6 No.2, March/April 2002
Lets just jump to the main recommendation: reduce your estrogen dominance and eat more fiber. As a pharmacist I see the problem of gall bladder issues A LOT. Every day it seems there is someone out there waiting for an appointment with the specialist to further evaluate the problem. The symptoms include:
- Pain or tenderness under the rib cage on the right side
- Pain between shoulder blades
- Stools light or chalky colored
- Fatty stools
- Indigestion after eating, especially fatty or greasy foods
- Burping or belching
- Feeling of fullness or food not digesting
- Diarrhea (or alternating from soft to watery)
- Constipation or frequent use of laxatives
- Headache over eyes, especially right
- Bitter fluid comes up after eating
- Constipation or frequent use of laxatives
Unfortunately the stress of experiencing gall bladder issues is intensified when the patient thinks they are having a heart attack. Of course it is important to determine that this is not happening so close investigation of the symptoms and pattern are important as is followup with your doctor.
So why reduction of estrogen dominance so key in dealing with your gall bladder and what is estrogen dominance anyway. While we’re at it, what is the gall bladder for in the first place? The gall bladder is a small thumb sized hollow organ located under the liver. It’s main job is the storage of bile or gall which is produced in the liver. In response to a fat containing meal, the gall bladder releases bile into the intestines and with the help of pancreatic enzymes, emulsifies the fat for absorption into the bloodstream. This is quite a simplified description but basically this is what this organ does.
It takes just a simple understanding of plumbing to understand what causes a gall bladder to act up: constricted flow and thickened secretion. What causes the flow to constrict? Well it turns out that estrogen dominance, a common topic of discussion with me results in a constriction of the Sphincter of Oddi, which controls the flow of bile out of the gall bladder. Estrogen dominance is an imbalance between the amount of estrogen compared to progesterone in your body, and just in case you’re a guy and think this doesn’t apply to you, the truth is you most likely have estrogen dominance as well. How do you know if you have it? Well for men,
- Prostate enlargement – benign prostate hyperplasia / hypertrophy (BPH) and the risk of prostate cancer.
- Urination – difficulty, increased frequency. Constricted urethra.
- Erectile dysfunction.
- Low libido.
- Adiposity (fat build-up) and the redistribution of fat. Estrogen stimulates the production of fat cells. However, fat cells also make a small amount of estrogen, causing a vicious cycle.
- Muscle development reduced.
- Body hair reduced.
- Veins become less prominent.
- Breast growth (man boobs).
- Sweat and body odour changes.
- Skin thinning.
Estrogen dominance in women,
- Mood swings, depression, irritability, anger, forgetfulness, inability to focus thoughts, panic attacks.
- Aches and pains, sore bones.
- Disrupted periods. Early, late, high/low blood flow.
- Low energy.
- Weight gain. Fat tends to deposit around the hips, abdomen, and thighs. Estrogen stimulates the production of fat cells. However, fat cells also make estrogen and so a vicious cycle starts.
- Low libido.
- Headaches or migraines.
- Decreased thyroid function (low body temperature and sometimes thinning hair).
- Fluid / salt retention, bloating (oedema) or weight gain due to fluid retention.
- Weak bladder control.
- Fibromas (fibroid tumours).
- Heart palpitations, chest pains.
- Food cravings.
- Insulin resistance / poor blood sugar control / hypoglycaemia.
- Blood clotting, reduced blood vessel tone.
- Breasts. Cyclical breast tenderness – tender or painful, feeling fuller or swollen, particularly in the pre-menstrual week. Use of progesterone cream on days 12 -26 of the menstrual cycle will balance the estrogen dominance. It usually takes three months of use to cure this problem.
- Cancer – increased risk of endometrial or breast cancer.
- Fibrocystic breast disease. Non-cancerous changes and lumps in the breast tissue. They can cause discomfort, varying in relation to hormonal influences from the menstrual cycle. Fibrocystic breast disease affects 30-60% of women.
These are pretty typical symptoms but they often go hand in hand with gall bladder inflammation. So how to you treat this estrogen dominance and allow your progesterone to relax the sphincter that may be causing the gall bladder associated pain? Well it turns out progesterone cream is perfect for both men and women. Also effective is zinc which blocks the conversion of testosterone to estrogen in both men and women. Lowering the fat content in your body will help also as this is the main source for this conversion. Other things can help like avoiding external sources of estrogen, or xenoestrogens in the environment that act like estrogen when introduced to your body. These include herbicides, pesticides, fertilizers, plastic drinking bottles, and heavy metals. Eating organic food and using organic products in the home can help with the avoidance of such ingredients. Supplements like Calcium-d-Glucarate, DIM and I3C also help to lower estrogen dominance symptoms as does exercise. Another great way to lower estrogen dominance is through the use of fiber. Fiber not only helps with gall bladder discomfort by decreasing estrogen and therefore estrogen dominance, it also helps to prevent the recirculation of cholesterol that is used in bile production.
A big problem with ongoing bile problems is the production of biliary sludge, a noticeable thickening of the bile with crystals of cholesterol monohydrate crystals and calcium bilirubinate granules. These can come together to form gallstones but even without that action the thickened bile makes for restricted flow of the bile through the bile duct. This is reminiscent of what happens in a sinus infection, thickening secretions obstruct flow and increased bacteria (in the case of the gall bladder, E.Coli, Klebsiella and enterococcus) result causing inflammation. There is a close relationship between the gall bladder and the bacteria in the intestines and these bacteria can work there way backward to the gall bladder when the Sphincter of Oddi is relaxed, but the “precipitating” factor is the sludge production.
Try reducing estrogen dominance and above all increase your fiber. These will help with many more issues than just gall bladder. Food sensitivities also can increase the incidence of gall bladder attacks so finding the offending agent with the appropriate test can help tremendously.
This is one of the most common conditions I see, and not just in women. Estrogen dominance is not necessarily an overload of estrogen, it’s an imbalance between estrogen and progesterone, which effectively does everything the opposite to estrogen. There are many reasons estrogen dominance occurs. The main reason is the constant exposure to environmental compounds that act like estrogen in the body. Continue reading