Answering the Estrogen Question
Marta had been taking Estrace and Provera for 4 years and was pleased with the results. She felt it had helped her out of menopausal depression and made her feel and look more youthful. She had read about the benefits of estrogen for preventing osteoporosis, heart disease, and Alzheimer’s. Then, her aunt was diagnosed with breast cancer and the first thing her aunt’s doctor had done was to take her off of Estrogen. Also, Marta’s gynecologist had sent her a letter advising all her patients to discontinue hormone replacement.
All the conflicting information and advice was making it difficult to make a decision. All she really wanted to know was: Do the benefits of taking estrogen outweigh the risks?
At our first office visit we performed a basic risk assessment: We found that on the positive side, she had delivered two healthy children, as well as having breast fed both of her children for over 3 months, both of which had lowered her risk. On the negative side, we found that the risk factors working against her were that (1) she had a family history of breast cancer, (2) she was eating a diet too high in sugar and fats, (3) she was taking estrogen without knowing how her body metabolized them, and (4) she was taking Provera, the synthetic progestin that has been linked with increasing the risk of breast cancer and blocking the benefits estrogen has on the heart.
We needed find out if her body metabolized estrogen favorably. The best method to find this out is by performing a 24-hour Urinary Sex Steroid Profile. Marta collected her urine for 24 hrs. and we sent the sample to the laboratory. The test measured progesterone, testosterone, DHEA, and the primary anabolic steroid metabolites. Also, her Estrogen Quotient (EQ) was calculated, along with her 2- hydroxy/16-alpha-hydroxy estrone ratio (“good estrogen”/ “bad estrogen” ratio). These two ratios tell us how well estrogen is being metabolized.
Women with an EQ under 1.0 have lower E3 levels and are at the highest risk for breast cancer. Those with an EQ greater than 1.5 have the highest E3 levels and are at the lowest risk for breast cancer. Basically, the lower the EQ, the higher the risk. Marta’s hormone results were an eye opener. First, her total estrogen levels were four times the normal levels of women half her age. Her estrone level was ten times the safe range, and her Estrogen Quotient was a high risk 0.1. Her “good estrogen”/ “bad estrogen” ratio was way below the safe range of 2.5. Five things were clear from her lab tests: 1) her estrogen levels were too high, 2), her intestinal bacteria and her liver were metabolizing the estradiol (E2) in Estrace into estrone (E1), 3) her own fatty tissue was producing large amounts of E1, 4) her liver was not converting the higher risk estrogens into the “good estrogen” metabolites, and 5) she needed an alternative to Provera that still gave her the benefits of hormone replacement.
Our first step to achieve this was to gradually begin lowering her Estrace dose while gradually increasing her E3. We did this by improving her liver function through diet changes, herbal medicines and giving her a natural form of E3 to take. She began taking phytonutrients to raise her “good estrogen”/“bad estrogen” ratio. She went off Provera and began taking natural progesterone. She took most of the sugar out of her diet, and lowered her total fat intake. Marta began eating more of the good fats such as olive oil, fish oils, and fresh nuts and seeds. She cooked using more garlic, pesto and fresh herbs containing protective antioxidant flavones and terpenes, which include basil, thyme, oregano, cumin and lemon peel. She reduced her coffee intake, replacing it with Gyokuro green tea. She added soy products to her diet for the cancer preventing isoflavones found in them. Marta added whole fresh ground flax seeds to help her liver metabolize estrogen. She guarded against constipation, which can increase carcinogenic bile acids in breast cysts, and added the Lactobacillus acidophilus and bifidus bacteria to her diet to help bile acid elimination.
And it worked! After 5 months of following the program we repeated the tests and were delighted to find that her total estrogen was now in the normal range, her EQ was a robust 2.21 ratio, and her “good estrogen”/“bad estrogen” ratio had risen to protective levels. She continued to gain all the benefits of hormone replacement therapy, including the absence of hot flashes, and prevention of heart disease, osteoporosis, and Alzheimers disease. She regained her youthful vigor. Best of all, she had peace of mind and now knows what to do to get the benefits of hormone therapy without the risk.
For the best evidence-based treatment of menopause, contact our doctors at Oregon Regenerative Medicine, 503 636-2734