You can read the video transcript below from the video Natural Hormone Replacement Therapy For Women:
Welcome, everyone. This is Dr. Nikolas Hedberg and today I’m going to be talking about natural hormone replacement for women. I’m a board certified naturopathic physician. I’m also board certified in nutrition. I work with many women with hormone imbalances, thyroid problems, adrenal gland imbalances, and what we would call sex or reproductive hormone imbalances. Before we begin, let’s talk about a little research and a little bit of history around hormone replacement therapy. This is a really big topic, a popular topic. Bio identical hormones have been very very popular for years now. Various movie stars and celebrities have made it fairly popular and many women are using it successfully to manage their symptoms as they transition into menopause and beyond. So I wanted to create a nice overview to give you a really good understanding of hormones and the symptoms of hormone imbalances, what you can do about it, and see if it’s something that’s right for you. The Women’s Health Initiative, this was a study designed to provide information, really about the risks versus the benefits of conventional hormone replacement.
So we had 40 medical centers, about 16,000 women, and it ran from 1996 to 2002. They gave half of the women Prempro, which is a combination of Premarin and Provera, and then half received the placebo. Premarin and Provera, they’re synthetic estrogens and progesterones. Now, this Women’s Health Initiative was initially supposed to last eight and a half years, but it was halted at about five point two years because so many women were developing health problems. Now, the good news of Women’s Health Initiative is that they found there was a 21% decrease in osteoporotic fractures, and a 37% decrease in colorectal cancer. So that was some good results. However, here are the reasons why they had to stop the Women’s Health Initiative early. They were finding a 29% increase in coronary heart disease, 41% increase in stroke, 2,100% increase in a pulmonary embolism. This is when a clot breaks off from a blood vessel, say it’s in the leg, and it travels to the lung, and can cause sudden death or a trip to the emergency room because the person can’t breathe, so very deadly. A 26% increase in breast cancer, they also find that Alzheimer’s was increasing by over 200%.
Now, this wasn’t new information. There was actually a previous 15 years study on 46,000 women and they were given Provera along with synthetic estrogen. They found that that increased the risk of breast cancer by 800%, compared to just using estrogen alone. Does the good outweigh the bad? I’ll leave that up to you to decide, but nevertheless, the women’s Health Initiative didn’t make it to the end. Now, here’s HRT Update Hormone Replacement Therapy Update 2012 from the annals of internal medicine entitled, “Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions”, a systematic review to update the U.S. preventive services task force recommendations. This is a free paper that you can read online. They found that same thing is the Women’s Health Initiative, the hormones decreased the risk of bone fracture, estrogen and progestin increased the risk of stoke, estrogen and progestin increased the risk of thromboembolism. So same thing as they found in the Women’s Health Initiative, increased the risk of gall bladder disease, increased the risk of urinary incontinence – so that’s when urine leaks out of the bladder – increased risk of breast cancer. Again, same data as the Women’s Health Initiative, increased risk of dementia, so that can tie in with the Alzheimer’s that they found in the Women’s Health Initiative. Estrogen alone did decrease the risk of breast cancer that was without progestin. So still a lot of negative side effects, so we have to weigh the benefits with the risks. This was the most recent update that we have, full review of hormone replacement therapy up to that point.
What is a hormone? It’s basically a chemical substance produced in the body, by a gland. So the thyroid makes thyroid hormone. The ovaries produce estrogen and progesterone. The adrenal glands produce cortisol and DHEA, etc., etc. Hormones are very specific. It’s like a lock and the key. The hormone has to find a receptor, and the receptor and the hormone have to fit together correctly in order for them to have their actions. Natural hormones, or what we would call “bio identical hormones”, these are identical, exactly identical to what your body produces. Synthetic hormones are not naturally occurring and they actually have a different chemical structure. You don’t really have to be a chemist to understand this. You can see here’s the chemical make-up of progesterone. So this is actually what your body produces. Then this is Provera. You can see it has the same foundational structure, but you can see they add a chain here and a chain here, as well. Now, why do they do that? The reason they do that is because natural hormones made in the body cannot be patented. It’s kind of like trying to patent oxygen, or carbon dioxide, or trying to pattern water, H2O. That’s completely illegal. It can’t be done, but if you alter the chemical structure of the compound, then it can be manufactured and sold to the market. Like I said, you don’t have to be a chemist to see a difference here.
We know that hormones are very specific, so this is going to fit nicely into a progesterone receptor. Whereas this, there may be binding but we don’t really know how well it’s going to be bound. We don’t know the other actions that it’s going to have on the rest of the body. That could explain all of the negative side effects of the synthetic hormone replacement therapy that we found in the previous two studies that we talked about. So as you go into menopause, perimenopause, you start here at the top, and the ovaries have a certain amount of eggs. The amount of eggs that you have, really continues to drop. You can see here, it drops all the way down to a very low level. About the average age of 51, the ovarian reserves of eggs are depleted to a very low level. This is kind of the average age of the final menstrual period. At age 38, however, the depletion rate can increase dramatically. Some women might actually start to develop symptoms of perimenopause kind of earlier than most women. It’s really an individual thing. But you can see estrogen here, it’s pretty strong, and then it really drops down. Then you can see progesterone here is also pretty strong, and then that also bottoms out. You can see a surge here in FSH, that’s Follicle Stimulating Hormone. So by definition, this is a stimulating hormone for follicle release from the ovary. So as those follicle reserves drop, the brain is trying to tell the ovaries to make more hormones and produce more follicles, so that’s why we would see an increase in that hormone.
But this is a nice graphical representation of how things happen as you move into perimenopause. This also explains why you would start to develop so many symptoms. That’s mainly because the estrogens and the progesterone are getting very very low. We’ll talk about what that does to your body. These are the symptoms of low estrogen. So we saw on the previous graph, estrogen starts to decline around perimenopause and then into menopause. We’ll see hot flashes, night sweats, vaginal dryness, incontinence, insomnia. You’ll see all kinds of sleep problems. It’s important to know that estrogen maintains bone quality, so we may begin to see the early signs of what we call osteopenia or osteoporosis. These are the symptoms of too much estrogen, quite a number. This is becoming a greater and greater problem for a number of reasons. The first is that the more body fat a woman has, chances are, the most estrogen she is going to have. We do have a problem in this country with weight, a big problem, not only obesity but also just being overweight. So the more body fat you have, the more estrogen you’ll probably have. You’ll start to develop all of these symptoms. You’ll see some of them are the same as symptoms of low estrogen, but some of the big ones that we’ll see are weight gain around the hips, thighs and the abdomen, heavy menstrual bleeding – that’s if you’re having a cycle – mood swings, irritability, depression, vaginal dryness, so the sex drive gets very low.
Another sign of too much estrogen is if you have uterine fibroids, fibrocystic breast disease, breast tenderness, dry, thin and wrinkly skin, so a lot of potential problems here with too much estrogen. These are the symptoms of low progesterone. You’ll start seeing these as you transition into menopause. Some of them you’ll see are similar to estrogen: depression, mood swings, brain fog, also uterine fibroids. You’ll also see excessive bleeding, so if you’ve had a history of a very heavy menstrual cycle, that could be either too much estrogen, or not enough progesterone, or a combination of the two, water retention, breast tenderness, memory issues and being tearful. Symptoms of low androgens, so these are mainly testosterone and DHEA. Women do need testosterone, they just don’t make as much as men. Then DHEA is made by the adrenal glands but if these drop, we’ll see a drop in sex drive, aches and pains. You’ll see a decrease in muscle mass, so it’ll be more difficult for you to build muscle or you might be a little flabbier in your muscle and in your muscle tone, more so than you used to be. Thinning skin, bone loss, rapid aging, and then you might actually experience ringing in the ears if these are low. Then the opposite, high androgens, and the main reasons we will see high androgens in women is if they have what is called PCOS, also known as Polycystic Ovarian Syndrome. PCOS can create high androgens as well as what we call insulin resistance.
Insulin resistance is a problem if you have difficulty metabolizing blood sugar or if you’ve eaten a lot of sugar, a lot of carbohydrates, if you’ve eaten a lot of comfort food over the years, binges, things like that, or a lot of alcohol intake. All of these can cause blood sugar and insulin surges. This can create an androgen dominance, too much testosterone, too many androgens in the body. So you’ll see acne, hair loss. We may see high cholesterol and triglycerides. Then you’ll see what’s called hirsutism or increased facial and body hair. Sometimes in women, we’ll see black male patterned facial hair growth, like a mustache, or on the chin where you’ll see heavy hair growth in the side burn area and things like that. Weight gain around the hips and waist, which can be very difficult to lose, oily skin and then a lot of mood swings. The adrenal glands are really important when you’re transitioning into menopause and beyond. Adrenal gland imbalances are mainly going to be due to some kind of either psychological, or physical stress, or a combination of two, fatigue, sleep problems, low stamina, just difficulty getting through the day, getting through tasks, getting through workouts, either salt or sweet cravings, dizziness, especially when standing up quickly, headaches, ringing in the ears. You could experience anxiety or depression, or combination of the two, muscle aches and brain fog.
Adrenal imbalances are extremely common in our society today because we’re overworked and overstressed. If you do have low progesterone, progesterone replacement can provide some good benefits, someone may notice their mood gets better. Then these issues with estrogen, like uterine fibroids, endometriosis, fibrocystic breast, where there is usually too much estrogen, progesterone will help to balance that. Progesterone does facilitate the thyroid, so some women will notice improvements in their metabolism, their body temperature, better sleep. That’s because progesterone has an overall calming effect on the brain, on the nervous system. It helps to calm women down. That’s why a lot of women like to take it at night to sleep better, better blood sugar metabolism. It really helps with many of the menopausal symptoms, especially hot flashes. It’s a natural diuretic, so if you’re holding a lot of water, it can help there. Progesterone really helps to build bone. Estrogen helps to maintain the quality of the bone and testosterone makes sure that the bone is very rigid and very hard. So you need a healthy balance of all three of those. Then, if you’re still cycling, progesterone can help with PMS. Your body makes actually three different types of estrogen, estrone, estrodiol and estriol. This is about the actual percentages that your body makes. Premarin is primarily estrone. Estrace is 100% estradiol.
You would think that if were going to go on hormone replacement therapy, you would want to take these in more of a natural balance of what your body produces. However, conventional hormone replacement therapy gives you very high doses of either estrone or estrodiol. Estriol is not used, even though it is the highest percentage of estrogen made by your body. So you’ll find a lot of bio identical natural hormone replacement treatment plans will include a good amount of estriol to create a better natural balance of replacement in the body. DHEA, it’s made by the adrenal gland, as mentioned before. DHEA is what we would call a very anabolic hormone, meaning it builds things up. It’s really good for the brain. It’s good for building muscle and burning fat. It’s good for the liver. It’s also been useful in a number of conditions, like auto immune diseases, like rheumatoid arthritis and lupus. DHEA is really the most powerful activator on the sex drive in both men and women. If you’re post-menopausal and your sex drive is very low, chances are your DHEA is also going to be pretty low. So that’s one of the first things some women notice when they take DHEA – if they are low – is an improvement in their sex drive. It can also help with some other conditions that you see here. DHEA is also involved in healthy bone metabolism.
Testosterone can be beneficial for these, as well. You’ll see some similarities with DHEA because they’re both androgens. As I mentioned before, testosterone ensures that your bones are very very hard. That’s how it’s involved in good bone health, but you’ll notice better improvement in muscle mass, sex drive, sense of well-being. Women can boost their testosterone levels without taking it. If a woman takes DHEA, some of it will convert to testosterone because testosterone is pretty strong and pretty powerful. So if a woman is going to take it, it should be under the guidance of a physician at a very low dose. Now, if you just want to increase it, resistance training focused on building lean muscle mass will raise your testosterone, assuming that you’re eating enough protein and enough healthy fats, you can increase your testosterone that way. I’ll just talk briefly about pregnenolone because we do use this in some women. Pregnenolone is actually the precursor to all of your adrenal and your sex hormones. The levels are highest in the brain. We find it most beneficial for fatigue, brain fog and depression. Here we can see how stress can affect your hormones. You can see here at the center is pregnenolone, and that’s made from cholesterol. You probably didn’t know this but all of your adrenal and your sex hormones come from cholesterol.
Pregnenolone gets converted into progesterone, or pregnenolone converts into DHEA, and then DHEA can make estrogen and testosterone. However, if you’re under a lot of stress, if you have adrenal gland imbalances, we have what’s called a pregnenolone steal, meaning that your pregnenolone is being stolen to make cortisol; a stress hormone. You can see that stress can affect all of your other hormones because if there isn’t enough pregnenolone to make them because of stress, then they can become low and out of balance. This is really the core reason why I always like to test the adrenal glands with women who want to explore hormone replacement therapy, to make sure we don’t have this scenario happening. So just the couple of herbs, these you probably know about. The black cohosh, that’s one of the most popular over the counter remedies for menopausal symptoms, especially hot flashes and night sweats, might even help a little bit with vaginal dryness, sleep problems and mood swings. It’s just a gentle phytoestrogen, meaning that it can bind estrogen receptors and make your body think that your estrogen levels are okay. Then we’ll also use chaste berry, also known as vitex agnus castus. This works on the pituitary hormones, these are made in the brain. LH signals the ovaries to make more progesterones. FSH signals the ovaries to make more estrogen.
So chaste tree can work well to balance those. That can be utilized either while you’re menstruating or post-menopausal. These two are fairly safe and effective over the counter. Now, let’s talk about the best methods of delivery for taking natural hormones. Creams, now, a lot of women try progesterone cream. They get it on the internet or over the counter, but they don’t really notice any improvements in how they’re feeling. That’s mainly because the cream is not being applied correctly. If you just apply it to your skin in various places, you’re not really going to get very good absorption. So these types of creams are best applied to the vaginal labia, which is a mucosal barrier. That is where the best absorption is going to happen. That’s also where we’ll notice the best improvement in symptoms.
Sublingual, meaning just under the tongue, some of it will just get absorbed directly into the bloodstream, through the mucous membranes in the mouth, and into the blood vessels. Some of it, though, as you swallow it, will go through the liver and be metabolize that way. But sublingual works extremely well. Then capsules, this can be affected by the integrity of the digestive system and the liver, how well the liver is detoxifying, the gall bladder, and things like that. Usually, you’ll see women taking a progesterone capsule and then they’ll be using a vaginal estrogen cream, for example, or you can use the combination of the two.
We will use creams when there’s vaginal dryness and low sex drive. It works really well for that. The oral or the sublingual tends to work better if there are issues with sleep, hot flashes or issues with the brain, like mood swings, depression and anxiety. But each woman just has to find out what method works best for her. What’s the best form of testing? Salivary hormones are very very popular. They’re readily available, easy to do the testing, but they’re not really that great for sex hormones. Blood is going to be fairly accurate. However, you’re not seeing how the body is metabolizing each hormone. Hormone levels can fluctuate quite a bit over a 24 hour period. So if you take a salivary test or a blood test, you’re mainly going to get a snapshot of when the sample was actually taken. If you do for salivary samples, you’ll get a little bit better view. However, again, I’m not really a good fan of salivary hormones. Urine is really the method that I prefer. There are a couple of options. There’s a 24 hour urine, which can be difficult to get every single collection of urine over a 24 hour period. So we use what’s called urine spot testing, which is four or five single samples taken over a 24 hour period. This has been shown to be equal to a full 24 hour urine, as far as its accuracy.
So the great thing about the urine testing is that not only do you get the actual hormone levels, but you get to see how the hormones are being metabolized. Whereas saliva and blood, you don’t get to see that metabolism. How hormones are being metabolized can be just as important as the hormone levels themselves, so that’s why we prefer urine testing. The key, really, to getting your hormones balanced is being precise. Your hormone levels really should be tested. One example of the reason why is because, for example, thyroid function is intimately involved with estrogen metabolism. So we’ll always look at the thyroid in detail to make sure that’s working well if we’re going to consider hormone replacement therapy, as an example. You’ll also want to look at all the other systems of the body, like I said, the thyroid, your blood sugar. Maybe the insulin resistance is creating too much testosterone and DHEA. Maybe the liver isn’t detoxifying or metabolizing your hormones the way that they should, the kidneys, the adrenals, your digestive function. So if you have issues with stomach acid or yeast overgrowth, parasites, and then what we’ll call dysbiosis, where the bacteria in the digestive system are out of balance, that can effect a hormone metabolism.
It’s really important to take a look at the whole body, the whole bio-chemistry, before doing any kind of hormone replacement. Otherwise, there could be issues with absorption, metabolism, and detoxification of these hormones and how your body is actually using them. For more information, we didn’t get into a tremendous amount of detail on the adrenals but I did create a webinar called Restore Your Adrenals, if you want more information on that. My website, drhedberg.com has quite a bit information on the thyroid, the adrenals, and your sex hormones. We like to do our testing through precision hormones. That does the urine spot testing. I have no affiliation with that lab, it’s just my favorite lab to test with. I think they provide the most precise and the most accurate results. So these are some great resources to get started on. This should have given you a pretty good overview of what you should know before considering hormone replacement therapy. Now you kind of know the symptoms to look for if one of your hormones or more than one is out of balance.
We’ve looked at the benefits of these hormones, if they’re low. I want to reiterate how important it is to know what your hormone levels are before you would actually take them because it can be very very dangerous to take a hormone if you don’t know what your levels are. One example could be DHEA. I have seen a number of people who have just taken it because they read about the benefits. But their levels were not low, so they actually had normal DHEA levels. Then they started taking a lot of it and it just created all kinds of symptoms and health problems for those individuals. So get checked by your doctor, get tested, and again, make sure that you work with someone, say a functional medical practitioner, who can really evaluate how the other systems of your body could be interacting with your hormones. I hope you’ve enjoyed this webinar on hormone replacement therapy for women and we’ll see you next time. Take care.