Female sex hormones - what to do if levels are low

Female sex hormones - what to do if levels are low

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Any person who had asked me about this previously would know it was an area about which I have concerns. This is because hormones have extremely powerful effects and the wrong dose may have far reaching implications for risk of cancer and heart disease. However some of my CFS patients have done well on small doses of female sex hormones, whether they have been sanctioned by me or not!

I recently attended a day at the Royal College of General Practitioners about the use of hormones, at which Dr Jonathan Wright spoke. He has pioneered the use of what he calls "Biologically Identical Human Hormones" in the treatment of a wide range of conditions. His philosophy is simple - copy Nature. Hormones should only be used where there is a demonstrable deficiency, in physiological doses, using biologically identical hormones, delivered transdermally (so they slowly leak into the circulation, bypassing the liver), mimicking natural cycles, where relevant. Treatment must be monitored.

I was very happy to hear Dr Wright say this because this has also been my philosophy. These principles I apply to thyroid hormones (which can be given by mouth because they are not digested and slow acting), cortisol and DHEA. The sex hormones are different because they are digested in the gut and cleared by the liver.

Hormones such as progesterone, oestrogen and testosterone have been prescribed for many years. However, all such "prescribables" are synthetic analogues, not biologically identical hormones, which have been given in supraphysiological doses (i.e. high doses) with scant regard for biological cycles and doses. Most have been given without any monitoring. Therefore this method of use has caused long term side effects. The action of any hormone can be changed hugely and unpredictably by minor alterations to its chemical structure - hence the need for biologically identical hormones.

You might ask why was this not done in the first place? The answer is patentability. Natural hormones cannot be patented therefore nobody can make any money out of them. Lots of money can be made from promoting synthetic hormones because the manufacturer gets the monopoly.


Oestrogen
Oestrogen exists in the body in three different forms namely oestriol, oestradiol and oestrone, in the proportions 60-80%, 10-20% and 10-20%. This compares with Premarin (from pregnant horses) with equilin 6-15%, oestradiol 5-19%, and oestrone 75-80%. As a result of the "foreign" and unbalanced oestrogens in Premarin, it has a thousand times greater growth promoting effect on the womb. To replace oestrogen correctly, one first needs to measure oestrogen levels and prescribe what is appropriate for that age in the correct physiological proportions, namely by using triple oestrogen cream. An average dose would be 2.5mgs daily, adjusted according to monitoring. However this is expensive and only available from America. The next best thing in UK is an oestradiol patch.

Progesterone
Again levels must be measured and the biologically identical progesterone given transdermally with progesterone cream aiming for a daily dose of 30mgs, again adjusted according to monitoring.

Testosterone
Again the same principles apply - measure levels, use the biologically identical hormone given transdermally and monitor. Apparently a common effect is improvement in muscular strength and stamina - hardly surprising when one considers the effect of testosterone on prepubertal boys!

When to give?
Sex hormones need to be given in women according to their menstrual cycle as it is or how it used to be. This is in order to mimic the natural secretion of hormones. So, for example, for a woman with a 30 day cycle the recommended supplementation looks roughly like this: Triple oestrogen cream on days 1 to 26. Progesterone cream on days 12 to 26 Testoterone cream on days 1 to 26 DHEA for all days.
(Day 1 of the cycle is the first day of your period i.e. the first day of bleeding.)


Prevention of cancer
The greatest worry when using sex hormones is the long term risk of cancer. Oestrogens are converted in the body to different oestrogens, some "good" such as 2-hydroxyoestrone, some "bad" such as 16 alpha hydroxyoestrone . The enzyme which controls this balance is inhibited by a natural substance indole-3-carbinol found in cabbage and all such brassicas. Indeed a study by Dr Marie Bell demonstrated complete regression of cervical cancer in over 40% of women simply by taking indole-3-carbinol. This ratio of 2/16 alpha hydroxyoestrone is critical and improved by eating cabbage. So the message is, if you want to prevent breast, cervical or womb cancer, eat up your cabbage!

Monitoring hormone levels
All these hormones can be checked using salivary samples. This makes it very user friendly! I can supply the kits (you can order some of them through the website, others I can send you details if you write to smyhill@globalnet.co.uk) and you do the tests in your own time and post them off to the laboratory (Great Smokies) directly.
For example:

Adrenal stress index test: measures cortisol levels over 24 hours and DHEA.

Post menopausal profile: oestradiol, progesterone and testosterone - 4 salivary samples over 2 weeks.

Pre-menopausal profile: oestradiol, progesterone and testosterone - 11 samples over 28 days.

Male hormone profile: testosterone - 4 samples over 24 hours.

Great Smokies also offer a comprehensive panel of premenopausal profile plus cortisol, DHEA and melatonin.
(Some of these tests are on the website, but if you are interested in a test which is not on this website, please email smyhill@globalnet.co.uk and I'll send you the details)
Bear in mind that if hormones are prescribed, then levels must be monitored. The cheapest and easiest way to do this may be by testing serum levels of the hormones from a sample obtained by a finger prick. Again, this can be done at home without involving your GP and I can supply the kits.