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From the Townsend Letter
February / March 2019

Hormone Therapies to Cure Female-Related Disorders: Practical Tips
by Thierry Hertoghe, MD
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Prevention and cure of breast cysts, under- and overdeveloped breasts, breast ptosis, amenorrhea, hypomenorrhea, and menorrhagia, poly- and spaniomenorrhea, irregular menstrual cycles, ovulatory pains, spasmodic and constant dysmenorrhea, premenstrual and menstrual migraines, ovarian cysts and polycystic ovarian syndrome, vaginal dryness, dyspareunia, endometriosis, lichen sclerosis, hirsutism, etc.

Most female-related disorders are caused by deficiencies, excesses, or imbalances of the two important types of female hormones – estrogens and progesterone. In this article, we will review the most typical female-related disorders and suggest how to correct them with hormone supplements.
To determine which female hormone deficiencies and excesses are causing female-related disorders, and which hormone supplements to provide as a treatment, I recommend physicians train their skills in recognizing the differences in actions and deficiency signs and symptoms between estrogens and progesterone.

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Estrogens increase progesterone production by stimulating ovulation through the production of a high preovulatory peak that stimulates a peak secretion of LH, the pituitary hormone that triggers ovulation.

  • Estrogens stimulate the (ortho)sympathetic nervous system directly and through conversion into catechol estrogens, making women excited and enthusiastic, but excess estrogens render women nervous, aggressive, and anxious.
  • Estrogens also cause a person to retain fluid and benefit from adequate hydration of the skin and mucosa, but in excess they lead to painful swelling of breasts and lower abdomen.
  • Estrogens also stimulate healthy epithelial cell proliferation, particularly in the genital areas (breasts, ovaries, and endometrium), however, at excessive levels, they stimulate excessive cell proliferation in these areas producing enlarged breasts or breast cysts, ovarian cysts, endometrial glandulocystic hyperplasia, and fibroids.

Progesterone has in these domains opposite actions that protect against estrogen excess. Progesterone reduces estrogen activity by reducing the levels of estradiol, the most potent estrogen, through a stimulation of the conversion of estradiol into the three to 10 times less active estrone.

  • Progesterone stimulates the parasympathetic nervous system, making women calm and in control.
  • Progesterone is diuretic, increases water excretion through urine, protecting in this manner against excessive fluid retention. This diuretic action is not shared by all progestogens. High doses of synthetic derivatives of bioidentical progesterone can cause fluid retention, particularly when they derive from androgens.
  • Progesterone also stops estrogen-induced epithelial cell proliferation and differentiates epithelial cells into more functional cells. For example, progesterone stops estrogen-induced anarchic proliferation in the endometrium, differentiating these cells so that the endometrium of the uterus can accept implantation of a fertilized egg cell and nourish it.

Table 1 shows the differences in actions of the two types of female hormones.

Female hormones

BDNF EssentialsExcesses (predominance) in these female hormones will accentuate these effects. Estrogen predominance produces nervousness, water retention, and excessive cell-proliferation. Estrogen predominance is frequently encountered in premenopausal women who are not supplemented with female hormones. In contrast, postmenopausal women usually show estrogen predominance only when taking an imbalanced female hormone treatment (e.g., the medically unsafe, treatment with estrogen alone without progesterone) usually prescribed to women after hysterectomy. Progesterone supplementation is necessary to keep not only the uterus tissues but also the ovarian, breast, and brain tissues well-balanced and safe. Progesterone dominance with depression and dehydration is rarely encountered, generally only when excessive doses of progesterone or progestogen derivatives are given.

Deficiencies in female hormones will provide opposite effects to their actions. In estrogen deficiency, low mood and energy, dehydration, and atrophy prevails. In cases of progesterone deficiency associated to adequate estrogen levels, nervousness predominates; and, in the genital areas, swelling and excessive epithelial cell proliferation. Table 2 reviews the most typical and pathognomonic signs and symptoms of each female hormone deficiency, enabling physicians to quickly detect which female hormone deficit(s) a patient is suffering from. .pdf

At what time of the day are female hormone deficiency complaints the worst? Contrary to hypothyroidism and cortisol deficiencies where symptoms are more severe at specific times in the day (upon awakening for hypothyroidism and in stressful moments for adrenal deficiency), women with estrogen and progesterone deficiencies find that most complaints appear at the same intensity at any time of the day, with the exception of vasomotor disorders (hot flushes and sweats), which tend to occur more at night and in stressful conditions. In premenopausal women, estrogen deficiency symptoms are worse during menstruation and in the follicular phase, whereas progesterone deficiency symptoms predominate in the luteal phase, during the 5 to 14 days before the period.

What are the most efficient and safest female hormone treatments? The most efficient and safest treatment consists, in my experience, of transdermal estradiol and oral or vaginal progesterone, in accordance with the current scientific literature. Estriol is interesting as an estrogen but does not absorb well through the transdermal route and has insufficient effects for the brain, bones, and cardiovascular system. The data are not all conclusive about its cancer safety or protection (the risk of endometrial cancer is several times higher in women taking estriol alone without progesterone). It is efficient for the vaginal mucosa and reduces ocular dryness. For this reason, I consider 1-2 mg/day oral estriol as a worthwhile adjuvant estrogen, but it does not replace the essential estradiol.

From what age do women need female hormone supplements? As soon as female hormone deficiency is diagnosed. Some women with weak ovaries may already need female hormones at the end of puberty because their ovaries never succeed in producing sufficient amounts of female hormones to be fully healthy. In most women, however, the need for estrogen and progesterone supplementation starts between 30 and 35 years old, as confirmed by research that shows that the levels of both hormones start progressively and significantly to decline at these ages.1-2

Which conditions can accelerate the natural age-related decline in female hormone production long before menopause? Pregnancies also weaken the ovaries. Research demonstrates that women who have been pregnant have significantly lower serum levels and urinary excretion rates of estrogen metabolites than women of the same age who have never been pregnant.3 In my experience, most women after pregnancy show premature signs of estrogen and progesterone deficiencies and look like older mothers rather than the energetic and young-looking ladies they were before. To keep their health and good looks, they need small doses of estrogen and progesterone. Practice of intensive sport (reduced estrogen and progesterone metabolites),4-5 stress (estrogen and progesterone deficits),5 malnutrition,5 overweight (decreased progesterone and its metabolites), smoking (decreased estradiol),6 a history of induced abortion,3 uterine tubal ligation7-8 also reduce production of female hormones and their metabolites. These deficits make it necessary for women to get additional estrogen and progesterone therapies to correct the hormone deficits long before menopause.

Female-Related Disorders That Can Quickly Be Corrected in Days or Weeks
Droopy breasts (breast ptosis) are signs of significant estrogen deficiency. For this reason, in premenopausal women add estrogen daily during most of the menstrual cycle (follicular and luteal phases) but administer the protective progesterone only in the second half of the cycle, the luteal phase. In postmenopausal women, I usually prescribe both transdermal estradiol and oral or vaginal progesterone on the same days: from the 1st to the 25th day of the month. This usually and safely blocks menstruation, a relief for most older women.
The estradiol should be taken upon awakening because it increases energy, and progesterone at bedtime because it induces sleep. An efficient dose to bring back the breast volume and tone is 1.5 to 3 mg/day of transdermal estradiol (upon awakening) and 100 mg/day of oral or vaginal progesterone (at bedtime). If the breasts remain droopy, increase the estradiol dose further until the breasts regain their normal tone and volume.
Tip: The patient should avoid consuming (unsprouted) whole grains as the fiber contained in grains prevents intestinal reabsorption of female hormones. About 60% of the female hormones are attached (conjugated) by the liver to a glucuronate or a sulfate. These glucuron- and sulfo- hormone conjugates are secreted then by the liver into the bile, which flows into the small intestine. In the gut, bacteria break off the bonds between the glucuronates and sulfates and the estrogen and progesterone, permitting reabsorption of the latter through the intestinal wall and reutilization as hormones. This enterohepatic cycle is interrupted by the non-absorbable cereal fiber that strongly binds to the hormones and drags them into the stools, almost tripling the net loss of these hormones in the stools and lowering the female hormone levels 20 to 40% in the serum.
Amenorrhea and hypomenorrhea in premenopausal women who are not yet menopausal (FSH is still well below the 30 mIU/ml threshold for menopause) and still have healthy egg cells result from severe estrogen deficiency. Normal menstruation is restored by adding estradiol and progesterone as mentioned above (usually 2 to 3 mg/day of transdermal estradiol gel from the 5th to the 25th day of the menstrual cycle) and 100 mg (usually not more) progesterone from the 15th to the 25th day of the cycle. In postmenopausal women treated with both estradiol and progesterone on the same days (typically from the 1st to the 25th day of the month), amenorrhea is generally the rule and is safe because the progesterone blocks the proliferation of endometrium by estradiol and the possibility of having periods. I recommend stopping the treatment during 3-5 days at the end of the month as the interruption decreases the breast cancer risk and permits an abnormal endometrial cell that might have developed to die during the estrogen-free interval.
Amenorrhea and estrogen deficiency may be caused by low-protein and low-fat intakes as in low-calorie diets, for example. Recommend the patient eat at least 200 g/day (a little less than a half pound/day) of meat or fish and take a daily soupspoon of butter (preferably ghee, butter that has been clarified (cleaned) from its proteins) or an egg yolk. Eating more animal protein and fat boosts female hormone production.
Menorrhagia: How to reduce heavy menstrual bleeding by adding progesterone. Progesterone deficiency allows excessive menstrual bleeding by permitting an excessive proliferation of the endometrium under impulse of estrogens. Once progesterone treatment is administered at a sufficient dose, it stops any further production of endometrium. By this inhibition, it reduces the material for bleeding as endometrium is what bleeds away during periods. In case of mild menorrhagia, 100 to 150 mg/day from the 18th to the 25th day of the cycle should be sufficient to reduce the bleeding back to normal. In case of heavier bleeding, 150 mg to 200 mg/day from the 15th to the 25th day of the cycle may be necessary. In extreme cases of severe menorrhagia, 50 mg/day from the 5th or the 10th day to the 14th day and then 150 mg to 200 mg/day from the 15th to the 25th day of the menstrual cycle can be required.
Tip: Check for hypothyroidism or adrenal (cortisol) deficiency as they both can cause insufficient ovulation, which results in progesterone deficiency. Check also for vitamin K, B3, etc., as well as thyroid (again), as these deficiencies are associated with insufficient production of coagulation factors and treat those deficits whenever they are confirmed.

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