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Hormone Replacement Therapy
The hormone "balancing" being done to women uses synthetic and abnormal versions of the real goods, when the natural hormones are available, safer, and more appropriate to their bodies. It should be clear that nature produces the substances that serve us best. The production of hormones is a dynamic, fluctuating system: constantly responding to changing body conditions and needs. Hormones are the control messengers for a vast, interrelated, ever-changing network of organ-system commands. As such, they must be continually synthesized for moment-to-moment situational needs and likewise must be metabolized and removed from the system when no longer needed in order for their presence to fall as their need diminishes. The liver is constantly metabolizing and excreting hormones as they pass through in the bloodstream.
Progesterone, in addition to its own hormonal effects, is a main player in the creation of all these hormones. Various cells in key organs throughout the body use progesterone to create the other specific hormones, as needed, specifically the adrenal corticosteroids, estrogen, and testosterone. This precursor nature of progesterone distinguishes it from many other hormones that are at a metabolic end point, meaning they are unable to be used further expect to be broken down for excretion. The synthetic progestins now being heavily promoted in hormone replacement therapy (HRT) have undergone molecular alterations at unusual positions. As these strange, not-found-in-nature molecules travel down the hormone pathways, they occupy progesterone receptor sites, create actions different from natural progesterone, cannot be used as precursors of other hormones (as progesterone can), and are difficult for the body to metabolize and excrete. These molecular alterations carry a heavy burden of potential undesirable side effects. Most of the progestins are synthesized from progesterone or from another hormone called nortestosterone and are not found in any living forms.
Throughout much of the medical literature, natural progesterone is either equated with progestins, as if they were the same thing, or classed as one of the progestins, which is also incorrect. There is only one progesterone, the specific molecule made by the adrenal glands or by the ovary as a result of ovulation. Natural progesterone is necessary for the survival and development of the embryo and throughout pregnancy. On the other hand, Provera, the most commonly prescribed progestin, carries the warning that its use in pregnancy may increase the risk of early abortion or congenital deformites of the fetus. These are only two of the many serious side effects of the progestins. Many synthetic drugs are made patentable simply by changing a few atoms of the natural substance. This may sound harmless enough, but the addition of or subtraction of a few atoms of a molecule can make a big difference in their effects on the body. This holds especially true with hormones. Tiny amounts can create major effects on the whole body. The molecular difference between testosterone and estradiol (a form of estrogen) is one hydrogen atom and a couple of double bonds. Adding or subtracting one hydrogen atom at a specific place on a molecule can make the difference between a man and a woman! In the mid-seventies, a Mayo Clinic consensus conference concluded that estrogen should never be given to any woman with an intact uterus (any woman who hasn't had a hysterectomy) without also giving progesterone or a progestin as protection from endometrial cancer. The effect of this was to expand the market for progestins to include all women, whether menstruating or postmenopausal! The financial implications of this are staggering.
Our doctors need to be reeducated in the realities of their female patients' hormones. Women, today, are suffering from a real menopausal disorder of which we have only a rudimentary understanding and for which our present mainstream treatments are simply not satisfactory. The typical treatment with supplemental estrogen may reduce hot flashes and treat vaginal dryness, but it does so at the risk of inducing a higher incidence of endometrial cancer; it also causes unwanted fat and water retention. Turning menopausal symptoms into a disease of estrogen deficiency has resulted in Premarin, made from pregnant mare's urine by the Wyeth-Ayerst Company, being one of the top 10 prescription drugs sold in the United States. Hormone replacement sales overall in the year 2000 are up to a billion dollars a year! A large percentage of advertising and research dollars are spent trying to convince women that estrogen will cure everything from heart disease to Alzheimer's, but there is scant evidence for any of these claims, but reams of evidence that synthetic estrogens are highly toxic and carcinogenic. Any American woman of menopausal age that complains to her doctor of any symptom will undoubtedly receive a prescription for Premarin. Any symptom that persists after estrogen supplementation is often considered trivial or cause for a tranquilizer or mood elevator prescription and/or a referral to a psychiatrist.
Women are emerging from under a cloud of historic medical neglect and are rightly demanding new and more effective approaches. After being told that diethylstilbesterol (DES), a hormone that was supposed to guard against miscarriages, was safe, hundreds of thousands of women discovered the hard way that it caused cancer in their children. Women were told that Valium was a safe and effective remedy for depression, only to find out that it was addictive. Now, their physicians are trying to convince them that once they have reached menopause they should automatically go on hormone replacement therapy featuring synthetic estrogens and progestins, which are making them sick and putting them at risk for cancer, strokes, and heart disease. The real tragedy is that the natural forms of these hormones, used wisely and in moderation, could be of very real benefit to millions of women. When estrogen is unopposed by progesterone, it creates an estrogen dominance condition, causing salt and water retention; increased blood clotting, promotes fat production; opposes thyroid hormone; promotes uterine fibroids, mastodynia (breast pain) and fibrocystic breasts; increases the risk of gallstones and liver dysfunction; and increases the risk of endometrial cancer, pituitary tumors (prolactinoma), and breast cancer.
There are 30 million menopausal women in North America and some 20 million women on the brink of menopause, a perfectly natural part of a woman's life cycle that has been turned into a disease by the Western medical profession and pharmaceutical companies. Even the threat of breast cancer has not stopped the market for estrogen/progestin hormone therapy. Menopause is the cessation of menses, the end of menstrual cycles. The unpleasant "symptoms" of menopause that some women suffer, such as hot flashes, vaginal dryness, and mood swings, are peculiar to Western industrialized cultures and they are virtually unknown in the Far East and third-world countries. In native cultures, menopause tends to be a cause for quiet celebration, a time when a woman has completed her childbearing years and is moving into a deeper level of self-discovery and spiritual awareness (croning). She is becoming a wise old woman. In these cultures, menopausal women are looked up to and revered. They are sought out for advice and their opinions are heavily weighed in the decision-making process of the community. In the Western world, menopause is known as a horrible time, the end of a woman's sexuality, a descent into a dried-up and painful old age of arthritis and osteoporosis. It's a combination of poor diet, unhealthy lifestyle, environmental pollutants, cultural attitudes, the incorrect use of synthetic hormones, and advertising.
In a normal menstrual cycle, every 26 to 28 days, the ovaries, which hold a woman's eggs, receive a hormonal signal from the brain that it's time to get some eggs ready to be fertilized. Anywhere from a few to a few hundred eggs begin to mature inside sacs called follicles. After 10 to 12 days one egg has moved to the outer surface of the ovary and the follicle bursts, releasing the egg into the fallopian tube for its journey to the uterus. The follicle then becomes the corpus luteum. As the egg is ripening in the ovary, the uterus is ripening in preparation for the possibility of growing a fetus. The uterine lining thickens and becomes engorged with blood that will nourish the growing embryo. If no fertilized egg implants itself in the uterus, it sheds its lining. This shedding is the blood of menstruation. Then the cycle begins again, with the signal from the brain telling the ovary to ripen an egg.
Estrogen is the dominant hormone for the first week or so after menstruation, stimulating the buildup of tissue and blood in the uterus as the ovarian follicles simultaneously begin their development of the egg. Around the time of ovulation, estrogen causes changes in the vaginal mucus, making it more tolerant of male penetration during sexual activity and more hospitable to sperm. At this phase in the menstrual cycle, the vaginal mucus tends to somewhat resemble uncooked egg whites; there is a rise in body temperature at the same time. About twelve days after the beginning of the previous menstruation, the rising estrogen level peaks and then tapers off just as the follicle matures and just before ovulation. After ovulation, the now-empty follicle becomes the corpus luteum. The corpus luteum is the site of progesterone production, which dominates the second half of the menstrual month, reaching a peak of about 20 milligrams per day.
Progesterone production during this phase of the cycle, along with estrogen, leads to a refinement and "ripening" of tissue and blood in the uterus. Progesterone also contributes to the changes in the vaginal mucus seen at the time of ovulation. The rise of progesterone at the time of ovulation causes a rise of body temperature of about one degree F.--often used to indicate ovulation. If pregnancy does not occur within 10 to 12 days after ovulation, estrogen and progesterone levels fall abruptly, triggering menstruation, and the cycle begins anew. If pregnancy occurs, progesterone production increases and the shedding of the lining of the uterus is prevented, thus preserving the developing embryo. As pregnancy progresses, progesterone production is taken over by the placenta and its secretion increases gradually to levels of 300 to 400 milligrams per day during the third trimester.
A woman's hormone balance can begin to shift at anywhere from her mid-thirties to her late-forties, depending on a variety of factors such as heredity, environment, how early or late she began menstruating, whether she had children and if so at what age and how many, and her lifestyle. Hormone balance is intimately connected to stress levels, nutrition, and daily environmental toxin. The ability of the follicles to mature an egg and release it may begin "sputtering," so-to-speak, a decade before actual menopause, creating menstrual cycles in which a woman does not ovulate, called anovulatory cycles. If she isn't ovulating, she isn't producing progesterone from the ovaries and she may begin experiencing menopausal symptoms such as weight gain, water retention, and mood swings. Menstrual cycles can continue even without the progesterone, however, so most women aren't aware that the lack of progesterone is causing their symptoms. This is known as perimenopause, or premenopause.
It used to be that the majority of women began menopause in their mid-forties to early-fifties. In the last generation, things appear to have changed. Women now may have anovulatory periods starting in their early thirties and yet do not experience cessation of periods until their fifties. During this time, the ovaries continue to produce estrogen sufficient for regular or irregular shedding, creating what Dr. John Lee calls estrogen dominance. Some women may go for years with irregular cycles and slowly wind down, or may just suddenly stop menstruating one month and never menstruate again. They may be overwhelmed with unpleasant symptoms or hardly notice what has happened other than not having to worry about birth control or buy tampons every month. How menopause is experienced is as individual and unique as each human being. During the many months of anovulatory periods, estrogen production may become erratic, with surges of inappropriately high levels alternating with irregular low levels. Periods of vaginal bleeding may become erratic, some much heavier than others.
When estrogen surges, women undergoing these changes may notice breast swelling and tenderness, mood swings, sleep disturbance, water retention, and weight gain. These may be the symptoms of estrogen dominance caused mainly by lack of ovulation and thereby lack of progesterone while their estrogen levels are still in the "normal" range. Their doctors may check their estradiol levels and the FSH (Follicle Stimulating Hormone) and LH (Leutenizing Hormone) levels, but rarely does it dawn on them that their patients' progesterone levels are too low. In taking the usual blood tests, the doctor may find the estrogen normal that day or even a bit on the low side and FSH levels a bit too high. On another day, the estrogen might be elevated and FSH levels normal. If the former is found, the doctor may even prescribe some estrogen on the theory that the patient is nearing true menopause. The woman usually finds that his does not help her. More often, the doctor ascribes her complaints to emotional causes or simply some defect of Mother Nature that women must endure.
Steroid is a generic name for dozens of body regulators (hormones) made from cholesterol. Cholesterol, the basic building block for the steroid hormones, gives them all a similar structure, resembling cholesterol in their basic structure. Switch a few atoms around and the role of the hormone can change dramatically. Some of the more familiar steroids are estrogen, progesterone, testosterone, the corticosteroids, and DHEA. The first step in the body's manufacture of steroid hormones from cholesterol happens in tiny energy packets called mitochondria found within every cell of the body except red blood cells. From cholesterol, the mitochondria make a hormone called pregnenolone, which, as it passes through the bloodstream to the ovaries and adrenal glands, can then be transformed into progesterone or 17-OH-pregnenolone. Then, from these two steroids, all the other steroid hormones can be made by relatively minor molecular modifications, depending on body need. Although the steroid hormones are remarkably similar in shape, each of them has markedly different effects, and these arise from very slight variations in their molecular structure. The steroid hormones are made primarily in the ovaries of women, the testes of men, and the adrenal glands of both sexes. The transformation from one hormone to another requires an enzyme, which in turn requires vitamin and mineral cofactors. A substance that is the source of another substance is called the precursor.
Pregnenolone is derived from cholesterol. The flow of hormones then progresses from pregnenolone along one of two major pathways: one down through the adrenal DHEA pathway, or straight down through progesterone in both the ovarian and adrenal glands. Both pathways lead to what is called metabolic end points. Aldosterone, cortisol, and the estrogens are the metabolic end points on the steroid hormone pathways. With the exception of the end points, all of the steroid hormone molecules are capable of being converted into some other molecule. Testosterone, for example, can be a precursor of the estrogen called estradiol, and androstenedione can be a precursor of testosterone or estrone, another estrogen. Estrone and estradiol can be interchanged into each other via a redox (reduction/oxidation) system in the liver. The ebb and flow of steroid hormones along their pathways is a result of enzyme action monitored and controlled by biofeedback mechanisms in the limbic brain (hypothalamus). Each enzyme performs but one function, such as the splitting of a single chemical bond in a specific molecule.
To perform that function, an enzyme must precisely "fit" the structure of the molecule, like a complicated key-and-lock system. Molecular conformation is the key to the smooth running of these enzyme pathways. Molecular conformation is the factor that distinguishes natural hormones most strongly from the synthetic versions sold by drug companies. Synthetic hormones have altered shapes not known in nature. Thus, synthetic steroids, such as those found in the typical hormone replacement therapy prescription, are not subject to the usual enzymatic pathways.
We don't naturally have enzymes designed to handle any of the synthetic steroids; their effects cannot be "tuned down" or "turned off" as needed, nor can they be efficiently excreted through the usual enzymatic mechanisms. Despite their advertisements, synthetic hormones are not equivalent to natural hormones. Harmony and balance are lost when biologically active synthetic compounds are thrown into the dance of the steroids. The problems they can create in the normal ebb and flow of vital steroid hormones is usually responsible for a great deal of hormonal imbalance. We know that atoms join together to create molecules. Although the atomic bonding necessary to create molecules involves a sharing of electrons not well understood, we can still glean information from nature's hidden forces. Steroids are stabilizing, energizing, and nurturing to our cells and tissues, ensuring repair and replication of vital body parts; protecting us against damage, and for fostering the genesis and development of a new life.
There are slight differences among the various steroids. They are made of the same parts but with minor variations in how the parts are put together, which correlates with the work each is doing. Each is designed with a specific job in mind. Some steroids will, in the blink of an eye, suddenly transform into another kind of hormone. This magical transformation is accomplished by protein globules (enzymes) passing amongst them, and, in a flash of electromagnetic energy, will leave them with slightly altered elements and new functions. In the liver, they are combined (conjugated) to bile acids and carried away to where they are needed. They are inactivated by hydroxylation (estrogens) or hydrogenated and conjugated with glucuronic acid (progesterone) for excretion in bile.
Estrogen replacement therapy (ERT) was first conceived in the late 1950's the era of "better living through chemistry." This was a time when the belief that, for every human ailment there was a drug to cure it, was being popularized. Both the chemical and pharmaceutical companies were learning the value of cleverly disguised public relations campaigns in which articles extolling the virtues of their products were "planted" in magazines and newspapers. The media participated with this approach, as they still do, reaping huge benefits in advertising dollars from these corporations. The public then, as they still do now, believed that if they read it in a major publication, or saw it on TV, it must be true. The major women's magazines are a virtual pipeline of information for drug companies, eager to push their products, under the guise of editorial neutrality. Women were thought to be at their best pleasing their husbands sexually and raising healthy, happy children. It's no coincidence that HRT was born just as the first big wave of American women, raised to be happy homemakers, was approaching middle age and menopause. Their children were leaving home, their hair was turning gray, and their breasts were sagging. Symbolically, their usefulness had come to an end: If they were no longer raising children, and no longer sexually attractive to their husbands, of what use were they? Psychological problems such as depression became common among women of this age. Millions of women became hooked on Valium and other tranquilizers. Meanwhile, Ayerst, found a gold mine making of a conjugated estrogen called Premarin. Women were made to be seen as dried-up, cranky, sexless old hags that could only be saved from that "tragedy" by this magic pill. Dr. Robert A. Wilson a New York gynecologist produced a book entitled Feminine Forever, copies of which were quickly disseminated to doctors' offices by Ayerst sales reps throughout the United States.
In truth, estrogen had been very poorly researched. Its approval as a prescription drug was based on a dubious study with a relatively small number of women in Puerto Rico who took birth control pills. The pill first used was only a progestin, which was later found to be contaminated with estrogen-like substances. When estrogen was taken out of the birth control pills, they didn't work as well, so a synthetic estrogen was intentionally added. Twenty percent of the women in the study complained of side effects, but they were dismissed as neurotic. The three women who died while taking these pills were not autopsied to find out the cause of death. There has been ample evidence since then that these pills caused blood clots and strokes, but that evidence was dismissed and suppressed for the supposedly higher good of controlling the population explosion. Meanwhile, the pharmaceutical companies scrambled to find a combination of synthetic hormones that had fewer side effects.
Hormone therapy has been called "a product in search of a market." Most research on menopause is designed to demonstrate the desirability of medicalized interventions. Although the use of hormones to help women cope with common signs of menopause, such as hot flashes, has been known since 1937, hormone treatment was popularized for a mass market in the 1960's. It was promoted not simply as a palliative for the discomforts of menopause but also as a panacea for "psychological problems" supposedly related to the change of life. Such claims were unproven but were treated as common knowledge. These assertions promoted a stereotyped view of postmenopausal older women as asexual, neurotic, and unattractive. As a result, exogenous estrogen was approved for prescription use without adequate testing and soon became one of the five top-selling prescription drugs. By 1975, the scene changed; women on ERT were developing uterine (endometrial) cancer at a rate four to eight times greater than in untreated women. Multiple researchers confirmed the link between estrogen supplementation and uterine cancer. This cancer rarely, if ever, occurred during one's fertile years when normal progesterone and estrogen levels were present. When the bad news hit the newspapers, sales of estrogen supplements dropped precipitously. Not only were women deciding not to start ERT and those on ERT deciding to quit, but physicians were understandably reluctant to prescribe it, despite its apparent virtues.
But the estrogen bandwagon was only temporarily stalled. Medical authorities pulled themselves together and switched from ERT (estrogen replacement therapy) to HRT (hormone replacement therapy). The difference was the addition of the progestins (synthetic versions of progesterone). Estrogen combined with progestins actually prevented endometrial cancer--unopposed estrogen was the culprit. Endometrial cancer was unknown in women whose ovaries produced a proper balance of estrogen and progesterone. The promoters of HRT also decided that estrogen and progestins could cure other ills, and were soon declaring that HRT would also lower a woman's risk of heart disease and prevent osteoporosis. These assertions were followed by massive marketing campaigns to "popularize" and educate women about osteoporosis. Doctors "threatened" women with predictions of heart disease and osteoporosis if they didn't take estrogen--regardless of whether they had any risk whatsoever for these diseases! Most people don't have the medical background to check and question the original research from which these assertions are made. Somewhere early in the development of the HRT industry, progesterone was not only forgotten, it was mislabeled and mistaken as its distant cousins, the synthetic progestins. Even well researched books on menopause tend to make this error. No one questioned why women in other cultures don't experience the side effects such as weight gain water retention, migraine headaches, swollen and fibrocystic breasts. Why do symptoms start before menopause when estrogen levels are still high? What ever happed to progesterone? It has been assumed that most women suffer from menopause symptoms, but there is no solid evidence to support this assumption. There is a small percentage of women who suffer from severe enough hot flashes and vaginal dryness to warrant treatment with natural hormones. Then there is a large population of women in their mid-thirties and on up suffering from the symptoms of estrogen dominance brought on by a sedentary lifestyle, a poor diet, birth control pills, HRT, and exposure to environmental estrogens (xenoestrogens).
Many of these women can find relief simply through exercise and a good diet. Others can solve their problems with a few herbs, vitamins, and mineral supplements. Most of the rest find relief by using a natural progesterone cream. Estrogen is only needed by a very small percentage of women, and then only for a short time. There is no good evidence that the majority of menopausal women are unhealthy, suffer debilitating symptoms, or lose their sex drive. Those women showing up in doctors' offices with problems are the ones who have had their uterus and/or ovaries removed, a very specific kind of menopause. Physicians and the pharmaceutical industry have largely fabricated menopause as a disease. There is also no evidence to support the claims that estrogen retards aging, keeping women "young and feminine" forever. On the contrary, for most women, it has unpleasant side effects, ranging from annoying to life threatening. When breast tenderness, weight gain, bloating, and mood changes occur in adolescence, they are attributed to high estrogen exposure. Yet, when these same symptoms are experienced during the transition to menopause, they are said to be a result of estrogen deficiency! In reality, we know more about the natural history of AIDS than we do about menopause! Mainstream medicine is firmly entrenched in its belief that menopause connotes the onset of an estrogen deficiency disease that requires estrogen treatment. This is not only scientifically inaccurate but is a parochial, patriarchal, and narrow-minded view that retards a deeper and more constructive understanding.
Most of estrogen's undesirable side effects are effectively prevented by progesterone. This syndrome, with symptoms familiar to most women in industrialized countries, commonly occurs in the following situations:
1. Estrogen replacement therapy
2. Premenopause (early follicle depletion resulting in a lack of ovulation and thus lack of progesterone well before the onset of menopause)
3. Exposure to xenoestrogens (cause of early follicle depletion)
4. Birth control pills (with excessive estrogen component)
5. Hysterectomy (can induce subsequent ovary dysfunction or atrophy)
6. Postmenopausal (especially in overweight women)
It is the custom to prescribe unopposed estrogen for women who do not have a uterus. Premenopausal estrogen dominance is simply ignored. A peculiarity of Western industrialized societies is the prevalence of uterine fibroids, breast and/or uterine cancer, fibrocystic breasts, PMS, ovarian cancer, premenopausal bone loss, and a high incidence of osteoporosis in menopausal women. Most of these are the symptoms of estrogen dominance. The following is a list of symptoms that can be caused or made worse by estrogen dominance:
Acceleration of the aging process
Allergies
Breast tenderness
Decreased sex drive
Depression
Fatigue
Fibrocystic breasts
Foggy thinking
Headaches
Hypoglycemia
Increased blood clotting (increasing risk of strokes)
Infertility
Irritability
Memory loss
Miscarriage
Osteoporosis
Premenopausal bone loss
PMS
Thyroid dysfunction mimicking hypothyroidism
Uterine cancer
Uterine fibroids
Water retention, bloating
Fat gain, especially around the abdomen, hips, and thighs
Gallbladder disease
Autoimmune disorders such as lupus erythematosus and thyroiditis and Sjogren's disease
Most physicians are attempting to push hormone replacement therapy featuring synthetic estrogens and progestins onto all menopausal women. The chief argument for postmenopausal estrogen supplementation is the deeply ingrained assumption of estrogen deficiency after menopause. Mainstream medical practitioners tout this in all pharmaceutical estrogen ads, many medical texts, and lay publications. Women are reminded that their mood swings, depressions, hot flashers, vaginal dryness, loss of sex drive, and accelerating osteoporosis are indisputable evidence of estrogen deficiency. Menopause is treated as the onset of an estrogen deficiency disease. It is true that menopause is known to be associated with decreasing estrogen levels, but what is not known is whether these decreased levels of estrogen do in fact, cause all the symptoms of menopause. There is no direct proof that estrogen lack causes heart disease or other ailments associated with menopause. No study proving the relationship between estrogen deficiency and menopausal symptoms and related diseases has yet been done. Instead, a notion has been put forward that since estrogen levels go down, this is the most important change and explains all the things that may or may not be related to menopause. So estrogen treatment at this stage of our understanding is premature. This is a kind of backwards science. It leads to ridiculous ideas--like calling a headache an aspirin deficiency disease. Western women tend to have a 10- to 15-year period prior to menopause when they are estrogen dominant and suffering from estrogen dominance symptoms, and some doctors are giving them more estrogen. Something is terribly wrong here!
During menopause, progesterone decreases to 1/120 of baseline levels, whereas estrogen decreases only one-half to one-third of premenopausal baseline levels. Typical premenopausal levels are 2.35 and untreated postmenopausal levels are 2. This is a drop of only 15%--just enough to allow menstruation to stop. But 85% of a woman's estrogen is still present! Estrogen and progesterone are in balance during the secretory phase of a normal menstrual cycle. In an anovulatory menstrual cycle, estrogen remains the same and progesterone production drops to very low levels. After menopause, estrogen production decreases 40 to 60% and progesterone remains at very low levels. Thus in anovulatory and menopausal conditions, estrogen dominance persists. Estrogen levels are below that necessary for pregnancy but sufficient for other normal body functions. Menopause should be regarded as a normal physiologic adjustment reflecting a benign change in a woman's biological life away from childbearing and onward to a period of new personal power and fulfillment. Deficiency is an error unsupported by fact. We should view our menopause problem as an abnormality brought about by industrialized culture's deviation from a healthy lifestyle.
Bioidentical hormone replacement therapy is used to help treat the symptoms of menopause, perimenopause, and post-menopause. The term "bioidentical" is used by some marketers because the administered hormones are chemically synthesized to have the same molecular structure as the endogenous hormones of the human body: estradiol, estrone, progesterone, estriol (another natural estrogen), and testosterone are the most common. Several bioidentical hormone products are available in government-approved, well-tested brands, but typically this term is used for hormone recipes made from a prescription by a compounding pharmacist.
Bioidentical hormones, sometimes referred to as natural hormones, are those that are molecularly identical to the hormones that are produced in the body. Hormones and steroids are taken from plants and animals and altered to be identical in molecular structure, then put into a form that can be absorbed by the body: cream, oral, suppository or injections. The plants that the hormones are extracted from are soy and yams, while the animals are pigs or horses. Although these hormones become molecularly identical to the ones humans produce, they cannot be considered completely natural due to the fact that they are altered in a laboratory. There are about 3,000 pharmacies in the United States that fill orders for custom-made hormonal compounds, and they get their ingredients from the same suppliers the drug companies do.
Treatment with bioidentical hormones usually includes creating a unique cocktail of hormones for the individual patient, based on hormone deficiencies identified via saliva samples. These are often referred to as "custom-compounded" hormone products. The major benefit of this type of treatment is that doses are individualized, and the mixture of products may not be commercially available. However, although the estrogen and/or progestogen components are government approved, the mixtures themselves are not, as they have not been studied to confirm that they are absorbed appropriately or provide predictable levels in blood and tissue.
Whether these exogenous, synthetic hormones are safer or more or less effective than non-identical synthetic hormones has not been proven. All synthetic progesterone is considered a suspected human carcinogen. These synthetic substances are called progestins and are often confused with the natural hormone called progesterone. Estrogens in general have been declared to be known carcinogens. By contrast, synthetic hormones are intentionally different. Drug companies can’t patent a bioidentical structure, so they invent synthetic hormones that are patentable (Premarin, Prempro and Provera being the most widely used examples).
Though bioidentical hormones have been around for years, most practitioners are unfamiliar with them. There are several branded versions now available for use in the kind of hormone replacement therapy (“HRT”) typical of synthetic hormones. This is generally a one-size-fits-all dosage regime.
The great appeal of bioidentical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing side effects. Synthetic hormones are quite strong and often produce intolerable side effects. Moreover, the compounded bioidentical hormones can be matched individually to each woman’s needs — something that’s just impossible with mass-produced products.
European medical studies suggest that bioidentical hormones are safer than synthetic versions. This makes perfect sense. But we must be cautious here, because they have not been well-studied, especially for long-term use. And in any case, no woman should think of a drug as completely safe.
One usually begins with laboratory tests of hormone levels (a so-called “hormone panel”). Then they are prescribed a precise dosage of bioidentical estrogen, testosterone or DHEA that is made up at a compounding pharmacy. Each patient is then monitored carefully through regular follow-up hormone panels to ensure they get symptom relief at the lowest possible dosage. In the initial stages, a hormone panel is done every three months. Once balance is restored, one panel a year is done at the time of the annual exam.
The great majority of women can rebalance their hormones without the use of drugs. Often, about 85% can find relief through an approach that combines medical-grade nutritional supplements, over-the-counter bioidentical progesterone, and dietary and lifestyle changes. It is usually recommended that every woman start with this combination approach as a foundation of health. Even with this foundation, a minority of women will need to add prescription-strength hormone supplements to get complete relief, at least through a transition period. It is recommended they use bioidentical hormones, preferably in a compounded form personalized to their needs by an experienced practitioner. It’s important that the hormones be used in addition to the combination approach outlined above.
Potential advantages over conventional hormone replacement therapy.
· Emphasis on topical administration; avoids problems such as blood clotting that are caused by the rapid metabolism of orally administered hormones.
· Progesterone may work differently in the body than medroxyprogesterone acetate.
· Regular testing allows individualized doses rather than "one dose fits all" approach of conventional hormone replacement therapy.
· Inclusion of estriol may be protective against hormone-induced cancer. Unlike estradiol, estriol binds preferentially to the second estrogen receptor (ERbeta). ERbeta may function as a tumor suppressor.
However, the lack of testing means the potential benefits of BHRT are unconfirmed, and present the same risks for blood clotting, breast cancer and strokes as conventional HRT.
No hormones should be used long-term unless essential for symptom relief, and then only with a complete risk assessment. Bioidentical hormone therapy should not be used indefinitely as some kind of fountain of youth.
Breast cancer incidence has now risen to become the most frequently diagnosed cancer in women--175,000 cases per year, accounting for over 44,000 deaths. Environmental risk factors, such as diet, account for about 80% of breast cancers (dietary fat being the most suspicious), and genetic factors account for about 20%. Breast cancer incidence is highest in Western women, where fat intake averages about 40% of the diet, and lowest in third-world women, where fat intake is about 15% of the diet. The difference in breast cancer incidence between these two populations is six-fold. There is an inseparable connection between fat and estrogen. Breast tissues accumulate fat. Body fat raises estrogen levels, and estrogen increases the tendency to accumulate body fat. Fat & estrogen are synergistic for increased breast cancer cell replication. Fats also contain fat-soluble toxins and xenoestrogens. Most breast cancer cells have receptors for estrogen. Breast cancer and endometrial cancer both occur in tissues sensitive to hormones made by the ovaries (estrogens and progesterone). Unopposed estrogens are the only known cause of endometrial cancer. One or more of the estrogens are known to contribute to breast cancer incidence. Progesterone, the other hormone made by the ovary, has a balancing or opposing role to estrogens in cancer. Hormones float through the bloodstream and the fluid around the cells, and they only work if they unite with a receptor on the cell that is already designed to be there. The hormone fits into the receptor like a key in a lock. If the receptor is there, they hook up and make their way to the cellular DNA and chromosomes, and turn on the appropriate gene site of a chromosome to produce an effect, a hormone, or an action in that cell. Hormones only work if the receptor site is present on the cell. Progesterone receptors are not found unless plenty of estrogen receptors are present. Estrogen stimulates the emergence of progesterone receptors.
Breast cancer growth rate is quite variable; the doubling time ranges from one month to over two years, with the average doubling time being about three months. It is estimated that the time from the emergence of a single cancer cell to its growth to a size sufficient for diagnosis by palpation (touch) is typically about eight to ten years (diagnosis by mammogram may be made, at most, two years earlier). This lag time between onset and diagnosis means that many breast cancers start during the 10 to 15 years before menopause, which is the premenopausal time when estrogen dominance is so common. Thus progesterone supplementation in women with low progesterone levels during these years is effective prevention against breast cancer. The average person thinks of cancer as a foreign growth that has to be cut out, burned out, or destroyed by chemicals. This is a misguided approach. All cancer originates as a minor change in one of your own cells. We are losing the war on cancer using chemicals, radiation, and surgery. Both breast cancer and endometrial cancer tend to surface in women at a time in their lives when estrogen dominance is likely. Breast cancer is more likely to occur in premenopausal women with normal or high estrogen levels and low progesterone levels. It also occurs after menopause when women are given estrogen supplements without progesterone. Estrogen's job in the uterus is to cause proliferation of the cells. Under the influence of estrogen, uterine cells multiply faster, and then progesterone normally should come on the scene with ovulation and stop the cells from multiplying. Estrogen dominance also stimulates breast tissue: Premenstrual women who are estrogen dominant often suffer from breast swelling and tenderness. Progesterone is the hormone that brings maturation; it brings the cells back into balance, and thus can eliminate breast tenderness. Breast cancer occurs most often at the stage in life when estrogen is dominant for the full month and progesterone is not coming in at the halfway point at ovulation time.
The occurrence of breast cancer is 5.4 times greater in the women with low progesterone. Women with low progesterone experience a tenfold increase from all malignant cancers, compared to women with normal progesterone levels. Having a normal level of progesterone protects women from nine-tenths of all cancers that might otherwise occur. Estradiol significantly increases breast cell hyperplasia (increased cell growth), and progesterone decreases cell proliferation rates, even when estrogen is also supplemented. Estradiol is the most stimulating to breast tissue, estrone is second, and estriol by far the least. During pregnancy, estriol is the dominant estrogen, being produced in great quantities, along with progesterone, by the placenta. Testing blood plasma levels of progesterone is not useful in measuring actual progesterone absorption. A salivary hormone test is a more accurate reflection of progesterone absorption. Estrogen supplements given to postmenopausal women for five years increase the risk of endometrial cancer six-fold, and long-term use increases it 15-fold. The addition of phytoestrogens (plant estrogens) and natural progesterone during these years has the potential to significantly reduce the incidence of endometrial cancer as well as breast cancer.
Antibiotics are not the only pharmaceutical substance routinely used in U.S. beef production, though banned just about everywhere else. Currently, U.S. beef cattle are routinely implanted with sex hormones, including Zeranol, trenbolone acetate, progesterone, testosterone, and/or estradiol. These steroid hormones are used to make the cattle gain more weight, much as body-builders and weight-lifters sometimes take steroid to become bigger, even though doing so jeopardizes their health. More than 90% of U.S. beef cattle today receive hormone implants, and in the larger feedlots the figure is 100%. The U.S. cattlemen repeatedly say such use of hormones is safe. But since 1995, the European Union has completely prohibited treating any form of animal with sex hormones to promote growth, for the reason that these sex hormones are known to cause several human cancers and types of reproductive dysfuntion. Anyone who eats this kind of meat and poultry, is taking in more estrogens and contributes to estrogen dominance.
The medical-industrial complex dominates the typical doctor's medical education, in medical school and throughout his practice. He is constantly exposed to pharmaceutical advertising; even his medical journals are often nothing more than thinly disguised advertising. The typical medical journal is more than half advertising for drugs and other medical products. When estrogen is prescribed to postmenopausal women, it is not uncommon that vaginal spotting or bleeding may occur. Their doctor usually recommends an endometrial biopsy or D&C (dilatation and curettage). A common finding is endometrial hyperplasia (areas of excessive endometrial cells) or dysplasia (suspicious-looking endometrial cells). Quite often, the doctor then recommends hysterectomy, believing that the uterus in postmenopausal women is a useless organ, and it is better to be safe than sorry. With the uterus out, estrogen can be resumed for all its supposed benefits. This line of reasoning is not only condescending to women, but self-serving to the doctors. In pretending to act as protector of his/her patient, he/she manages to convert a side effect of a drug he administered into a lucrative surgical operation. Women treated by hysterectomy for endometrial cancer are advised to avoid "hormones" forever. Like patients with a history of breast cancer, they face a future of progressive osteoporosis, vaginal atrophy, and recurrent urinary tract infections without recourse to hormonal therapy. Not only does natural progesterone reverse osteoporosis, in many cases it corrects vaginal atrophy. If vaginal atrophy remains a problem, intravaginal estriol is the treatment of choice.
Adrenal cortical hormones are essential for life because life as we know it is stressful. The adrenal cortex secretes three classes of hormones--glucocorticoids, mineralcorticoids, and androgens--that play literally dozens of ongoing roles in regulating bodily functions. While the secretions of the adrenal medulla provide quick and short-term responses to immediate stress, the adrenal cortex hormones provide longer-term responses for stress and homeostasis (the maintenance of balance in bodily functions). The most important glucocorticoids are cortisol and hydrocortisone, which play a role in regulating blood sugar, how carbohydrates, proteins, and fats are moved in and out of cells, inflammation, and muscle function. If too many cortisols are present, the symptoms are weight gain (especially around the midsection), blood sugar imbalances, thinning skin, muscle wasting, and other signs of aging. Women whose glucocorticoid pathways are not functioning properly or who are deficient in the cortisols may have fatigue, low blood sugar, and sometimes weight loss and menstrual dysfunction. The mineralcorticoids, especially aldosterone, regulate the balance of minerals in the cells, mainly sodium and potassium, but magnesium is also affected. Stress triggers the release of aldosterone, which raises blood pressure by its action on body cells to hold onto sodium and lose potassium and magnesium. Long-term release of stress-level mineral corticoids can cause a potassium deficiency and a magnesium imbalance as well as chronic water retention and high blood pressure. The adrenal cortex also makes all of the sex hormones, but in very small amounts. One cortical hormone, DHEA, which is weakly androgenic, is made in large amounts in both men and women; its production is greater than that of any of the other corticosteroids. The sex hormones play a part in regulating many bodily functions and are inextricably bound up with the balance of the adrenal hormones.
Estrogen, progesterone, and thyroid hormones are interrelated. The thyroid is the hormone that regulates metabolic rate. Low thyroid tends to cause low energy levels, cold intolerance, and weight gain. Excess thyroid causes higher energy levels, feeling too warm, and weight loss. The thyroid gland makes two versions of thyroid hormone from tyrosine and iodine.
Both versions are then enveloped in a relatively large glycoprotein complex called thyroglobulin and stored in the thyroid gland. To be released into the bloodstream for circulation throughout the body, the hormones are separated from thyroglobulin and bound to a much smaller globulin thyroxin-binding globulin or albumin. However, only 0.5% of thyroid hormone is "free" to be biologically active. Thyroid's action in the cell is to increase the biosynthesis of enzymes, resulting in heat production, oxygen consumption, and elevated metabolic rate. Thyroid stimulates the oxidation of fatty acids, and reduces cholesterol by oxidizing it into bile acids. Thyroid also stimulates enzymes for protein synthesis and, when present in excessive amounts, can catabolize (destroy) muscle protein. Estrogen causes food calories to be stored as fat. Thyroid hormone causes fat calories to be turned into usable energy. Thyroid hormone and estrogen have opposing actions. Estrogen inhibits thyroid action in the cells, interfering with the binding of thyroid to its receptor. Both hormones have phenol rings at a corner of their molecule. The respiratory enzymes of cells are thyroid-dependent. When thyroid function is low, cellular oxygen is low (cellular hypoxia). Thus, estrogen-induced thyroid interference contributes to less-than-optimal brain function. Excess estrogen may compete with thyroid hormone at the site of its receptor. In so doing, the thyroid hormone may never complete its mission, creating hypothyroid symptoms despite normal serum levels of thyroid hormone. Progesterone, on the other hand, increases the sensitivity of estrogen receptors for estrogen and yet, at the proper level, inhibits many of estrogen's side effects.
Mineralized bone is a crystalline structure and, as such, will respond to physical stress just as other crystalline structures do. Any force tending to distort the crystalline arrangement generates an electric voltage, called the piezoelectric effect, producing a small electric current. This also happens in mineralized bone, and may explain the wondrous ability of osteoclast and osteoblast action in constructing and reinforcing bone trabeculae along lines best suited for maximum strength and physical efficiency. Rebound exercise stimulates the bones to create a healthy bone mineral density. Fluoride is a potent enzyme inhibitor and causes pathologic changes in bone, leading to increased risk of fracture. Everyone should avoid fluoride, in all forms--including drinking water and toothpaste. The patentable synthetic analogs of cortisone now in vogue (e.g. prednisone, prednisolone, triamcinolone, methyl prednisolone, and dexamethasone) are considerably potent and generally used in pharmacological dosages. People taking these drugs over a long period of time all develop osteoporosis.
Bone mass in women is highest during their early or mid-thirties--often fifteen years before menopause, when estrogen is still high--after which there occurs there occurs a gradual decline until menopause, when the loss rate accelerates for three to five years and then typically continues at the rate of 1 to 1.5 percent-per-year. It is during the years prior to menopause that progesterone levels fall due to anovulatory periods (no ovulation). Estrogen can retard but not reverse osteoporosis and estrogen cannot protect against osteoporosis when progesterone is absent. The menopausal acceleration of bone loss suggests that the decline in sex hormones is a causative factor. The pharmaceutical industry has viewed the potential osteoporosis market as a magnificent opportunity to sell their synthetic patent medicine hormones (HRT). Doctors have been treated to massive advertising campaigns via journal advertisements, promotional symposia disguised as continuing medical education (CME), personal visits by drug salesmen bringing boxes of free samples, and medical articles of studies spawned by generous grants from the industry, all touting the supposed bone benefit of estrogen and the protective effect (against endometrial cancer) of progestins (synthetic progesterone). Mainstream medicine strangely persists in the single-minded belief that estrogen is the mainstay of osteoporosis treatment for women. Even the most authoritative medical textbooks do not support it:
Cecil's Textbook of Medicine, 18th edition, 1998. "Estrogen is more effective than calcium but has significant side effects."
Harrison's Principles of Internal Medicine, 12th edition, 1991: "Estrogens may decrease the rate of bone resorption, but bone formation usually does not increase and eventually decreases" and "Estrogens retard bone loss, although restoration of bone mass is minimal."
Scientific American's updated medicine text, 1991: "Estrogens decrease bone resorption" but "associated with the decrease in bone resorption is a decrease in bone formation. Therefore, estrogens should not be expected to increase bone mass."
The authors also discuss estrogen side effects, including the risk of endometrial cancer, which "is increased six-fold in women who receive estrogen therapy for up to five years; the risk is increased 15-fold in long-term users."
None of the studies using estrogen alone showed any increase of bone mass.
Estrogen's actions regarding bone are only related to bone resorptin. The lack of estrogen stimulates production of a substance called interleukin-6, which stimulates growth of osteoclasts, thus increasing bone loss. This effect of estrogen lack causing increased bone loss is most noticeable in the five years immediately following menopause. After that period, continued use of estrogen is relatively ineffective, with bone loss proceeding at the same rate as in those not on estrogen. In cultures where overall estrogen levels are much lower, and thus the drop at menopause is much less, women are less likely to suffer from osteoporosis. Yet, physicians continue to be taught "estrogen is the single most potent factor in prevention of bone loss." The more important factor in osteoporosis is the lack of progesterone, which causes a decrease in new bone formation.
Adding progesterone will actively increase bone mass and density and reverses osteoporosis. Despite the menopausal acceleration of bone loss due to estrogen decrease, progesterone-induced new bone formation is sufficient to prevent bone mineral density (BMD) loss. In fact, women more than seven years postmenopausal will gain new bone and higher BMD from natural progesterone therapy whether or not they take estrogen. A main contributor of osteoporosis is an acid pH that the body attempts to buffer with alkaline minerals, especially calcium. The more acid the pH becomes, the more alkaline minerals are used to protect the tissues and blood from the effects of an acidic condition. The body will take them from the teeth and bones to maintain blood calcium homeostasis. Age is not the cause of osteoporosis; poor nutrition, acid pH, lack of exercise, and progesterone deficiency are the major factors. Natural progesterone cream, combined with proper diet and rebound exercise, steadily increases bone density, creating a true reversal of osteoporosis, regardless of age--there is no reason for any woman to have to take estrogen for osteoporosis.
Weighing only three pounds, the brain is composed of eight billion nerve cells held in specific structural arrangements by filaments, as well as by smaller, specialized connective tissue cells called glial cells, which comprise half of the brains weight. Each adult brain nerve cell has on average 5000 extensions, called synapses, by which it communicates with other brain cells. That means the brain has eight billion times 5000, or 4 x 1013 connections, a number almost too large to comprehend. If we think of the brain as a computer, that number of connections is many times larger than that found in the world's largest computer. The number of interconnections plus the range of sensitivity and complexity make the human brain a wonder to behold. Brain cells communicate with each other via electrochemical impulses carried between the synapses by neurotransmitters, which are substances made up of amino acids.
The brain communicates with all tissues and cells of the body via neurotransmitters circulating in the bloodstream and generated by nerve extensions throughout the body. When carried any distance, nerves are sheathed in an off-white insulating covering called myelin, which protects the nerves from trauma and chemical erosion and prevents short-circuiting of the electric impulses along the way. All along the peripheral nerves are special cells called Schwann cells, which continually maintain the myelin sheath. If the myelin sheath becomes eroded for any reason, nerve function is adversely affected. This is known as peripheral neuropathy, such as occurs in diabetic neuropathy, Guillian-Barre syndrome, and multiple sclerosis, for example. The ability of the Schwann cell to perform this vital function is a result of progesterone! In fact, the Schwann cell itself makes progesterone for this function. Anything that interferes with progesterone receptors in Schwann cells stops the production of protective myelin.
Within the brain, nerve cells in one part of the brain communicate with nerve cells in other parts of the brain and these nerves also need to be protected with myelin sheaths. Brain cells communicate with the body in other ways, too. Some brain cells make special neurotransmitters that flow through minute veins to the pituitary to tell the pituitary to make hormones that affect various organs of the body, such as the ovaries, testes, adrenal gland, and thyroid gland. Minute amounts of neurotransmitters also flow through the bloodstream and to the receptors present in all tissues, including white blood cells. The brain is in touch with every part of our body at all times. Not only does the brain tell the body what to do, but it monitors the response (electrolyte balance, hormone production, oxygen levels, nutrients, inflammation, temperature, blood pressure, and so on) to determine what to do next, even during sleep. This is the biofeedback cycle essential for maintaining optimum health. Sex hormones are major players in this cycle. Progesterone is selectively concentrated in brain cells, has a calming effect, and has a beneficial effect on recovery from brain injury. Although progesterone is not a sex hormone per se, it is important to central nervous system functioning, as are other sex hormones.
Progesterone is concentrated in brain cells to levels 20 times higher than that of blood serum levels. Progesterone has long been known to have a calming or mildly sedating effect. This effect may be caused directly by progesterone, or it may be caused by substances created from progesterone, that are active at GABA (gamma-aminobutyric acid) receptors. GABA is an amino acid that acts as a neurotransmitter-inhibitor and tends to have a calming effect. When estrogen interferes with thyroid production and slows the metabolism of brain cells, it indirectly decreases GABA production and increases brain cell excitability, a factor in epilepsy. Progesterone's sedation of the central nervous system is sufficiently potent in higher doses that it has been used as an anesthetic. When used in small doses, progesterone is commonly effective in restoring normal sleep patterns and promoting a sense of calm. A complete lack of estrogen appears to have no deleterious effect on brain function.
Progesterone plays a critical role in fetal brain development. During pregnancy, placental production of progesterone increases from 20 milligrams a day to over 350 milligrams a day during the last trimester. This is a phenomenal level of hormone. Progesterone promotes metabolism of maternal fat for energy and maintains stable blood glucose, both of which support fetal growth and development, especially of the brain. The brain requires approximately three times more energy than other body tissues. The brain of neonates is proportionately much larger relative to the body than it is in adults. Thus energy requirements of the brain of a neonate are especially crucial. The babies of mothers who received natural progesterone showed greatly improved intelligence. Progesterone babies are reported to have strong, serene, independent characters. When elderly patients have started progesterone therapy they can think again; mental clarity and concentration improve.
It is the experience of many women that menopause is associated with some depression and that estrogen supplementation can lift one's mood. Elevated mood occurs when noradrenalin, the form of adrenaline active in brain cells, is raised. This happens, for example, after fairly strenuous exercise or when some pleasant excitement happens. Noradrenaline is inactivated by the enzyme monoamine oxidase (MAO). If, for some reason, MAO is relatively high compared to noradrenaline production, a depressed mood results. Estrogen inhibits MAO and thus raises the mood. Synthetic progestins tend to stimulate MAO and thus, can lead to a depressed mood. Long-term use of estrogen can have a negative effect on mood however. This has to do with copper and zinc rations. Copper and zinc are important co-factors for brain enzymes. Estrogen increases a blood protein, ceruloplasmin, which binds to copper and prevents dietary copper from finding its way into brain cells. Too much ceruloplasmin leaves too much copper in the blood, causing zinc levels to drop in the blood and the brain. The result is an imbalance that leads to exaggerated stress reactions, serious mood swings, and depression (PMS).
The early proponents of estrogen replacement therapy (ERT) created a myth promising that estrogen would keep women "feminine" and sexually attractive "forever." Without the magic pill, they would turn into sexless hags and no longer be attractive to their husbands. It was a common misconception that older women were no longer interested in sex. Women who lose interest in sex usually have symptoms of estrogen dominance, including water retention, fibrocystic breasts, depression, and dry, wrinkling skin, and irregular, sometimes-heavy periods. They have fat accumulating on their hips and abdomen, their breasts are swollen, and they have a loss of sex drive. These signs and symptoms are indicative of a progesterone deficiency caused by a failure to ovulate while estrogen continues to be produced. Estrogen replacement has not restored their previous sex drive. When natural progesterone cream is added, sexual activity is revived. Libido, or sex drive, though mediated by sex hormones, is really a brain function. Specific areas of the brain have been identified in animals as essential for sexual receptivity and mounting behavior. When one or another of these areas is experimentally destroyed, sexual behavior is lost, regardless of hormone levels.
The underlying primary sexual drive in all mammals surely emanates from brain centers mediated by sex hormones. The effect of progesterone on human libido has been largely ignored in mainstream medical research. The common "wisdom" is that estrogen is the primary sex drive hormone in women. But in practice, it is only when progesterone is added that their flagging libido returns. Sex drive is a function of both estrogen and progesterone, and also testosterone. The administration of estrogen in the absence of progesterone does not accomplish stimulation of sex drive. In humans, estrogen production falls only 40 to 60% at menopause, whereas progesterone falls to close to zero when ovulation no longer occurs. This explains the loss of sex drive in premenopausal women with estrogen sufficient for monthly periods and in postmenopausal women on ERT, but lacking progesterone and the resumption of normal sex drive when progesterone is added. Among many researchers, testosterone is given credit for being the hormone attached to sex drive in both males and females. It is widely assumed that the increased sex drive, in fertile women at ovulation, correlates with a timely spurt of testosterone.
Many women experience depression in the days and weeks following childbirth. Other symptoms include headache, irritability, and sleeplessness. The depression can be incapacitating and prolonged. As pregnancy advances, placental production of progesterone rises to levels of 350 to 400 milligrams a day, and the ovaries' contribution at that point is nil. With delivery, the placenta-derived progesterone is suddenly gone. The only source of progesterone at that time would be the adrenal glands. It is possible that adrenal exhaustion plays a role in a woman's inability to provide even a modicum of progesterone in the days following childbirth. Postpartum depression is notoriously difficult to treat. Natural progesterone, promptly supplemented, can make postpartum depression much easier to treat.
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