I often hear women say ‘I don’t want to take hormones as I am afraid of breast cancer or I’m afraid of putting on weight’, are you one of these women?
Knowledge is power and every woman should increase their knowledge about hormones and what they know about that life changing time called peri-menopause/menopause.
Only then can you make the best choices for you, which isn’t necessarily the same as your girl-friend’s.
So, let’s start by looking at what HRT means.
HRT – Hormone Replacement Therapy means replacing a hormone, which is missing or diminished and we’re not just talking about Estrogen. Here are some examples of how HRT is used by many every day
If you suffer from Type 1-Diabetes you replace the hormone Insulin, which for some reason cannot be produced by your Pancreas. Not to be confused with Type 2 Diabetes where there is often an over production of Insulin. BTW – without Insulin your body cannot reduce blood sugar or store fat.
If you suffer with low Thyroid you replace or support the Thyroid hormones T4 and T3, where T3 is the key hormone responsible for increasing energy production. So, if for any reason you can’t make T3 from T4 then taking all the T4 hormone in the world is never going to give you more energy.
When women get to peri-menopause and menopause their ovaries are slowly retiring and the declining levels of Progesterone and Estrogen can be supported. You still produce Estrogen and Progesterone different places in the body, just not in the quantities as before. You lose about 70% of their production at menopause.
The same happens when the guys get to peri-Testi-pause and Testi-pause, where their testicles production of Testosterone declines and eventually ceases. Although replacing Testosterone is not the best way forward for men as much of it will just be converted to Estrogen, so a better approach would be to stop or slow the conversion.
Should we, or shouldn’t we?
So, what’s all the fuss about? Should we, or shouldn’t we? How safe is it to replace or support these hormones? Why is it so important?
Absolutely YES if you want to age gracefully with physical, mental and emotional strength and passion in other words YES if you want to keep your mojo.
We live longer
That we live longer is a well-known fact, but we’ve been doing this for the last 40-50 years, but life is now much different and more demanding than it was 40 years ago. The fact alone that many will be working until they are 67 – 70 years of age requires good physical, mental and emotional strength. Back in the 1920’s life expectancy for a woman was approx. 54 years of age, so supporting these hormones was of little consequence.
By the 1940’s life expectancy had increased to 65 and Estrogen was prescribed for the first time in 1942. Today life expectancy for women is approx. 82 years of age which means 30 or more years with exceedingly low levels of Estrogen and Progesterone if you decide not to support or replace them.
So why is Estrogen so important, what is it responsible for apart from getting you pregnant?
To decide if Estrogen replacement therapy/ERT is for you or not you need an overview of its many roles and functions within the body. It does much more than just creating your menstrual cycle.
Estrogen is an anabolic steroid, which means it is a building hormone responsible for building and repairing bone, skin and fat tissue. So, if you want beautiful skin and strong bones make sure Estrogen is on your supplement list.
Estrogen is a neuro steroid, which means it is a brain hormone affecting the production and efficiency of neurotransmitters. In other words, Estrogen affects your personality, mood and modulates most of the neurotransmitter, such as Serotonin and Dopamin. The declining level of Estrogen is the biggest cause of your personality changes, which occur around menopause, not to mention your declining memory. But for most women the worst symptom is the loss of joy, passion and enthusiasm for anything and everything in life – your mojo.
- When Estrogen is replaced, even in small amounts many women say ‘wow – I feel like myself again’. So, if you want to keep your mojo put Estrogen on your supplement list
- Estrogen maintains multiple physiological processes, such as: Insulin sensitivity, insulin is the body’s major fat storing hormone. After menopause women often store more fat on their belly and viscera, which increases the risk for developing Type 2 Diabetes. This study shows quite clearly the positive effects Estrogen has on belly fat.
After menopause women become more insulin resistant and carbohydrate sensitive, which means you tolerate less carbohydrate.
So, if you want to decrease tummy fat and control weight gain put Estrogen on your supplement list
- Estrogen regulates cholesterol by keeping LDL cholesterol down and HDL cholesterol up. So, if your doctor says your cholesterol ‘suddenly’ increased you might want to put Estrogen on your supplement list
- Estrogen plays a role in heart health by keeping blood vessel supple and dilated. So, if you want to maintain a healthy heart put Estrogen on your supplement list
- And by no means least, Estrogen keeps your vagina youthful with better bladder control and muscle strength, vaginal lining plump and moist, keeps pH levels low and thereby bacteria at bay, so less infections such as bladder infections and cystitis. So, if you want a youthful vagina put Estrogen on your supplement list
- Estrogen protects against colon cancer – see more here.
So, if there’s colon cancer in the family perhaps it would wise to have Estrogen on your supplement list.
Perhaps now you can see how supporting Estrogen will increase the quality of those extra 30 years.
But what about the risks, many ask ‘what about the increased risk of breast cancer’?
According to Cancer UK
0.5 – 2 % of breast cancer cases in the UK are linked to use of HRT. (studies show quite clearly that it is when Estrogen is combined with a Progestin there is an increased risk – https://blog.a4m.com/the-long-term-impact-of-hormone-therapy-on-breast-cancer-risk/?utm_medium=email&_hsmi=93752798&_hsenc=p2ANqtz-8XFjdDLFHbJlmUC12FL7pMVzVHYUgdDMvxlLZnlpj5dN70oadDXldS7KNreu0mUib_NztEnFDkK5vo0fNJzMEUSvw34A&utm_content=93752798&utm_source=hs_email)
9 % of breast cancer cases linked to obesity
8 % of breast cancer cases linkedto alcohol consumption (more than 1 unit per day)
5 % of breast cancer cases linked to physical inactivity
Question – Why is all the focus on how HRT increases the risk for breast cancer when it is crystal clear that, changing any of the above lifestyle habits will radically decrease your risk for breast cancer?
Other important facts about breast cancer you should consider
12.5% of UK women get breast cancer where approx. 80% are hormone/Estrogen sensitive.
12.5% is undoubtedly too many, but consider this, every woman has breasts and all of us produce Estrogen, so why don’t we all get breast cancer?
Cancer Research UK state that developing breast cancer is greatest in women over 60
How can that be? Estrogen levels are much less in women 60+ in comparison with those before menopause. So why is the risk increased?
The answer to both questions is that it’s not the hormones Estrone – E1, Estradiol – E2 or Estriol – E3 that creates cancer it’s the liver Estrogens the so called 4-OH-E1 and 4-OH-E2.
The liver is responsible for making the fat-soluble E1 and E2 Estrogens water-soluble so you can excrete them through your urine or via your stools. And just like other body functions your liver ability to do its job well decreases with age.
The liver detoxes Estrogens in two phases and in phase 1 it converts E1 and E2 into 6 new Estrogens, which are oxidised and referred to as the OH-Estrogens/Hydroxyestrogens.
Research shows quite clearly it is the 4-OH Estrogens that are connected with turning on the cancer process in DNA if they are not made water soluble and excreted.
We all make the 6 different OH Estrogens but some are genetically more inclined to make the 4-OH types and this will give them an increased risk of developing Estrogen driven cancers, especially if phase 2 isn’t working efficiently.
In phase 2 the OH-Estrogens are ‘wrapped up’ in nutrients, making these Estrogens water-soluble, but this requires you having enough nutrients.
Most of the essential nutrients are found here:
- Sulphur molecules called Sulforaphanes and other phytonutrients from green vegetables, especially cruciferous veggies – eat minimum 300g per day
Sulforaphane can be bought as a supplement – buy yours here – https://gc.nordicvms.com/product-broccolox%C2%AE_capsules-3094
- Antioxidants from coloured fruits and veggies – eat minimum 300g per day.
The following nutrients are especially important for optimal liver function
Alpha Lipoic Acid
See a selection here – https://gc.nordicvms.com/Catalogue-liver_support_testing-1116.html
A cocktail that will increase your risk for breast cancer is:
You genetically favour the making of the 4-OH Estrogens combined with a diet deficient in nutrients, especially sulforaphanes and antioxidants.
Though anyone who’s nutrient deficient will have an increased risk.
If you would like to know if you have a preference for the 4-OH then this urine test can help, which will also give you a picture of many hormones https://gc.nordicvms.com/product-dutch_complete%E2%84%A2-2064
It is very important that everyone supports liver function each and every day. An easy way to get many of the essential nutrients is to drink a litre of green smoothie every day – check my recipe here https://sally-walker.com/en/recipes/to-your-good-health/
Breast cancer during peri-menopause times
Until you are officially ‘done and dusted’ which isminimum 1 year since your last bleed your body has to ‘cope’ with Estrogen and Progesterone imbalances.
Many menstrual cycles can occur without ovulation (even though you have a bleed), this means Progesterone is not produced and as a result Estrogen activity not controlled.
Can this be a possible cause of peri-menopausal breast cancer?
This study demonstrates the effects of Progesterone in connection with breast cancer
Not just one type of HRT
Knowing your HRT is also an important area as the type in its self can increase the risk for cancer.
So here is a little lesson in HRT
Bio-identical means the that hormone in the product is molecularly identical to the hormone made by the body and on the product labels the hormone will have the same name as that hormone, such as Estradiol, Estriol, Progesterone, Testosterone, Thyroxin, Insulin, mm.
It is important to emphasize that any hormone you chose to replace should be bio-identical.
This ensures there are no side effects or diminished effects because the hormone works identical to your own hormone.
E.g. if you use bio-identical Progesterone you can expect it to offer 100% protection against Estrogens activities everywhere in the body.
If you use a Progestin it will protect your uterus but not your breast tissue or your blood vessels and thereby the uncontrolled Estrogen activity can lead to cancer or blood clots, etc.
Names like Ethinyl-estradiol, Diethylstibestol, Estradiol-hemihydrate, Levonorgestrel, Norethisterone, Medroxy-progesterone-acetate, etc., are examples of non-bioidentical hormones, all connected with side effects and possible diminished effects.
NB – having no side effects from using bio-identical hormones is one thing, but you can still create an imbalance if you get too much of the one hormone in relation to another. So, make sure you get qualified advice, guidance and monitoring.
Synthetic means that the hormone is made by a man in a laboratory in other words it is ‘man made’.
The hormone can be produced from plant hormones or be chemically produced, the most important is that the hormone being produced is bio-identical.
Medical grade hormones are standardized and thereby reliable, which means you can be sure you’re getting the same amount of hormone every time.
Phyto/plant means that the hormone comes from a plant such as soya or wild yams.
These hormones are not bio-identical and work more as modulators, which means they can increase Estrogens affects in one tissue and block for it in other tissues. Also, their production is often not standardized and their effects can therefore differ from batch to batch. Read more in my article about phytoestrogens
All of the above can be used to replace/support Estrogens and Progesterone, but my advice is to keep to the bio-identical types.
Estrogen only or combined with a Progestogen?
Studies are quite clear here, if you still have your uterus you must use Estrogen combined with a Progestogen to protect the uterine wall against the growth effects of Estrogen, i.e. the uterine wall produces blood, which can be seen via an ultra sound scan as thickening of the wall. Exclusion can (in time) cause uterine cancer.
If you have had a hysterectomy unopposed Estrogen can be used, though Progesterone has functions of its own so using some Progesterone can have a positive effect on breast tissue, brain function, blood vessels and bone health.
Though it’s important to point out that these guidelines are based on older studies using higher levels of Estradiol, such as 5 mg or more per day in pill form
Today the recommended dose is much lower and the hormone is often as creams and gels, using both Estradiol and Estriol but unfortunately new studies are limited which means guidelines are not updated.
If you are using the Estrogen type Estriol as a cream and creaming other areas than just in your vagina it is very unlikely that you will have increased activity in your uterus, even so is important with annual ultra-sound scanning of your uterus where the thickness of the wall is measured and the ovarian area checked for possible tumours. Ovarian cancer is a killer because it is often discovered too late.
Classic HRT pills, are still the standard treatment available from your doctor, which combines Estradiol with a Progestin, such as Activelle, even though there are several studies that show combining Estrogen with a Progestin increases the risk for breast cancer, as this study shows nearly triples the risk https://www.nature.com/articles/bjc2016231
There are studies demonstrating that using Estradiol without a Progestin in women whose uterus is removed, can actually reduce breast cancer risks.
Bio-identical Estrogen as pills, spray, gels, creams, plasters and pessary are all available in the UK / Europe
Bio-identical Progesterone in pill form called Utrogestan is available in the UK / Europe
Bio-identical Progesterone creams can only be bought through compounding pharmacies
Bio-identical Estrogen is used in HRT but not in contraceptive pills.
I would love to hear your views on and experiences with HRT, please send me an email firstname.lastname@example.org