I am debating whether or not to fill the prescription for Estradiol, and I want more information on this drug and estrogen in general. I need it for hot flashes.
–M.G., San Diego, California
Answer: Estrogen is a highly misunderstood hormone that both men and women have. Some men don’t even realize they have estrogen, likewise, women have testosterone, the “manly” hormone. It’s the amount of each that helps shape us.
When the word “estrogen” is used, it’s really defining three different hormones, estrone, estradiol and estriol. Estrone or “E1” as we call it, is the predominant estrogen post-menopausally. It’s important because there’s a strong correlation between healthy levels of estrone and your bone health, as well as proper insulin and BMI (body mass index) values which translate to diabetes risk.
Estradiol or “E2” is the most potent estrogen, and it’s what you have most of before menopause hits. Estradiol in a drug version as you have been prescribed is considered bio-identical (because we make estradiol), but if it’s a prescription cream or tablet, the dosage is much higher than what you need physiologically. It may help reduce hot flashes but I worry about long-term use (unless you test your levels). Now, contrast that with estradiol that is sometimes put into compounded bio-identical creams, they are using a fraction of the prescription dose, and it’s customized based upon your lab work. Keep in mind, the higher your serum estradiol, the greater the risk of certain cancers. Estradiol, in normal physiological amounts, assists the body in many good ways, it’s not to be feared, it’s to be respected and dosed only according to your needs. With a prescription dose, I fear it may be too much if taken daily for more than a few weeks or months.
Estriol or “E3” as we call it in the literature is actually derived from the other two estrogens. It’s the least potent of all three estrogens, and considered the safest.
Estrogen levels that are erratic or low, can cause menopausal symptoms like hot flashes, vaginal dryness, urinary leakage (incontinence), chronic anxiety, and increased risk of cardiovascular disease. Low estrogen in a man can result in some bone loss, high insulin, elevated blood sugars and abnormal cholesterol ratios. They don’t get the hot flashes!
What about high estrogen? Termed “estrogen dominance” or “progesterone deficiency” it could cause heavy, painful periods (bad PMS), uterine fibroids, endometriosis, fibrocystic breasts, higher risk of breast cancer, and increased TH1 immune activity which increases risk of autoimmune disorders like Hashimoto’s or Lupus.
In men, high estrogen tilts the hormone see-saw such that testosterone (T) goes down and estrogen goes up! Darn because that may cause low sex drive, erectile dysfunction, shrinking muscles, increased fat tissue (remember, estrogen causes weight gain), a disappearing 6 pack in trade for a ‘beer belly,’ enlarged prostate, diabetes and higher risk of cancer.
Regulate Estrogen Levels Naturally
There are ways to help ‘modulate’ or regulate healthy estrogen levels so they don’t get too high or out of control. Men and women could benefit from eating broccoli, or taking the supplemental form of broccoli extract called “I3C” which is short for Indole 3 carbonol.
DIM or Diindolylmethane is a component of I3C, also sold at health food stores and online. DIM was discovered over 10 years ago is a naturally occurring phytonutrient that is found in the cruciferous vegetables broccoli, Brussels sprouts, cabbage, and kale. You can ask your doctor about I3C or DIM, two dietary supplements sold at health food stores. In order for you to change IC3 to DIM there has to be adequate stomach acid. People over 40 years produce significantly less stomach acid. DIM may be a better choice if you are over 40 years old. Let’s talk about stomach acid for just a moment.
Low stomach acid is very common in our society and is also (surprisingly) responsible for the increase of acid reflux. We are all so busy trying to suppress acid but the sphincter “breaks” because of long-term hypochlorhydria (low acid). If you are over 40 and eating lots of broccoli and Brussels sprouts to prevent cancer (because crucifers are known for cancer prevention) you may just be teasing yourself because you don’t have enough acid to convert the I3C you get from those foods, into enough DIM. You might be (and you need to ask your doctor) be better off on a DIM supplement sold widely in the US. DIM and I3C affect estrogen ratios and this can be measured with hormone panels (done with an overnight urine catch) with a lab such as Genova or Rhein.
DIM is completely natural, and it encourages formation of good estrogen metabolites, while decreasing the so-called bad estrogens that have been shown to be associated with migraines. In high doses, both I3C and DIM may lower thyroid hormone production. Not only can I3C and DIM help to calm painful menstrual cycles where appropriate, these compounds support prostate health, you really just need to have balance. Too much I3C or DIM can reduce estrogen (and thyroid) too much, causing other problems.
Regulate Estrogen Levels Naturally with Black Cohosh
Cimicifuga racemosa, this herbal remedy is also known as bugwort. Insects hate it. It’s used by women in menopause to control hot flashes. It’s a dietary supplement sold at health food stores by various brands, and at the pharmacy as Remifemin. Years ago, there was a randomized, double-blind, placebo-controlled trial18 which found that black cohosh was more effective than prescribed conjugated estrogen (ie Premarin). Eighty menopausal women compared black cohosh extract (Remifemin taken twice daily) with sugar pills (placebo) and conjugated estrogen medication (0.625 mg/day). Both anxiety and daily hot flashes decreased in the black cohosh group but not so much in the placebo group, or the group taking medicine (conjugated estrogen). It went from 4.9 per day to 0.7 in the black cohosh group, and reduced only from 5.2 per day to 3.2 in the estrogen group, and 5.1 to 3.1 in the placebo group. About the same change in the conjugated estrogen group and the placebo! Only black cohosh has a positive impact.
As an aside, controlling estrogen can help reduce the frequency of certain types of headaches, namely menstrual migraines. Healthy levels of estrogen (and progesterone) can affect cancer growth. You want balance, not too high, and not too low.