Bioidentical Hormone Replacement Therapy
Estradiol, the hormone of Femininity
At menopause, the ovaries stop producing eggs, estrogen, and progesterone. When the egg supply is exhausted, usually between age 40-60, the ovary ceases producing the hormones needed to prepare for, and maintain, pregnancy. Estrogen production begins in earnest at menarche, and effectively ends at menopause. The female figure, sexual vitality, and numerous tissues (heart/cardiovascular system, bones, breasts, genitourinary tract, skin) are dependent upon the female hormones (estrogen and progesterone) to activate these various tissues and functions.
The menstrual cycle ends with menstruation, and begins again with maturation of a new ovum and uterine lining, proceeds to ovulation, maturation of the corpus luteum (the remnant on the developing ovum left on the ovary) which secretes progesterone to maintain a fertilized egg. The cycle ends when progesterone levels drop, which results in bleeding and preparation for a new cycle of growth.
The cycle is controlled by the pituitary, which secretes FSH (Follicle Stimulating Hormone) at the beginning of the cycle to develop an ovum from the supply of eggs present in the ovary at birth. At midcycle, the pituitary secretes a surge of LH (Leutenizing Hormone) to stimulate the release of an ovum from the ovary. The progesterone secreted by the corpus luteum maintains blood flow to the uterine lining, keeping it well nourished, and able to maintain pregnancy if the ovum is fertilized within a day or two of ovulation. After about 28 days, LH drops, the corpus luteum ceases to produce progesterone, the arterioles to the uterine lining constrict, the uterine lining (the endometrium) loses viability and sloughs off, and the cycle begins again.
During this dance of fertility and femininity, body tissues besides the uterus are affected by the progesterone and estrogen secreted by the ovary. The bones are stimulated to lay down collagen fibers, and calcium to harden the bones. The arteries are kept clean by MMP (Matrix Metallo Proteinase) an enzyme that dissolves plaque. The skin and fat depositions (breasts, hips, thighs) characteristic of youth and the female form, are primarily created and maintained by the stimulation of estradiol, the active estrogen. Progesterone, moderates the proliferative effects of estradiol, keeping the cell multiplication under control, thus reducing the risk of cancer of the uterus, breasts, and ovaries.
During the years of fertility, ovulation, and menstruation, the high levels female hormones (i.e. the alternating cycle of estrogen and progesterone) keep females largely protected from osteoporosis, cardiovascular disease, the female cancers (uterine, ovarian, breast), and the atrophy of the urinary tract, and narrowing of the vaginal introitus, that leaves older women subject to dysparunia (painful intercourse) and UTIs (urinary tract infections).
Thus, the rationale for BHRT (Bioidentical Hormone Replacement Therapy): after the reproductive years have ended, the sudden drop in estrogen leaves many women with the menopausal syndrome of hot flashes, night sweats, and mood lability. Replacement of the now-missing hormones, estradiol and progesterone, to average levels associated with the menstrual cycle, stops the hot flashes/night sweats.
With BHRT (Bioidentical Hormone Replacement Therapy) Estradiol is not given alone. During the years of menstruation, the female body is secreting both estrogen and progesterone. Likewise, after menopause, when giving bio identical replacement hormones, we administer both estrogen (estradiol) and progesterone. Just as during the second half of the period after ovulation, progesterone prevents the uterine lining from becoming thicker, we obtain the same result when both estradiol and progesterone are administered continuously from menopause till the end of life.
There are several types of molecules referred to as estrogen, E2 estradiol, E1 estrone, and E3 estriol. Estradiol is the most biologically active, with estriol having an activity about 1/80th that of Estradiol. Both estrone and estriol are breakdown products of Estradiol. Some practitioners doing BHRT believe that it is more natural to give estradiol, estriol, and estrone in the proportions found in the menstruating female. I have chosen to practice according to the theory that the body makes estradiol first, and then forms its own estriol and estrone by breaking down estradiol.
The concern about the female cancers has been alleviated by research showing that when estradiol and progesterone are administered together, there is no increase in the rate of cancers, and a decrease in osteoporosis and cardiovascular disease.
Research showing an increase in the rate of female cancers with non-identical estrogens and progestins (synthetic non-identical progesterone) should not be confused with BHRT, where actual bioidentical estrogen and progesterone are administered.
The benefits of BHRT are: maintenance of bone density, cardiovascular health, no increase in female/gynecological cancer risk, and maintenance of skin/Genitourinary health.
To access this therapy, call Dr. Thomas Abshier at 503-255-9500 to schedule an office visit. Fill in the intake form, print it and bring in to the office visit or email it. Read the Informed Consent document, send an email, or print and initial a copy that you agree to its terms. You will be given a lab requisition for doing a blood draw at a local laboratory to assess estradiol, progesterone, and a basic chem screen and CBC to assess your general health.
I encourage a full hormone evaluation (and repletion of the full suite of hormones). This includes: estradiol, progesterone, thyroid (TSH, Total & Free T4, Free T3), testosterone (Free & Total), DHEA-S (precursor to testosterone, IGF1 (the indirect marker for hGH - human Growth Hormone), Vitamin D (25-OH, for bone and immunity), Pregnenalone (for memory), and Oxytocin (for sexual response). If this panel is too costly to afford all at once, then any of the hormones may be evaluated, and then supplemented sequentially.
Each hormone is prescribed through a compounding pharmacy, either local or out of state, depending on your location and convenience.
Your hormone levels will be retested every month until the supplement/repletion levels reach the target level (young adulthood), and then retested every year after that.
(Note: I do not do saliva testing of progesterone, as it shows up as being extremely high when using transdermal creams. The blood serum level can be quite low even though the saliva progesterone levels is very high.)
I encourage doing a chem screen (lipids/cholesterol, hepatic panel, electrolytes) and CBC on an annual basis.
If the progesterone and estradiol are low (as they are almost certainly if the periods have stopped for 1 years), then they will be supplemented/repleted to the average levels during the years of menstruation. If any symptoms arise, such as breast tenderness, vaginal/uterine bleeding, or any other discomfort, then please call me, Dr. Thomas Abshier, at 503-255-9500. I charge the same rate, $75/hr, for phone visits, or email consultations. Payment is expected at the time of service.