Edward Lichten, M.D.,PC
189 Townsend Street- Second Floor Birmingham, MI 48009 
248.593.9999

 Why Women Should Take Bio-Identical Estrogen:
Synthetic Estrogen is Wrong for Many!

Estrogen replacement for menopausal women has been available for more than 50 years yet less than 15% of those who qualify for estrogen replacement therapy (ERT) take estrogen. “Why not?” you ask. The problem is definitely a combination of misconception by the patients in light of all the negative press from the Women's Health Initiative Study (WHI) and a lack of information about  alternative therapies by the treating physician. The following discussion will hopefully offer enlightening information on all these matters.

Thousands of women receive prescriptions for estrogen every year and thousands fail to take these medication. Premarin® and conjugated oral estrogen are the most prescribed hormonal (ERT) medication in the United States, yet up to half of all women discontinue the medication within six months or fail to fill the prescription at all. These same women took oral contraceptives in their 30’s and 40’s without complaint, however. while they understood the benefit of oral contraceptives, for some reason they do not understand the benefits of estrogen replacement when they are terribly deficient.  And unless they had experienced the rare side-effects of oral contraceptives, they should have no qualms about adding ERT and regularity into their menopausal  lives.

Reduced risk of cancer of the uterus and ovaries
But we know now, is that taking these oral contraceptives which are a combination of estrogen and progestins reduces the risk of both ovarian and endometrial cancer by 50 percent throughout a woman's life. Colon cancer is also reduced, states the WHI!

Breast Cancer Risk of Estrogen alone is small. Adding synthetic progestin (Provera) accounted for 95% of the increased risk!

It is not that women forgot the benefits of oral contraceptives and estrogen, rather, they become obsessed with the fear of breast cancer. Now, breast cancer strikes one in 8 women, 1:8 in their lifetime-- almost all of these being women are over 50. And the fear of cancer is the primary inhibition women have to taking supplementary estrogen.

In the last 35 years, more than 40 epidemiological studies have been performed to gather information about the risks of taking estrogen and developing breast cancer. Most studies show either no increased risk or slight increase with prolonged estrogen use. And to the physician, this information is both comforting and reassuring that prescribing estrogen is in the best interest of our female patients. But relating our security with estrogen replacement to our patients is not enough.

The WHI study released in 2002 included the data about Prempro® a combination of synthetic estrogen (Premarin®) and synthetic progestin (Provera® ). The second part of the WHI study released in 2005 showed the risk of breast cancer on the women was not significant to that of the combination protocol with Prempro® .  PROVERA®  was the primary cause of the increase in breast cancer, heart disease and stroke.

For women know that some breast cancers are “estrogen sensitive.” They interpret this to mean that ‘estrogen’ can make the cancer grow. And with the media pointing out the large settlements in legal cases for breast cancer, some women authors screaming against taking estrogen under any circumstance, and the poor tolerance by many of the oral estrogen preparation, the majority of women feel estrogen is “not natural” and could be dangerous in the menopause. Even though they took 3-to 6 times stronger estrogenic preparations just 5 years previously for oral contraceptives!

 So to make my point, I remind women who had been on oral contraceptives, that for both estrogen and birth control pills there are rare side-effects, but the benefits out-weigh the disadvantages. And in the same logical vein, they should consider taking estrogenic preparations in the menopausal years and avoid synthetic progestins because they, not estrogen, are the risk factor for breast cancer, heart disease and stroke.

Even if estrogen would ever so slightly increase the risk of cancer, very few women would have their lives shortened by that disease. The net gain, however, from using estrogen to prevent cardiovascular disease, stroke, osteoporosis and senility is at least 3 more quality life years! Why not take advantage of living longer and living better-- with estrogen!

SUMMARY OF RISKS AND SIDE EFFECTS OF ESTROGEN USE

1. Breast Cancer: Yearly mammograms, self examination.
   Early diagnosis limits the risks.
   Now, ERT can be prescribed for women  free from breast cancer for 5 years.




2. Adenocarcinoma of the Uterus
   Rarely aggressive lesions.
   Discovered by break-through- bleeding or uterine thickening on ultrasound. Reversible often, with short-term progestin therapy.




3. Resumption of menses Can be adjusted by changing ratio of bio-identical ERT and bio-identical progesterone (not Provera)!

Women think they can avoid these risks by not taking the estrogen. What they fail to realize is that the human body produces estrogen from fat and from conversion of adrenal and ovarian hormones. There is always, “some” estrogen around. And there is little proof that the slight increase in estrogen when taking bio-identical supplements will affects either initial cancer mutation or prolonged growth.

THE ALTERNATIVE FORMS OF ESTROGEN

1. Women who are fearful of estrogen causing breast cancer, find that the use of VAGINAL ESTROGEN CREAM is less objectionable. By using 1/2 to 2 grams daily, the vaginal and bladder symptoms are relieved with small amounts being absorbed. I tell patients that the estrogen level is usually well below half the level of an average 40 year old woman.




2. Women who want to take a bio-identical estrogen preparations may start with natural ESTRADIOl (E2) in the transdermal patch, or may elect to use a natural estrogen cream. This is commonly referred to as "Tri-Est" because it contains all three naturally occurring estrogens: estriol (E3), estradiol (E2) and estrone(E1). Using only small amounts or none of the predominant estrogen of menopause [estrone .05%], to which is added moderate amounts of the active estrogen compound of youth [estradiol .05%].  But the predominant estrogen in this cream is estriol. Estriol (2%) is the key estrogen of pregnancy; it is allegedly found to not stimulate breast tissue even in large amounts. Because of its different chemical structure, it is not recognized as being able to stimulate the endometrium to growth or thickening.

It may be effective at blocking hot flashes especially when used with natural progesterone (Prometrium®) or bio-identical progesterone cream (4%) applied nightly.


3. Natural Estrogen Pellets. An old technique for the 1950's and 1960's is returning into use. This technique places compressed pellets of natural estrogen under the skin of the hip with a minor, office surgical procedure. In exchange for the 5 minutes it takes the physician to place these pellets, most women can remain hormonally stable for 3 to 6 months! This therapy is ideal for women who suffer with migraine headaches or mood swings or breast tenderness that occur when their hormonal levels spike and drop.

The Failure of Oral Estrogen

The problem with oral synthetic estrogen is that it is not normal for homo sapiens ( women) to take hormones orally! In the natural state, estrogen as well as every other hormone (testosterone, thyroid, cortisol, progesterone,... to name a few) are released into the blood stream. They have their effects on all the tissues of the body before being processed by the liver. Therefore, the primary estrogen of women is estradiol (E2) not estrone(e1).

However, all oral estrogen is converted by the liver into estrone. The high levels of hormone delivered to the liver by oral ingestion can increase the risk of liver tumors and have a negative effect on some blood parameters including triglycerides. The other problems with conjugated estrogen (Premarin®) is that the most widely prescribed form comes from pregnant mare urine... and has many products that are entirely unnatural for women.

Lastly, oral ingestion of conjugated estrogens causes a rapid peak that lasts for about 4 hours and then a long period with relatively little or no estrogen. This is not natural and contributes to the symptoms associated with both too much and too little estrogen.

Parenteral Estrogen: Why It is Better!

Parenteral means that the delivery system is not oral. Parenteral includes transdermal patches, transdermal creams, vaginal creams, injections and pellet delivery systems. In every case, the first pass of the hormone is on the tissues of the body, not the liver. Therefore, the pellets keep the hormone levels level for months; the injections keep them level for 7-14 days, the patches keep hormones level for 3-7 days, and the topical gels or creams, level for 8-12 hours. Only the creams need to be reapplied every 12 hours.

But studies show that these creams are physiological; they mimic the body's natural estrogen levels. Therefore, the benefits are consistent and the side-effects minimized.

In Conclusion

The failure of women to take estrogen is a combination of a fear of estrogen and negative experiences with oral estrogen. By trying either the transdermal estrogen patch or the natural estrogen gels or pellets, many more women will find the beneficially effects of this hormone. And with supplementation of the additional hormones of "anti-aging" medicine, hopefully live a longer and better life!

Are you
Estrogen Deficient?

Jackie's video interview

A list of information below may help you understand how estrogen deficiency affects you. We urge to get appropriate laboratory testing.