Happy Thanksgiving! Part 1: Back to Basics – Estrogens

What a lovely fall we have had here in Wine Country! Haven’t you enjoyed these sunny, temperate days with the fall foliage that brightens our countryside? Glorious to me!

So, appropriate that we are moving into the season of Thanksgiving. Thank you for making your health a priority and letting us be involved in that process. We are grateful for that opportunity!

I want to thank the office staff personally for all the critical support services they provide so that Jon and I can keep your care finely tuned and on track for your best and safest good. And I want to thank you very much for your patience as we have transitioned with some new faces in the office.

This newsletter issue begins a series of back to the basics articles focused on what each hormone is, why our bodies needs it, why we use it, and why we need to respect it and use it wisely.

Of course, I will be addressing bio-identical forms of hormones in these articles. The content will apply to men and women, and I will explore gender differences. (Yes, men, estrogen is critical for your optimal function, too!) Let me know if you find these articles to be helpful. Here goes!

Part 1: Back to Basics – Estrogens

Estrogen in higher amounts is what makes women feminine. It is what changes girls into women by affecting our sex organs and creating full breasts, a sense of sensuality and sexuality. It makes our skin glow, and our eyes and vagina moist. It creates the menstrual cycle and prepares the uterus for the implantation of a fertilized egg for pregnancy.

Our cells have estrogen receptors on their membranes throughout our bodies. This is where the difference between bio-identical hormones and synthetic hormones comes into play. Bio-identical hormones have the same molecular structure as those produced by our own bodies so that the bio-identical estrogen is able to dock in these receptors and create the expected physiological results in the body. In contrast, synthetic estrogens are so different that they can only have some limited effects – like relieve hot flashes and prevent bone loss. At the same time, the synthetic hormones create high risks of disease development. In the case of estrogen, synthetics and their associated oral administration, have been shown to increase blood clot formation, strokes, and heart attacks (The Women’s Health Initiative Study).

Estrogens, by nature, are proliferative hormones. That means that they cause cells to grow more quickly. It’s similar to watering a plant or fertilizing it – it will grow more and faster. That is the desired effect in preparing the uterine lining to receive a fertilized egg and be able to support a viable pregnancy. However, it is not the desired effect if cancer cells are in the body and are starting to grow. There is no evidence that bio-identical estradiol causes cancer, but it will facilitate the growth of any existing cancer cells, like any other cells. That is why it is critical for you WOMEN to do yearly mammograms and monthly breast self-exams at home to find any changes as early as possible. For that reason also, it is important to adopt lifestyle habits that are known to prevent cancer.

There are primarily 3 types of estrogens that are produced by the human body – estrone (E1), estradiol (E2), estriol (E3).

The amounts of these change throughout our life cycle and they play different roles in our bodies.

Estriol (E3) is a weak estrogen and is made in large amounts during pregnancy. At some point, it was believed that estriol provided a high level of breast protection. But now we know from more recent research that protection is only minimal and that estriol can displace estradiol (the most important estrogen) by preventing it from getting into the estrogen receptors to do its job. Estriol, however, has been shown in studies and clinical practice to be very effective when used as a vaginal preparation for vaginal and bladder rejuvenation. It also can be used on the face for plumping, improving hydration and lessening wrinkles in many patients.

Estradiol (E2) is the most potent estrogen, and therefore gives the most estrogenic effect in our bodies for creating balance. When estradiol production lowers during menopause, women’s bodies age and disease progression accelerates. These women not only experience hot flashes, brain fog, mood problems (including depression), insomnia, vaginal dryness, and low libido but their collagen starts declining, their skin loses its smooth and glowing texture, their memory declines, and general arthritis like pains develop in their joints. As a result, their quality of life suffers, impacting also those around them. Physiologic changes that end in diseases are triggered by this decline in estrogen (coupled with declines in progesterone and testosterone).

Estradiol (E2) protects us from osteoporosis, reversing osteopenia and many cases of osteoporosis. It also aids in maintaining good memory and preventing dementia and Alzheimer’s, reducing risks by 65-75%. The list of disease prevention with estradiol includes heart disease, diabetes, Parkinson’s, and colon cancer. More recent research also shows prevention of breast cancer.

As testosterone declines in men at mid-life, the natural physiologic response is for estrogen to become more dominant, particularly in men with a glucose metabolism problem. This is a critical factor to monitor because elevated estrogen creates higher risks in mid-life men for cardiac disease, diabetes, and weight gain.

But as with all hormones, it is particularly important for men to maintain adequate and balanced estrogen levels to continue to have good cognitive function and memory.

Estrone (E1) is the estrogen that post-menopausal women produce at high levels. It can also be high due to the conversion of high levels of other estrogens into estrone. And a major contributing factor to high estrone is a poorly functioning COMT (estrogen detox) pathway of the liver, particularly in patients with a genetic predisposition. By optimizing post-menopausal estradiol levels, the body will naturally lower the estrone production in many women. Because estrone creates more inflammation within the entire body, lower levels are more healthy. And, lower levels mean less tendency for belly fat development. Estrone is a hormone that is checked periodically, and particularly in post-menopausal women, and is always included in the 24 hr urine tests that you do. If the levels of estrone need to be lowered, we do this with various levels of clearing protocols and sometimes adjustments in doses.

Estrogens have gotten a lot of bad press in recent years that has led to so many people believing that it is a problem hormone that causes cancer. This is blatantly FALSE. We need estrogens!

Our bones, our brains, our hearts, our whole body needs estrogen.

And, we need balanced hormones to give us the quality of life and the disease prevention that is possible. However, with these opportunities comes the responsibility to use hormones wisely over time so as to re-create the physiologic balances of estrogen, progesterone, and testosterone that the body produced at the peak of our vitality and good health.

Happy Thanksgiving to each of you and may the time spent with family and friends be a meaningful highlight of this season!

Jane Kennedy, CFNP, MN, MPH

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