I am always eager to discover newer and more effective ways to approach the issues we face around hormones and mid-life to help improve my own life and yours, my patients. So I took off in early July for Chicago to attend the Institute of Functional Medicine conference. Such a fun city - fabulous architecture, art, music and shows. I particularly enjoyed my walks by the river and my boat tour. I recommend it to anyone.

But back to why I went...which is what this edition is all about.

As we review the published literature on bio-identical hormones, we find that the use of BHRT is associated with lower risks for breast cancer, heart disease, strokes, osteoporosis, dementia, and Alzheimer's. On the contrary, the use of synthetic hormones is associated with increased incidence of cancer, blood clots, strokes, and heart attacks.

Progesterone

Studies demonstrate that progesterone is not a hormone that we should just take at any dose and for any purpose. It needs to be used in a knowledgeable way to avoid getting our levels too high. This is particularly true after menopause when our bodies need less of it. Too much progesterone given continuously would set us up for weight gain, dysregulation of glucose metabolism (creating insulin resistance), and ligament instability (creating the risk of injury with excessive flexibility of joints and muscle structures). Also, less progesterone will be needed when our adrenals are working well to support our bodies.

If you have not had your progesterone levels checked within the last 6 months, I would suggest that we do that soon and re-evaluate your progesterone level and dosage.

Estriol

Once thought to be highly protective of the breasts, we are now seeing in several studies that estriol plays less of a role in this regard. And, too high a dose of estriol will fill up our estrogen receptors, keeping estradiol out and creating a need for higher levels of estrogens to control symptoms. Because estriol is a very low potency estrogen, it has a low estrogen effect - not what we need as we try to prevent the symptoms of naturally lowering estrogens. So, if we give more estradiol and less estriol from the onset, we can give fewer estrogens overall and yet get the effect we need.

Older formulations of prescriptions of Diest in the 80/20 formula have more Estriol than is currently recommended because of this reason.. I prefer to use at least a 50/50 concentration of Estradiol and Estriol. I am going more towards an even higher level of estradiol and seeing good results.

Using estriol intra-vaginally helps to re-create normal moisture and to rehabilitate the tissues to become more elastic again. This can be used by any woman but is particularly helpful to women who are post-breast cancer and need some support for these symptoms without extra estrogen effects throughout their bodies.

Risk/Benefit and Testing

As with everything else in life, the benefits of bio-identical hormones, such as the decrease of adverse quality of life symptoms and the reduction of the risk for major chronic illness, have to be weighed against any particular individual's health risks along with the risk of cancer. We always want to be on the favorable side of this risk/benefit analysis, and a balanced hormonal physiology is usually achieved when doses are not at extremes.

Some of the newer ways to assess risk is to do a 24 hour urine sex hormone test that looks for specific metabolites (end products of hormones) and their quantities. Some are potent cancer preventing molecules and others can promote cancer. Our own detox system and its ability to eliminate detrimental metabolites determines who is at risk. This is a useful tool, particularly after you have been on bioidentical hormone therapy for a year or so and have achieved a stable and optimal level of hormones.

Ways you can increase the good metabolites include flaxseed, omega-3 fatty acids, soy isoflavones, I3C & DIM (short term use only or consult your clinician), rosemary, turmeric, kudzu, exercise, and weight loss.

Cysts

Several of you have experienced ovarian cysts. You can benefit from eliminating xenoestrogen (estrogen like molecules that cause endocrine disruption) exposures and doing a liver detox. Also beneficial is treating inflammation and insulin resistance with diet and proper supplements, as well as exercise, adrenal support, and the cyclic use of progesterone.

Birth Control Pills

Birth control pills are associated with higher risks of breast cancer and can deplete the body of essential nutrients and hormones. It can be helpful to take B vitamins, progesterone, and sometimes testosterone while using birth control pills.

Osteoporosis  

For osteoporosis, the first focus has to be on healing the gut. I t is recommended that you use a low glycemic/anti-inflammatory diet with absorbable calcium (such as citrate or hydroxyapatite), boron, molybdenum, magnesium, vitamin K, vitamin D, and strontium. Also, a weight bearing and balanced exercise program along with bioidentical hormone replacement therapy with estradiol, progesterone, and testosterone will contribute to stronger bones, often reversing osteopenia and in many cases osteoporosis.

Sleep

For sleep issues, consider adrenal support and lowering adrenaline (the response to stress). By getting 30 minutes of exercise a day you will burn off the extra adrenaline you produced during the day that can prevent good sleep. Treat hot flashes and night sweats along with any thyroid imbalances. Use progesterone under the tongue or orally before bed. No news or negative or stimulating messages for 1-2 hours before bed. Take magnesium 200-600mg at night. Be in bed by 10 pm at the latest and use earplugs and eye masks as needed.

Sexual Abuse

One surprising fact that came out at the conference was that sexual abuse of women remains at staggering high levels. It is estimated that one in three female patients has some type of sexual trauma in her history. If you are one of them, let's please talk so you know what options are available for your support.

 I hope you find these hints useful as you continue to create balance in your life and health during mid-life and the years ahead! Next month I will share about the   treatments I am offering in the office for hair loss and skin rejuvenation using your own platelets to stimulate tissue healing including collagen formation. Exciting new techniques!

Happy ending days of summer to all of you,