Bioidentical Hormone Replacement: Estrogen Therapy
Estrogen Changes over Time
Estrogen begins decreasing over time in the 40’s after progesterone begins declining in the 30’s. Female patients may begin experiencing hot flashes, night sweats, acne, anxiety, or irritability. Other symptoms include thinning skin and vaginal dryness. Estrogen, like testosterone, is important for bone density, and the risk osteoporosis is higher with age. Hormonal birth control is a common cause of low estrogen because synthetic hormones trick you body into thinking that you are making enough, so your body produces less of your own.
Polycystic ovarian syndrome (PCOS) is a common cause of high testosterone that can cause a relative estrogen deficiency. High progesterone can do the same. A liver that isn’t clearing excess estrogen may be a cause of high estrogen. Bioidentical hormone replacement can help reverse these symptoms.
Effective Ways to Increase Estrogen
- Topical cream or suppository
Benefits of Bioidentical Hormone Replacement with Estrogen
- treat hot flashes
- improve mood stability
- deeper sleep
- increased energy
- smoother skin
- sharper concentration
- stronger bones
Oral estrogen is not bioidentical, but synthetic estrogen is covered by insurance and can help with unwanted symptoms of estrogen deficiency. Over-the-counter supplements with plant phytoestrogens such as soy are gentle and may relieve night sweats and foggy thinking. Supplements may be just enough to take the edge off to help you function better.
Unlike oral estrogen, topical estrogen is bioidentical. This means that estrogen cream has estrogen that is what out body makes naturally and will hit all of the estrogen receptors in our body, including the brain, bones, skin, breasts, ovaries, and uterus. This is why I recommend progesterone with estrogen in order to keep the effects balanced throughout the body.
Estrogen is highest in the morning and tapers down throughout the day, which is why night sweats occur when estrogen levels are at their lowest. Topical estrogen is applied once or twice a day, depending on symptom onset and severity.
The 3 estrogens that our bodies make are estradiol, estriol, and estrone. Estradiol (E2) is the primary active estrogen associated with most of the effects of estrogen. Estriol (E3) is a less potent but is usually included with estradiol for its anti-inflammatory, anti-cancer, and vaginal skin thickening effects. Estrone (E1) is typically avoided due to its inflammatory and pro-cancer effects. Urine testing is used to ensure that estrogen is metabolized well and that the ratio of these three estrogens are balanced. Oral DIM can be used to promote healthy estrogen ratios.