Wellness and You
Estrogens and Menopause
August 25, 2008
A 37-year-old patient has tested for estrogen levels less than
32 pg/mL. She has all symptoms of menopause and post-menopause in
spite of continuing monthly periods. How can this happen?
I've long said that judging the adequacy of a woman's hormonal
status by the presence or absence of periods is like judging the
adequacy of a man's hormonal status by the presence or absence of
a five o'clock shadow.
Actually, women are more complicated than that. While a man's five
o'clock shadow fluctuates fairly well with his relative testosterone
level, a women's periods reflect the estrogen levels for the entire
time since her last period.
Following the last menses, the body starts to increase estradiol
levels causing the new lining of the uterus (endometrium) to proliferate
(grow thicker). If mid-cycle ovulation occurs, the body begins making
progesterone shortly after that. Progesterone stops the proliferation
of the endometrium, and helps it mature into one suitable for implantation
of a fertilized ovum.
Then, if there is no pregnancy, the progesterone levels will drop
12-14 days following ovulation. It is this drop in progesterone
that begins the next period, when everything is working right.
The level of estradiol needed to make the endometrium grow is often
much lower than the body and brain needs for optimal function. Additionally,
a blood test is a snapshot of a dynamic process that varies from
day to day, and even hour to hour.
Most importantly, those "normal" ranges that doctors
use to check estradiol levels are not necessarily "healthy".
They simply reflect what is average for specific age groups in the
women (usually those that we suspect are too low on estradiol) we
send to the Laboratory.
At our lab, "normal" estradiol levels are:
|Post menopausal women
||From day 1 of bleeding until ovulation at midcycle
||From ovulation to bleeding
||Up to 36 pg/mL
||Males and females before puberty
Obviously these "normal" ranges are too broad to accurately
reflect how a women is really doing.
A lack of natural estrogens (those estrogens that are naturally
found in people) can cause a wide variety of symptoms; and, much
of the time, the synthetic estrogens (chemicals not found in people)
do not have the same beneficial effect on the brain.
If you and your physician decide upon hormone supplementation to
normalize symptoms it is important to know the difference between
“bioidentical” and “synthetic” hormone replacement.
"Bioidentical" simply means hormones with the same molecular
structure as those found naturally in the body, as opposed to those
extracted from pregnant mare urine (Premarin and others), or those
made in a laboratory and patented so higher prices can be charged
for them. Medically, natural hormone replacement (lab-created hormones
molecularly identical to those naturally made in the body; often
referred to as "bioidentical" hormones), mostly acts to
postpone the degenerative changes that occur with menopause. The
side effects tend to be much less, and the benefits tend to be much
better, than with synthetic hormones.
Synthetic hormones simply means those that are “put together
in a laboratory.” They may or may not be molecularly identical
to those found in the human body.
One of the more commonly used estrogens is extracted from the urine
of horses. Premarin, (PREgnant MARe urINe) can cause elevation in
blood pressure, joint pains, and trigger autoimmune responses in
some people. A very common situation is that the foreign estrogens
(those not naturally found in the human body) may work well for
some of the things that estrogen does, for example, get rid of hot
flushes or bring about a period, but they may not help the brain
with mood or memory in the same manner as bioidentical estrogens.
On the other hand, carefully used natural or bioidentical hormone
supplements can actually improve mood, memory, energy, and sleep.
At the very least, natural progesterone can save women from bone
loss and prevent billions of dollars in health care costs for osteoporotic-related
fractures and the long term pain and disability.
In "Screaming to be Heard: Hormonal Connections Women Suspect...And
Doctors Ignore," Dr. Elizabeth Vliet gives an excellent explanation
of this phenomena.
I have observed in my profession that many doctors like to feel
that they know what is "right" for the patient, and are
not particularly interested in discussion. Other physicians like
to provide information about options so informed consent can be
provided for any treatment received. I strongly suggest finding
a physician in the latter group. It is quite possible that addition
health issues such as thyroid problems, adrenal deficiencies, and
vitamin deficiencies (especially B-12 and D) may show up. It is
extremely common for women with thyroid problems to have a hysterectomy
for painful, heavy clotting periods. Most docs have forgotten that
the problems that hypothyroid women most frequently have include
"periods from hell," infertility, miscarriages, and depression.
In addition to considering hormone replacement with bioidentical
hormones if a low estrogen status is found, it would be a good idea
to have a DEXA bone density test to determine the state of bone
health and steps can be taken to prevent bone loss. I would encourage
you to read our segment on osteoporosis for more information, particularly
the section on "therapies" (choose from the right-hand
column). Click here.
For more information visit the website of
Board Certified in Psychiatry and Board Eligible in Neurology
with special interest in Thyroid, Adrenal, Chronic Fatigue,
and Natural Hormone replacement for men and women.
other articles by Dr. Michael:
and Breast Health