What is hormone replacement therapy (HRT)?
The use of exogenous hormones to achieve physiologically active levels in the body. What the heck does that mean?! It means using hormones from an external source to top up your own hormone levels. There are two main types of hormone replacement, classic hormone replacement therapy (HRT) and bio-identical hormone replacement therapy (bHRT). Bio-identical hormones are hormones that have the same chemical structure as the hormones our bodies make naturally. They act the same way in the body as our own hormones, easily binding to the same receptors and activating the same pathways. They can be derived from nature or they can be made in a lab. Classic hormone replacement therapy is the use of synthetic non-bioidentical hormones. Examples are Premerin, Progestins, and hormonal birth control. The traditional model mostly uses the synthetics non-bioidenticals, with a few exceptions such as Synthroid. Hormones I commonly prescribe and their ideal forms are as follows:
- Thyroid -oral Liothyronine, Levothyroxine, natural desiccated thyroid
- DHEA- sublingual, micronized, & topical
- Testosterone – injections, creams & gels
- Progesterone- creams & oral
- Estrogen- vaginal suppositories, creams, patch
- Oxytocin- nasal spray, sublingual
- Cortisol- cream, oral
- Pregnenolone – cream, oral
Today we will largely discuss estrogen and progesterone replacement therapy, their health risks and benefits.
Does taking hormones cause cancer?
This is a huge concern for patients, and for good reason, we hear it from our primary care physicians all the time, “oh your taking hormones, you know that causes cancer!”
This idea was perpetuated after the Women’s Health Initiative study came out in 2002. This study enrolled over 160,000 healthy post menopausal women to investigate the use of hormone replacement therapy (HRT). They found an increase risk of breast cancer and cardiovascular disease. So yes, taking oral synthetic estrogens and progestins is linked to an increased rate of cancer. This does not mean taking bio-identical hormones or having healthy hormone levels causes cancer. Here is what you need to know about this study:
They used synthetic oral estrogens- Conjugated Equine Estrogens (CEE) similar to Premarin, and oral synthetic progestins (NOT PROGESTERONE).
Now lets keep this in mind as we review the facts.
Bio-identical hormones are not the same as synthetic hormones
Conjugated equine estrogens (CEE) like Premarin and progestins like Prempro, or other oral synthetic hormones like the birth control pill are not bio-identical. They don’t fit into the receptors the same, they are not metabolized in the body the same, and as a result they create more inflammation and other negative side effects. Synthetic hormones waste energy by giving incomplete messages to cells which then fail to produce a balanced hormonal response.
If natural hormones caused cancer then every man and women in their prime would be riddled with cancer. As you know most of us feel the best in our prime, young men in their 20s with peak testosterone levels, women in their menstruating years with healthy amounts of estrogen and progesterone cycling through our bodies the way nature intended. Unless of course you’re on hormonal birth control then you do not have natural hormonal rhythms. It’s when hormones get out of balance that we see a rise in prostate cancers (increased rate in men over 50), breast cancers (increased rate in menopausal women), and decreased quality of life, lower libido, hot flashes, night sweats, moodiness etc.
We feel the best when we have healthy hormones, and have better markers for health. Why is this? Because our natural hormones have very beneficial effects in the body. Bio-identical hormones mimic our bodies natural hormones, and there are no studies that link bHRT to any kind of cancers. But this is not to say they are not with out risk, or that more research is not warranted. The type of hormone, the mode of delivery, and your bodies way of processing all influence the risk/benefit profile. Lets dive a bit deeper to discuss this.
How you Break Your Hormones Down Matters
When looking at getting hormone replacement therapy the form of estrogen makes a difference in its safety and efficacy profile. Also how your body naturally breaks down estrogens plays a role in your risks for osteoporosis, estrogen sensitive cancers and dementia. Our body produces three different types of estrogens that have different effects in the body, both protective and carcinogenic.
- Higher amounts after menopause
- Some metabolites are carcinogenic
- Estrone metabolites include:
- 4-OH Estrone: very carcinogenic, damages DNA, Premarin/CEE increase this one! May be associated with fibroids.
- 16a-OH Estrone: is both carcinogenic & important for bone preservation, high levels associated with obesity
- 2-OH Estrone: very protective
- Most biologically active
- Primarily produced during menstruating years
- A small amount converts to estrone
- In men it’s converted from testosterone
- Has positive effect on cardiovascular system (increases HDL, lowers LDL/TG)
- Helps to maintain memory
- Increases absorption of calcium, magnesium, zinc (all good for your bones)
- Increases happy hormone serotonin
- Safest and weakest form
- Protective against breast cancer
- Produce in high levels during pregnancy, helps to maintain pregnancy
- None converts to estradiol or estrone
- Maintains vaginal lining (prevents thinning/tearing), healthy pH of vagina
- Improves menopausal symptoms
- Good for gut bacteria
Our liver metabolizes and breaks down our hormones through a mechanism called methylation. How well a person methylates can influence their risks for cancers. There is a methylation enzymes called COMP that neutralizes the carcinogenic estrones. In some people this enzyme doesn’t work very well, which means they have probably gone most of their life not metabolizing/neutralizing their hormones very well. Studies have shown an increase risk for breast cancer in women with a COMP enzyme mutation.
Ideally when a practitioner is prescribing hormones they are giving you 70-80% of the cream as estriol (the safest most protective form) and 20-30% estradiol for the bone, brain and heart protection. You will get some conversion to the estrone for the bone protection and ideally minimal to 4-OH. To further protect against carcinogenic metabolites we support COMP by including:
- Methyl-B12, B6, B2
To increase protective 2-OH Estrone include:
- Consume brussel sprouts, broccoli and cabbage which are rich in Indole-3-carbinol & DIM
- Moderate exercise
- Add flax and organic soy
- Omega-3 fatty acids
- B6, Methyl B12, and Methyl-folate
- Rosemary & Turmeric
- Lose weight
- High protein diet
What else can you do to support healthy metabolism of your estrogens and hormones:
- Avoid Xenoestrogen found in pesticides, meat products (choose hormone free, grass fed and finished, pasture raised or organic), avoid plastics- water bottles, food containers, kerig coffee cups, and cosmetic. For more info on this see EGW.org
- Consume less than 3 alcoholic drinks per week
- Antibiotic free animal products (meat, poultry, diary)
- Have your estrogen metabolite tested, even get your SNPs tested to see what your COMP & MTHFR activity is like.
If you’re a patient of mine more then likely you have done a urinary test, and know exactly how well you are breaking down your hormones. We use urinary metabolites to measure all these estrogens and their metabolites to asses potential risks for cancer and evaluate how well you methylate.
In summary, estrogens have the good, the bad, and the ugly, how well your body detoxifies your hormones plays an important role in your risks for making potential cancer causing estrogen metabolites. A good practitioner will give you the safest forms of estrogens with the lowest risk for conversion to problematic estrogens, and will measure and monitor how your breaking them down which further mitigates your risks. They will educate you on healthy eating and lifestyle modifications, and include nutrients to improve your health.
Oral Estrogens are not Safe
The second risk that came up in the WHI study was the cardiovascular risk, mostly relating to clot formation- strokes, embolism, and other forms of clots. Oral estrogens (synthetic or not) have a long list of side effects that are very hard on your health and cardiovascular system including increased clotting. For more information in this see my blog on Cardiovascular health.
Other Health Benefits of Estrogen
When women hit menopause and estrogen takes a dive they often experience:
Oh but menopause is a natural part of life you say?! Sure sure it is, but we also used to die in our 40s! Now women are spending half their lives in post-menopause, I don’t know about you but I don’t want to spend half my life with a quarter of the complaints on that list! Estrogen is involved in over 400 functions in the body including:
What about Progesterone:
First make lets make a very clear distinction between progesterone and progestins. They are not the same, progesterone is naturally produced by the body in the second half of the cycle after ovulation and can be taken as a bio-identical form made from wild yam. Progestins are a synthetic non-bioidentical compound and some of the common side effects of progestins include:
Natural progesterone either endogenously produced or as bio-identical replacement therapy have the following effects in the body:
Bio-identical progesterone is very safe, and can be taken orally or topically. Orally it’s great for helping with sleep and reducing anxiety. Topically it has many of the other beneficial effects listed above.
Estrogen and Progesterone over a Lifetime
It’s important to understand that hormones are like a symphony, they work together in synchronicity to create balance, vibrancy, and good health. In a woman’s body estrogen and progesterone fluctuate up and down over the cycle of a month. When we take birth control- oral, hormonal IUDs, patch, pellet, shot- we stop our bodies natural rhythms and can interfere with our long term health. When we take bio-identical hormone replacement we want to be sure we mimic the bodies natural rhythms the best we can. Always giving estrogen and progesterone together, and ensuring other hormones in the body are balanced will optimize health. A lifetime of hormonal imbalance also increases your risks for hormone sensitive cancers, infertility, mood disorders, cardiovascular and other diseases. If your still cycling and having menstrual symptoms I highly recommend your get a full hormone panel done. If your peri/menopausal and either taking hormones or not, I highly recommend you get your hormones tested (ideally a urinary panel with metabolites) to evaluate how your doing and where you need to go to reach and maintain optimal health long term.
Naturally Reduce Your Risks for Cancer
Women’s risks for breast cancer have tripled in the last 40 years, having a first degree relative who had breast cancer is considered an increased risk, however about 1 of 10 cases are in women who have a genetic predisposition. With more then 100,000 synthetic chemicals in use in the US currently, we know environmental factors play a big role. Along with a life time balance of hormones, our bodies ability to metabolize hormones and toxins. This means that what eat, how we treat our liver, and maintaining healthy hormones play a big role. Here is what you can do:
- Keep alcohol intake to 3 drinks or less per week
- Exercise at least 30 minutes of vigorous activity per day
- Maintain healthy levels of Vitamin D
- Drink green tea
- Maintain a health weight
- Eat healthy: organic, plenty of fruits and colorful veggies, whole food diet. Limit processed meats, processed foods, packaged foods, sugars. Overall a Mediterranean diet is a good guideline.
- Avoid smoking tobacco- cigarettes and e-cigarettes
- Get your regular screening done
- Support your liver- lemon water in the morning, annual liver cleanse
If you want to get your hormones tested, balance your hormones, inquire about hormone replacement therapy, do a liver cleanse, get some support around the right type of diet or nutrients for your health Dr. Escobedo can help. Call today for your free 15 minute phone consult 650-271-9453 or book online here.