by Dr. Joseph Debé
Thousands of holistic practitioners around the country (and many so-called traditional ones, too) are heralding in a new era of medical treatment based on state of the art laboratory testing. This testing offers new hope to patients with a variety of conditions, including women suffering from conditions of hormonal imbalance.
Many women today are finding better answers to a long list of conditions caused, in part, by imbalance, excess, insufficiency or altered timing in secretion of the sex hormones. These conditions include uterine and breast cancers, premenstrual syndrome, painful and prolonged blood flow, amenorrhea, infertility, cystic breasts, polycystic ovary disease, endometriosis, uterine fibroids, urinary tract infections, recurring headaches, miscarriage, perimenopausal and a variety of menopausal symptoms. In addition, studies show that there is a hormonal component not only to osteoporosis, but also to Alzheimer's disease and cardiovascular disease.
What are these tests, and how are they different? Let's examine just one variety, the Female Hormone Panel and Post-Menopause Hormone Panels, which utilize saliva specimens to measure levels of estrogen and progesterone. Doctors have been using blood samples to evaluate these hormones for years. So what's the advantage of using saliva specimens?
Hormones exist in both protein-bound and unbound (or "free") forms. The free hormone, found in saliva, is biologically active, and does the active work of the hormone. The hormone in blood is primarily protein-bound, or inactive. Therefore, salivary hormone measurements are more meaningful, and their accurate measurements can lead to more effective and individualized treatment.
Salivary testing offers other advantages, too. First, let's examine the Female Hormone Panel. This test is appropriate for premenopausal women and those less than five years past menopause. Eleven saliva samples, taken on separate days over the course of a woman's menstrual cycle, are mailed to the laboratory, which measures the hormone levels from each sample and plots them on a graph. Normally, estrogen levels peak mid-cycle, followed by elevations in progesterone in the latter part of the cycle. So, we wind up with a picture of the fluctuations in hormone levels over the course of a cycle. This is tremendous information to have, and can obviously not be obtained with a one-time-only blood sample - even if it were an accurate testing method.
Each woman's hormone profile is unique. In fact, levels of hormones may vary from woman to woman up to fifteen fold! By contrast, a single blood specimen may show a particular hormone level, but tells us nothing about the rise and fall of the hormone over the course of a cycle. The Female Hormone Panel not only reveals whether estrogen (specifically estradiol, the most active estrogen) and progesterone levels rise too high or fall too low, it also uncovers defects in timing of hormonal output. The relationship between estrogen and progesterone is accurately portrayed with the Female Hormone Panel. This test also gives single measures of DHEA and testosterone. This information therefore allows for greater customization with regard to which hormones to supplement, the form to use (usually either pill, sublingual, or transdermal), the quantities to use, and the days during the cycle they should be taken.
These saliva tests reveal many women to be estrogen dominant - i.e., having high estrogen levels relative to progesterone - who might have been shown to have normal or even low levels with the blood tests. Estrogen dominance produces a myriad of symptoms and increases risk to certain cancers. It is therefore very important that a woman know she is estrogen dominant, so she can correct the problem, and not end up taking estrogen, which might exacerbate it.
There are a number of things women can do to lower estrogen levels naturally. These include exercise, reducing stress (more precisely, stress hormone levels), reducing meat consumption, consuming free range and organic food, increasing dietary fiber (especially oats), eating ground flax seeds and soybeans, losing excess body fat, and supplementing with acidophilus, bifidobacteria and calcium D-glucarate.
If a woman is more than five years past menopause, her hormones are no longer secreted in a cyclical fashion, and only a single saliva specimen is required. In addition to estradiol, progesterone, testosterone, and DHEA, the Post-Menopause Hormone Panel also measures estriol and estrone, two other forms of estrogen. (The traditional blood test only measures estradiol.) Estriol is the weakest form of estrogen and is non-carcinogenic. Estrone and especially estradiol are carcinogenic.
Again, results of this Post-Menopause Hormone Panel allow for customized hormone replacement. For example, if estriol were the only hormone found lacking, there would be no need to consider using estradiol, which is potentially dangerous, but is, however, the form of estrogen most commonly prescribed by traditional doctors. For a woman desiring hormone replacement the Post-Menopause Hormone Panel leads to appropriate therapy, minimizing overdosing and underdosing. This is a vast improvement over the way things are usually done.
You may be surprised to learn that doctors typically do not perform any tests before prescribing standardized doses of Premarin and Provera to menopausal women. Premarin (estrogen derived from horse urine) appears to carry a strong potential to cause DNA damage, which can initiate cancer. Provera, synthetic progesterone, is also somewhat dangerous. These are the hormones most commonly prescribed for replacement therapy during menopause.
It is a mistake to assume that every menopausal woman needs estrogen and progesterone replacement, let alone the same dosage. In actuality, many need no estrogen. And if they need it, the body has other sources of estrogen production besides the ovaries. DHEA and other hormones produced by the adrenal glands can be converted by fat cells into estrogen. The fatter the woman, the more likely her body will manufacture significant quantities of estrogen. Dr. Ilias Ilyia, director of Diagnos-Techs™ laboratory and developer of the Female Hormone Panel, has found that seventy percent of women given supplemental estrogen did not need it in the first place!
When estradiol, estrone or estriol are found to be lacking on the Post-Menopause Hormone Panel, natural forms of the particular hormone should be considered. The same is true of progesterone. These natural forms of both hormones, manufactured from plant sources, are available from compounding pharmacies and are identical to the body's own hormone. Repeat testing several months later can help fine-tune an individual woman's therapy.
These hormones should not, in my opinion, be used in the form of a cream applied to the skin. For instance, "natural" progesterone and Mexican wild yam creams are particularly popular with women today. However, some research questions the body's ability to convert wild yam into hormones, as claimed. Diosgenin from wild yam can only be converted to progesterone in a laboratory. These creams often contain hormones that are not listed on the label. Another drawback is that even if the amount of hormone is listed on the label, a woman cannot know how much she is taking because the hormones oxidize and degrade with time.
There is an even more dangerous problem with hormonal creams: possible overdosing. Some of the hormone in these creams passes quickly into the bloodstream upon application to the skin. Once in the blood, it circulates throughout the body, influencing metabolism. A percentage of the hormone in these creams does not pass directly into the bloodstream but instead gets deposited in the subcutaneous fat, which acts as a reservoir. The hormone stored within the fat slowly leaks into the bloodstream. With continued application of hormone cream to the skin, day after day, hormone levels in the blood rise in an exponential fashion due to the contribution of the hormone from the fat stores. This very easily leads to excessive levels of the hormone in circulation. I routinely see patients who have used natural progesterone and other creams whose salivary hormone level are so high they are beyond values the laboratory even tests for! Progesterone overdosing can produce weight gain, water retention, breast engorgement and depression. Not only does an excessive concentration of a given hormone produce toxicity in and of itself, but it leads to further damage by imbalancing other hormones with which it shares complex relationships.
So how should a woman who needs natural progesterone, get it? Sublingual and pill forms are two reliable methods.
Another option to consider before estrogen replacement therapy is the enhancement of the body's own levels. For instance, assuring adequate intake of fat - particularly animal fat - promotes higher levels of biologically active estrogen. American vegetarian women have been found to have 20% to 40% lower levels of estrogen circulating in blood than women who eat plant and animal foods, and I have observed that vegetarian women have a greater incidence of amenorrhea (cessation of the menstrual cycle). Underweight women can increase their estrogen levels by attaining normal weight. Since conversion of DHEA to estrogen is spurred by cortisol, assuring adequate levels of these adrenal hormones is important. The mineral boron has been found to increase estrogen levels when given in supplemental form. Licorice, P.A.B.A., and naringinin (found in grapefruits) can slow the body's elimination of estrogen and thus increase its retention. Caution must be exercised with this approach, as other hormones and chemicals are also retained in circulation.
Soybeans may also offer a viable alternative to estrogen replacement therapy. The power of soybeans is due to isoflavones, available in supplemental form, which have estrogen-balancing actions. Isoflavones produce many of the same effects as estrogen but cannot substitute for it in all its capacities. Isoflavones, like estrogen, have beneficial effects on bone, the cardiovascular system, the brain, and also reduce symptoms of menopause such as hot flashes. Besides estrogenic activity, isoflavones exert many other beneficial actions in the body, including anti-cancer effects. This is why, while estrogen is associated with an increased risk to breast cancer, isoflavones inhibit breast cancer cell growth.