Estrogen occurs in our bodies in 3 forms: estradiol, estrone and estriol. Estradial is the most potent form of estrogen. Estrone and estradiol cause most of the risks associated with estrogen use. Estriol which has the weakest estrogenic effect has many benefits. Treatment involves giving estradiol alone or with estriol in a ratio 80% estriol/20% estradiol. Recent research has been very promising for estrogen replacement therapy (ERT). A recent Danish study found, women beginning estrogen therapy at menopause have had significantly reduced risk of mortality, heart failure, myocardial infarction, cancer, stroke and blood clots. To add, early initiation and prolonged hormone replacement therapy did not result in an increased risk of breast cancer or stroke. Bio-identical estrogen replacement now appears to be most effective when replaced at menopause. Breast cancer and hormone replacement is the area where the most confusion lies. A study on 80,377 postmenopausal women found no increase or decrease in breast cancer in women on bio-identical estrogen and progesterone.A Women’s Health Initiative researcher stated, “Being obese, not exercising or excess alcohol consumption confers higher absolute risks for breast cancer than HRT use. ”
New research shows that hormone therapy taken soon after menopause has widespread beneficial effects on the brain. In women who took hormones before age 65, dementia risk was reduced by almost 50%. However, HRT begun after 65 slightly increased risk of dementia in this study. Estrogen has been shown to protect the brainfrom oxidative stress, ischemic injury and damage by amyloid protein (the protein associated with Alzheimer’s) ERT was found to regulate serotonin pathways in the brain, decreasing serotonin breakdown. Serotonin being the neurotransmitter involved in both moods and sleep. Therefore estrogen can act as an antidepressant, and sleep aid. Research has also shown that among women over 65 those that have taken ERT perform better on cognitive tests. Estrogen increases acetylcholine which is critical to memory and markedly reduced in Alzheimers.
We now know that cardiovascular diseases affects more women than men and is responsible for more than 40% of all deaths in American women. For every 1 women who dies of breast cancer, 10 die of heart disease. Researchers have connected this pattern to decreasing levels of estrogen during menopause. In 2008, results of a Danish study—the largest since the WHI study—showed that how and when women take HRT may affect their risk of heart attack. During a 6-year period, researchers looked at almost 700,000 healthy Danish women aged 51 to 69. Results of the Danish study showed that there was no increased risk of a heart attack in women who were currently taking HRT compared with women who had never taken HRT. Estrogen with progesterone actually resulted in a reduced risk of heart attack compared to women who had never taken HRT. Numerous studies have shown a 40-50% reduction in cardiovascular morbidity and mortality with hormone replacement therapy in women. The mechanisms involved are: 1) Improvement in arterial function independent of lipid effect. 2) promoting vasodilation 3) Lowering blood pressure 4) Faster repair of vascular wounds 5) Lowering fibrinogen levels which decrease coagulation 6) Decreasing inflammation.
Other benefits of ERT include; epidermal hydration, improved skin elasticity and skin thickness, reduced skin wrinkles, and osteoporosis protection. Vaginal estriol replacement improves both incontinence, vaginal dryness, and has been shown to reduce recurrent urinary tract infections by 91%. A review of 12 studies determined intravaginal estriol did not cause endometrial proliferation and is not associated with an increased risk of uterine cancer.
Estrogen routes of administration should be via the skin as oral estrogen is associated with increased C-reactive protein ( a marker for inflammation), increased triglycerides, elevated liver enzymes, increased gall bladder disease, increased risk of blood clots, and lowered growth hormone levels.
Estrogen metabolism is another factor to consider if desiring estrogen replacement. We know there are genetic and acquired defects in the estrogen metabolism process. Testing can identify whether estrogen is being metabolized into the harmful forms of estrogen. Genetic polymorphisms (mutations) may impair estrogen detoxification. MTHFR and COMT are both methylation markers that should be checked if patients have familial risk factors such as fibroids, hormonal cancers, and endometriosis.
Many plants contain phytoestrogens which have an estrogen-like effect in the body and can be used if menopausal symptoms are mild. The highest phytoestrogen containing plants are: soy beans, red clover, flax seed and maca, however many foods eaten have safe estrogenic properties.