estrogen dominance

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Estrogen Dominance By: Michael Lam, MD, MPH www.DrLam.com Introduction In the past 40 years, we have seen a dramatic rise in female-related illnesses never seen before in history. Today, we see the age of puberty (menarche) dropping precipitously to as low as 10 years of age, endometriosis afflicting 10% of all perimenopausal women; Premenstrual Syndrome (PMS), rising and afflicting close to 30% of perimenopausal women, uterine fibroids affecting close to 25% of women from age 35 to 50, and breast cancer afflicting close to 10% of all women. Being a woman in the 21st century is certainly a high risk profession. Navigating through this hazardous profession is not easy. Imagine having endometriosis, PMS and fibrocystic breasts when you were young, progressing to uterine fibroids, hysterectomy, misguided hormone replacement and ultimately breast cancer as your menopause approaches. The very thought of this journey can send chills up through anyone's spine. Fortunately, scientific evidence is mounting that hormone disruption is the key cause of all these seemingly separate but related diseases. For too long, we have ignored the importance of hormone balance. For too long, physicians have been misguided on the real truth about hormonal balance. Now, we know that the common thread in many female hormone diseases such as those mentioned above is a little known condition known as estrogen dominance. The underlying problem is a relative excess of estrogen and an absolute deficiency in progesterone. In the west, the prevalence of estrogen dominance syndrome approaches 50% in women over 35 years old. Here are some typical complaints from patients having estrogen dominance: 1. My breasts are swollen and getting bigger. 2. I can't put my rings on my fingers. 3. I am more impatient now than ever. 4. People tell me I am too bossy. 5. I am getting cramps again like when I was younger. 6. I no longer get my period. 7. I miss my periods regularly. 8. My periods come irregularly. 9. I get scared when I see large clots during my period. 10. I have Pre-Menstrual Syndrome (PMS). 11. When I get a hug, my breasts hurt. 12. I have fibroids. 13. I have endometriosis. 14. I cannot fit into my shoes. 15. I have a cyst in my breast. 16. I feel tired all the time.

Before we look at estrogen dominance in more detail, let us first review the basic menstrual cycle and the key female hormones. Modern Menstruation One hundred years ago, the average woman started her menses at age 16. She got pregnant earlier and more frequently. She often spent more time lactating. In total, women back then experienced the menstrual cycle about 100 to 200 times in their lifetime. Today, the average modern women starts puberty at age 12, seldom lactates, has less children, and menstruates about 350 to 400 times during a lifetime. Incessant menstruation has been associated with the increased occurrence of a myriad of pathological conditions including infertility, cancer, fibroids, anemia, migraines, mood shifts, abdominal pain, fluid retention, and endometriosis. What a difference a century makes! It is apparent that modern woman goes through a lot more than her counterpart just a century ago. Could this have any bearing on the epidemic of female related illness plaguing our society? To answer that question, let us take a closer look at the hormones responsible for regulating the female menstrual cycle. Female Hormones The two primary female hormones secreted by the ovaries are estrogen and progesterone. The properties of one offsets the other and together they are maintained in optimal balance in our body at all times. Too much of one hormone or the other can lead to significant medical problems. Estrogen Estrogen is produced in the ovaries. It regulates the menstrual cycle, promotes cell division and is largely responsible for the development of secondary female characteristics during puberty, including the growth and development of the breast and pubic hair. Estrogen therefore affects all female sexual organs, including the ovaries, cervix, fallopian tubes, vagina, and breast. As a general rule, estrogen promotes cell growth, including signaling the growth of the blood-rich tissue of the uterus during the first part of the menstrual cycle and stimulates the maturation of the egg-containing follicle in the ovary. It softens the cervix and produces the right quality of vaginal secretion to allow the sperm to swim and to lubricate during intercourse. Furthermore, it lifts our mood and gives a feeling of well-being. In non-pregnant, pre-menopausal women, only 100-200 micrograms (mcg) of estrogen are secreted daily. However, during pregnancy, much more is secreted. Estrogen in our body actually is not a single hormone but a trio of hormones working together. The three components of estrogen are: estrone (E1), estradiol (E2), and estriol (E3). In addition, there are at least 24 other identified types of estrogen produced in the woman's body, and more will be discovered. In healthy young women, the typical mix approximates 15/15/70 percent respectively. This is the combination worked out by Mother Nature as optimum for human

females. Today, we use the word estrogen loosely to include also a family of hormones, including animal estrogens, synthetic estrogens, phytoestrogens (plant estrogens), and xenoestrogens (environmental estrogens, usually from toxins such as pesticides). Estrogen is a pro-growth hormone. Since too much of anything is generally not good, the body has another hormone to offset and counterbalance the effects of estrogen. It is called progesterone. Progesterone As its name implies, progesterone is a pro-gestation hormone. In other words, it favors the growth and well-being of the fetus. Without a proper amount of progesterone, there can be no successful pregnancy. It protects us against the "growth effect" of estrogen. When progesterone is secreted, further ovulation is prevented from taking place in the second half of the menstrual cycle, and a thick mucous that is hostile to sperm is produced that prevents its passage into the womb. Progesterone is made from pregnenolone, which in turn comes from cholesterol. Production occurs at several places. In women, it is primarily made in the ovaries just before ovulation and increasing rapidly after ovulation. It is also made in the adrenal glands in both sexes and in the testes in males. In women, its level is highest during the luteal period (especially from day 19 to 22 of the menstrual cycle). If fertilization does not take place, the secretion of progesterone decreases and menstruation occurs 12 to 14 days later under normal conditions. If fertilization does occur, progesterone is secreted during pregnancy by the placenta and acts to prevent spontaneous abortion. About 20-25 mg of progesterone is produced per day during a woman's monthly cycle. Up to 300-400 mg are produced daily during pregnancy. Estrogen Effect vs. Progesterone Effect As mentioned earlier, progesterone acts as an antagonist to estrogen. For example, estrogen stimulates breast cysts while progesterone protects against breast cysts. Estrogen enhances salt and water retention while progesterone is a natural diuretic. Estrogen has been associated with breast and endometrial cancers, while progesterone has a cancer preventive effect. Studies have shown that pre-menopausal women deficient in progesterone had 5.4 times the risk of breast cancer compared to healthy women. The following table clearly shows how progesterone and estrogen balance each other. It is very important to note that both hormones are necessary for optimum function. Progesterone will not work without some estrogen in the body to "prime the pump", for example. Estrogen Effect Causes endometrium to proliferate Causes breast stimulation that can lead to breast cancer Increases body fat Increase endometrial cancer risk Progesterone Effect Maintains secretory endometrium Protects against fibrocystic breast and prevents breast cancer Helps use fat for energy Prevents endometrial cancer

Increase gallbladder disease risk Restrains osteoclast function slightly Reduces vascular tone Increase blood clot risk Estrogen Dominance

Promote osteoblast function, leading to bone growth Restores vascular tone Normalize blood clot

Estrogen and progesterone work in synchronization with each other as checks and balances to achieve hormonal harmony in both sexes. It is not the absolute deficiency of estrogen or progesterone but rather the relative dominance of estrogen and relative deficiency of progesterone that is the main cause of health problems when they are off balance. While sex hormones such as estrogen and progesterone decline with age gradually, there is a drastic change in the rate of decline during the perimenopausal and menopausal years for women in these two hormones as mentioned earlier. From age 35 to 50, there is a 75% reduction in production of progesterone in the body. Estrogen, during the same period, only declines about 35%. By menopause, the total amount of progesterone made is extremely low, while estrogen is still present in the body at about half its pre-menopausal level. With the gradual drop in estrogen but severe drop in progesterone, there is insufficient progesterone to counteract the amount of estrogen in our body. This state is called estrogen dominance. Many women in their mid-thirties, most women during peri-menopause (midforties), and essentially all women during menopause (age 50 and beyond) are overloaded with estrogen and at the same time suffering from progesterone deficiency because of the severe drop in physiological production during this period. The end result - excessive estrogen relative to progesterone, a condition we call estrogen dominance. According to the late Dr. John Lee, the world's authority on natural hormone therapy, the key to hormonal balance is the modulation of progesterone to estrogen ratio.