Safe alternatives to Estrogen replacement

by Dr. Joseph Debé

Imagine a pill purported to improve mood and memory, protect against heart disease and osteoporosis, and relieve uncomfortable symptoms associated with menopause. It is called Premarin. No wonder it is the top-selling drug in America. Premarin is estrogen derived from horse urine and is not identical to human estrogen. The truth is there is a lot wrong with using Premarin at menopause. The one thing I would like to point out is that published studies have concluded that horse estrogens are carcinogenic (cancer-causing). A recent finding? Would you believe 1938!?

The good news is that new scientific discoveries are leading to safe, effective ways of raising estrogen levels/action, thereby improving a woman's health in a more natural way. It is useful to have a little understanding about estrogen metabolism to understand what can go wrong and what approaches will correct the problem. Estrogen is produced by the ovaries and plays an important role in reproduction, secondary sexual female characteristics and more. Ovarian estrogen production basically (not entirely) begins at puberty and ceases at menopause. This is normal. However, other factors can result in deficient estrogen activity before menopause. Many factors determine if estrogen will have healthy desirable effects in the body. These include: Production by the ovaries and other tissues, transport in the bloodstream, binding to cell receptor sites, conversion to secondary metabolites, detoxication in the liver, elimination/recirculation from the intestinal tract, and balance with other hormones such as progesterone and testosterone.

Some of the symptoms and conditions associated with low estrogen activity are: amenorrhea (cessation of periods), infertility, heart disease, depression, cognitive/memory problems, Alzheimer's disease, osteoporosis, accelerated biological aging, hot flashes, hair loss, dryness of the hair, skin, eyes and vagina, polycystic ovary syndrome, and symptoms of androgen dominance, which will be described shortly.

Low estrogen levels can be corrected in many ways, depending on the cause. Estrogen production can be suppressed by chronic inflammation. Inflammation can be assessed with blood tests. Sources of inflammation to investigate (and then resolve) include infection, toxicity, food sensitivities, stress, and nutrient imbalance.

A physiologic state that contributes to inflammation is hyperinsulinemia (elevated insulin levels). High insulin levels are associated with abnormal carbohydrate metabolism and can increase production of male hormones, producing androgen dominance. Conditions associated with this state are polycystic ovary syndrome, weight gain, increased fat around the midsection, infertility, mood swings, fatigue, increased blood triglycerides and reduced HDL cholesterol, irregular periods, infertility, scalp hair loss, male pattern hair growth, and acne. Hyperinsulinemia is best diagnosed with a two-hour glucose-insulin tolerance test. The solution to this problem is to improve the way insulin works in the body through dietary modification, nutritional supplementation, exercise, and weight loss.

Food intake can influence estrogen levels in several ways. The body manufactures estrogen from cholesterol. If blood cholesterol levels are too low, estrogen levels will be suboptimal. Eating cholesterol-rich foods, such as egg yolks or organ meats may help. Alternatively, or in addition, supplements of cholesterol are an option. Sonic Cholesterol is such a product. Low blood cholesterol levels should prompt an investigation as to why. Maldigestion and malabsorption (as result from gluten sensitivity and inflammatory bowel disease) are common contributors to low blood cholesterol.

Some of the estrogen in circulation is recycled hormone derived from the intestinal tract. The body excretes estrogen into the intestines for elimination. Bacteria in the intestines produce enzymes that result in re-absorption of estrogen. This process is stimulated by eating more frequently and by eating red meat. Not surprisingly, I have observed that my premenopausal patients who suffer amenorrhea are usually vegans.

Low levels of estrogen can result from inadequate concentrations of the stress hormones cortisol and DHEA. Cortisol stimulates fat cells to convert DHEA to estrogen.  If cortisol or DHEA are low they can be normalized through supplementation, herbs, and stress reduction. If the woman is too lean (as is seen in anorexia nervosa) for whatever reason, attaining adequate body fat status will aid estrogen production from DHEA, testosterone and androstenedione.

A number of natural compounds can slow the breakdown, and thus increase retention, of estrogen in the body. These include grapefruit, the B vitamin PABA, and the plant compound quercetin. The mineral boron has been shown to raise estrogen levels in postmenopausal women. Another consideration is the herb Black Cohosh. It increases the production of FSH (follicle stimulating hormone) by the pituitary gland. FSH, in turn, stimulates the ovaries to produce more estrogen. 

Cigarette smoking accelerates the activity of detoxication enzymes that remove estrogen from circulation. Therefore, female smokers with low estrogen levels can improve levels by quitting smoking.

An approach that is particularly appropriate for the low estrogen of menopause is to use soy products and supplements. Soy contains isoflavones, which are compounds that are structurally similar to estrogen. They have weak estrogenic activity but, taken in adequate concentration, can produce beneficial effects. Isoflavones can be consumed in soy products or taken in supplemental form. Beware that some soy products are poor sources of isoflavones. If you choose to eat soy foods or take soy supplements, make sure they are not from genetically-modified sources. 

Hands down, the most effective supplement for perimenopausal and menopausal symptom relief is Estrovera®. This is an extremely well-reserched plant-based product, derived from Siberian rhubarb root. It is as effective as low-dose estrogen replacement but, because of a different mode of action, doesn't carry the risks. In fact, there is reason to believe that this product could protect against breast cancer. Unlike Premarin, Estrovera® targets the estrogen receptor beta, which translate to healthful physiological changes.

One other item of note: I have observed symptoms of estrogen deficiency in patients who are overdosed on progesterone, DHEA or testosterone replacement. These hormones must be in proper balance for good health. In my experience, progesterone creams result in overdosing more times than not. These hormones are best evaluated with salivary testing, which I have been doing through Diagnos-Techs Lab for almost 20 years.


Sample Salivary Female Hormone Panel Report

Sample Salivary Menopausal Hormone Panel Report