Estrogen dominance — is it real?

[Guest guest]

Estrogen dominance — is it real?

by Marcelle Pick, OB/GYN NP

 

Most conventional doctors still tell women that menopause — and all

the menopause symptoms — is the result of a drop in estrogen

production. In their view the solution is estrogen supplementation,

or HRT, usually with synthetic hormones.

http://www.womentowomen.com/menopause/estrogendominance.asp

 

In contrast, many alternative practitioners believe that women have

too much estrogen, leading to a condition known as " estrogen

dominance. " The late Dr. John Lee broke new ground when he claimed

that estrogen dominance is the real cause of menopause and pre-

menopause symptoms, especially in younger women. In his view the

obvious solution is progesterone supplementation to offset high

levels of estrogen.

 

This idea has led to the marketing of hundreds of brands of

progesterone creme and other progesterone products — all promising a

quick fix and miraculous results in curing menopausal and pre-

menopause symptoms.

 

Unfortunately, both of these views are simplistic and misleading for

women. We've written other articles telling you the truth behind the

estrogen deficiency theory and our view about synthetic HRT versus

bioidentical hormones.

 

Let's focus today on the concept of estrogen dominance, the

incredible claims being made for the efficacy of progesterone, and

what it all means for you and your health.

 

What is estrogen dominance?

Estrogen and progesterone are two of the primary female sex

hormones. During a normal menstrual cycle, they take turns driving

the process of maturing and releasing an egg and preparing the

uterus for possible pregnancy: estrogen rises in the first half of

the cycle, peaks at ovulation, then falls in the second half as

progesterone rises. Progesterone is released by the rupturing of the

egg follicle during ovulation. If there is no pregnancy, you have a

period and the whole cycle begins again.

When estrogen and progesterone are doing their jobs, they work

together. How much or how little of each hormone is made at any one

time relies on a complicated feedback system between the brain:

specifically the hypothalamus and the pituitary gland, which release

LH (luteinizing hormone) and FSH (follicle stimulating hormone), and

the ovaries. Stress and diet affect that feedback system and so

directly impact your hormonal balance.

 

 

© 2005 Women to Women *

 

What's critical here is the role of progesterone, which " opposes "

the estrogen by helping the body break it down into metabolites that

are absorbed and removed in the process. Estrogen stimulates tissue

growth, and progesterone signals the body to slough it off.

 

The original concept of estrogen dominance was very simple. Dr. Lee

argued that the first sign of menopause is a drop in progesterone

production (not estrogen deficiency!). Without enough " opposing "

progesterone, estrogen levels stay unnaturally high in the second

half of the menstrual cycle. This causes discomfort in a great many

women and can lead over time to some severe health consequences.

 

(The history of HRT contains a tragic example of the effects of

unopposed estrogen. For many years after the creation of synthetic

estrogen — Premarin — it was prescribed to women without any

accompanying progesterone. The result was an epidemic of uterine

cancer that led to the bundling of Premarin with Provera, a

synthetic progesterone — i.e., a progestin — which was called

Prempro, for decades now the most widely prescribed synthetic HRT in

the world.)

 

Over time a second, powerful argument has been added to Dr. Lee's

concept of estrogen dominance. This is the view that our overall

estrogen levels (in women and men) are too high because of

xenoestrogens — chemicals in the environment that mimic estrogen in

our bodies and act as endocrine disruptors.

 

As evidence, it's often noted that women in Western Europe and the

U.S. have estrogen levels that are much higher than women in

underdeveloped countries. Many experts link these high levels of

estrogen with the rise in breast cancer, autoimmune diseases,

infertility and other health issues. They question whether or not

xenoestrogens are the cause.

 

The truth about estrogen dominance

While we all owe a huge debt of gratitude to Dr. Lee for his

groundbreaking work on the importance of progesterone in relation to

estrogen, to my mind the concept of estrogen dominance is too

simplistic, as is the concept of progesterone supplementation.

 

It is true that estrogen is often too high relative to progesterone.

Most of us who have had PMS are familiar with this temporary, benign

form of excess estrogen. You can see by the chart above how

progesterone levels gradually fall during the course of a regular

menstrual cycle. In some women this drop may be more precipitous and

cause symptoms of PMS.

 

During pre-menopause it's common for estrogen levels to decrease

slowly while progesterone levels plummet — a natural result of fewer

ovulations, fewer burst follicles and less progesterone. This can

cause many of our worst symptoms. (See our article on irregular

periods to learn more.)

 

Calling this state " estrogen dominance " is catchy but misleading. It

implies there is one problem, which isn't true; and not all women

experience the condition anyway. And it implies there is one

solution, which also isn't true. Most of the tens of thousands of

women we have treated for pre-menopause symptoms have suffered not

from simple estrogen dominance but from a more fundamental

disruption of the body's ability to maintain hormonal balance. There

are usually multiple causes, including stress, emotional factors,

and the estrogen-like chemicals in our environment called

xenoestrogens.

 

The truth is, healthy hormonal balance is complicated. It isn't just

a matter of not enough progesterone. That's a little like arguing

that menopause is caused by not enough estrogen.

 

There's no simple test for estrogen dominance. But if you have

severe symptoms of PMS, pre-menopause or menopause that don't

respond to a program of increased support for your body within a

month or two, you may have persistently higher than normal levels of

estrogen. Let's talk about why it's important to pay attention to

these symptoms.

 

What are the health consequences of " estrogen dominance " ?

Another of Dr. Lee's contributions was to raise women's awareness of

the profound connections between hormonal imbalance and health.

 

When estrogen levels are high in relation to our progesterone we

experience many severe symptoms, among them anxiety, breast

tenderness, cyclical headaches or migraines, depression, digestive

issues, fuzzy thinking, palpitations, food cravings, irregular

bleeding, water retention, weight gain and more.

 

(Note that a number of these symptoms are also indicative of the

exact opposite condition — a deficiency of estrogen — another

example of why the concept of estrogen dominance is too simplistic.)

 

If estrogen levels stay unopposed, women may develop infertility,

endometriosis, amenorrhea (skipped periods), hypermenorrhea (heavy

bleeding), fibroids, uterine cancer, stroke, and decreased cognitive

ability, among other conditions.

 

Another concern we have with Dr. Lee's concept of estrogen dominance

is that it's used by many to portray estrogen as a " bad " hormone.

There have been studies and speculation for example about the

connection between high levels of estrogen and breast cancer. We

think many unanswered questions remain about this link; to learn

more, read Dr. Dixie Mills' article on estrogen and breast cancer.

 

Estrogen has many wonderful qualities. It creates our fertility,

protects our health in myriad ways, and serves as a powerful anti-

inflammatory. But we are very concerned about environmental

estrogens. They're another story entirely.

 

Awash in a sea of xenoestrogens

For the most part, our bodies are amazingly resilient. We are hard-

wired to resist threats to our equilibrium. What our bodies are not

designed for is exposure to the many endocrine disruptors in our

environment, among them the family of chemicals known as

xenoestrogens.

 

Many of these xenoestrogens are proven carcinogens. They are also

well known for their ability to damage the immune system and

interrupt hormonal balance. Our cells can't always distinguish fully

between our own estrogen and xenoestrogens. Every cell has estrogen

receptors that recognize and open to the shape of an estrogen

molecular chain, regardless of where it comes from.

 

Pesticides are perhaps the biggest source of xenoestrogens. Most

bioaccumulate, meaning they are stored in fat cells of fish, poultry

and other food sources in increasing concentration until they reach

the top of the food chain — where you and I consume them! They are

highly estrogenic, and some experts estimate that the average

American ingests over a pound of pesticides a year.

 

A second major source of xenoestrogens is the many growth hormones

given to livestock and poultry, most of which contain fat-soluble

estrogens. When we consume those animals or their milk, we ingest

that estrogen. Organochlorides like dioxin (a by-product of chlorine

when it is burned or processed), PCB's, PVC's, and some plasticizers

are just a few of the many chemicals that act like estrogen in our

bodies. Many others have the effect of interrupting our normal

endocrine function, hence the name " endocrine disruptors. "

 

Mainstream medicine is finally paying attention because

xenoestrogens not only affect the cells of women, but those of men

and children. Sperm counts have dropped by 50% in some studies, a

significant factor in the epidemic of infertility. The age at which

girls develop secondary sex characteristics (breasts and pubic hair)

is also dropping. It is not exactly clear what role endocrine

disruptors as a whole have in the steady rise of chronic diseases in

children (at earlier ages!) but studies are underway to evaluate

this.

 

It is easy to see why Dr. Lee's advice to support our bodies with

extra progesterone makes some sense. Let's examine the role

progesterone plays in our bodies and how it can help in hormonal

balance.

 

The role of progesterone

Progesterone is the building block for many other major hormones.

Cortisol, DHEA, testosterone and estrogen are all made from

progesterone in a process that begins with cholesterol. Take a look

at the chart below of the metabolic pathway.

 

 

© 2005 Women to Women

 

These hormones are present in our bodies to varying degrees at all

times, but only progesterone is readily converted into its sister

hormones if needed. Importantly, if we are under a lot of stress and

our adrenals are pumping out cortisol, our bodies will take any

available progesterone and divert it to meet that demand. If too

much progesterone gets diverted for cortisol, as happens when you

suffer from adrenal fatigue, there is not enough to make the

testosterone needed for a woman's sexual response — let alone to

oppose rising levels of estrogen. No wonder we feel sick, lethargic

and uninterested in sex when we're under stress!

 

Insufficient progesterone is hard on our health in other ways

because, in addition to reproductive function, all women need normal

levels of progesterone to spur new bone growth (and ward off

osteoporosis), convert fat into energy, metabolize glucose, and

perform many other vital cell functions.

 

But it's equally obvious that just adding progesterone isn't the

answer. If stress is creating your hormonal imbalance, adding

progesterone will just treat the symptom, not the cause. Hormonal

balance is never a matter of taking a magic pill. Let's talk about

how to find a solution that works for you.

 

Your unique path to hormonal balance

In looking at the illustration of the metabolic pathways of

progesterone, it's helpful to think of your endocrine system as a

kind of orchestra, and hormonal balance as its music. Each of us has

a unique body and biography, so each of us has a unique orchestra

and a unique symphony. We all make different demands on our bodies;

we all need different kinds of support. Adding any one element to

the exclusion of others may make you feel worse, not better. For

instance, many women convert progesterone immediately into estrogen;

for them, a progesterone supplement will only worsen their imbalance.

 

There are many women whose bodies, either naturally or due to

external factors, produce an abundance of estrogen. I call these

patients highly estrogenic, and they are more susceptible to

experiencing severe symptoms. They also feel the most dramatic

improvement when they add progesterone to their routine.

 

While genetics have some influence, lifestyle is the single biggest

factor in the production and storage of estrogen, progesterone and

our other hormones. Our modern diet, filled with refined flour and

sugar, simple carbohydrates and artificial ingredients, combined

with our lack of exercise, promotes metabolic irregularities that

lead to insulin resistance, obesity, digestive problems, and

cardiovascular disease, which in turn affect the healthy flow of

hormone production shown in the chart above.

 

Stress plays a major role in estrogen overproduction by triggering

an elevated level of cortisol, which interrupts the feedback loop

between the brain, pituitary, and the ovaries that regulates

hormones. I'm sure most of you have had the experience of skipping a

period or two when you are under stress. At the practice we have

learned that most women don't understand that unhappiness is a form

of stress. To make the point, I sometimes actually write a patient a

prescription that says " Play! "

 

Limiting our exposure to xenoestrogens is also very important.

Thoroughly wash or peel all produce to remove at least some of the

pesticides. Eating only lean, organic meat and dairy products is

wise. Heat food in metal or porcelain containers, not plastic, and

definitely not in the microwave with plastic wrap! Drinking out of

glass containers instead of plastic, previously used water bottles,

or Styrofoam cups is also a good choice.

 

A diet rich in phytoestrogens is thought to be protective.

Phytoestrogens are plant-based substances found in soybeans,

licorice, yams, and alfalfa that naturally mimic estrogen in a

healthy way when consumed. This action supposedly protects the cell

receptors from accepting the more damaging xenoestrogens.

 

In addition to making healthy choices in our diet, I recommend

taking a high-quality daily nutritional supplement as a very

important step towards restoring hormonal balance naturally.

 

How and when to use natural progesterone supplementation

Additional progesterone can be a shot in the arm for many women with

moderate to severe symptoms — especially at the beginning of pre-

menopause — and particularly when used as part of a comprehensive

plan. We've seen women respond extremely well to small amounts of

progesterone in over-the-counter formulations for just weeks or

months; others need therapeutic doses over longer time periods.

 

If you are experiencing moderate to severe, persistent symptoms of

hormonal imbalance, or weaning yourself off HRT, you probably would

benefit from additional progesterone. As long as you're receiving

regular medical check-ups to rule out any serious problem, it's

relatively safe to experiment with non-prescription strength

bioidentical progesterone. However, if you don't respond well to

that, I always recommend having your health practitioner do a

hormone panel. A simple saliva test, and possibly a blood test, will

show whether or not you have a serious progesterone deficiency that

warrants a prescription-strength version.

 

Conventional doctors will often prescribe synthetic progesterone, or

progestins, to women who experience major discomfort. In my

experience, progestins help with heavy bleeding but only in the

short term, and they may make PMS and depression worse. Longer

exposure can cause even more problems.

 

Progestins are large synthetic molecules that do not bind with the

progesterone receptors in a cell. In other words, they are not

bioidentical — their shape does not quite fit the cell receptor — so

the cell has a diminished capacity to accept it. However, your body

does register the presence of these synthetic progestin molecules in

your bloodstream and consequently downgrades its own progesterone-

release mechanism. So by using synthetic progesterone you diminish

your body's own ability to generate the natural form!

 

The most effective method for delivering progesterone support to our

bodies is by way of a bioidentical formulation. We've had superior

results with a transdermal cream containing micronized progesterone

USP. ( " USP " means the progesterone meets the standards set by the

U.S. Pharmacopeia, which works closely with the FDA.)

 

Progesterone USP is real progesterone, not a phytoestrogen. The wild

Mexican yam contains a phytoestrogen that is closely related to

human progesterone, but requires a simple molecular manipulation to

become identical. That is why yam creams alone are not effective;

their phytoestrogens must be transformed into progesterone USP to be

truly therapeutic. If you've tried some over-the-counter

progesterone products and been disappointed, you may still benefit

from the right kind of progesterone support in the right dosage for

you. If your symptoms are moderate to severe, like most women's, you

also need to combine progesterone use with other forms of support.

 

I recommend to my patients that they apply 30–40 mg of high-quality,

micronized progesterone USP cream to the inner part of the wrists

for two weeks, starting at the mid-point of their monthly cycle.

Since everyone is different, some women need more while some need

less to restore their equilibrium. We find our progesterone cream is

so safe that we can experiment with dosages to see what works best

in our patients.

 

In all but the most severe cases I prefer using progesterone in a

skin cream form because transdermal delivery is more natural than

oral delivery in pill form. The hormone is absorbed through the skin

directly into the bloodstream, which allows us to achieve the

desired results with lower dosages than those required to survive

the digestive tract. We've found the progesterone cream in our

Personal Program to be the most efficient, most recognizable, most

natural way to give your body what it needs. You don't have to use

ours, but you should look for a progesterone cream with the

following attributes:

 

Contains pharmaceutical-grade progesterone USP

Micronized

Bioidentical

All natural

Hypoallergenic

When patients with severe PMS, heavy bleeding or other severe

symptoms don't respond to progesterone cream, I often switch them to

a pill form because it's easier to deliver the necessary higher

dosage orally, and because oral dosage delivery is standardized.

 

We disagree with Dr. Lee's assertion that women should use

progesterone supplements like progesterone cream for the rest of

their lives. Our belief is that the smallest intervention that

restores hormonal balance is best. In most cases we recommend you

use progesterone as a bridge, and curtail its use or drop it

entirely when doing so won't result in a return of your pre-

menopause symptoms.

 

A special note about progesterone use after menopause: although

there is no evidence that it's unsafe, it clearly is not natural to

add progesterone to your body indefinitely after menopause, and we

feel adequate long-term study is needed before making this

assumption. We tell our post-menopausal patients they may safely use

additional progesterone for up to a year. These women often benefit

immediately from the extra progesterone, but it's wisest to use it

as a bridge to a new, more natural balance in their bodies.

 

Remember, progesterone can't do it alone!

I hope it's helpful for you to read up on how our bodies really seek

hormonal balance, and what each of us can do to find a solution that

works for us. Viewing our symptoms as simply a sign of estrogen

dominance is as misleading as attributing them to estrogen

deficiency alone. And a combination approach works better than any

kind of magic pill. Improving our nutrition, adding a robust

nutritional supplement, reducing stress, and minimizing

xenoestrogens are measures that are just as important as adding

progesterone. Together they will help support the demands on your

body and restore the vitality and good health that come from natural

hormonal balance.

 

So many of us make New Year resolutions that are hard to keep. But

everyone can adjust their diet, take a nutritional supplement, and

add a little exercise to their routine. You'll be surprised to find

that those simple changes will give you the energy you need to do

just about anything you choose.

 

We wish you the very best in 2006!

 

Our Personal Program is a great option. The Program supports healthy

endocrine function during pre-menopause and menopause with

nutritional supplements, bioidentical progesterone cream and dietary

guidance. (The dietary plan we use was devised by a noted

endocrinologist).

 

Click here to learn more about the >> Personal Program or call us

toll-free at 1-800-208-7118.

 

call us toll-free at 1-800-340-5382.

 

 

 

* Adapted from information at McGill University and the University

of Wisconsin.