Jonathan Wright, MD
By Dave TuttleApril 2005
By Dave Tuttle
Estriol is also effective in relieving menopausal symptoms. A six-month study of 52 women with severe symptomatology found that supplementation with 2-8 mg of estriol succinate produced significant improvements within one month, which continued throughout the therapy.11 Estriol also reversed vaginal atrophy and improved the quality of cervical mucus. No breakthrough bleeding occurred in subjects, and biopsies of the inner uterine mucous membrane show-ed no endometrial hyperplasia (excessive proliferation of the uterine lining cells), a condition that can precede uterine cancer. The reduction in menopausal symptoms occurred without any reported side effects. As expected, symptom improvement was related to the dose.
A longer-term study of estriol therapy revealed that this treatment was successful in 92% of the cases.12 In 71% of the subjects, hot flashes and sweating were eliminated completely, while in 21% they were weaker and occurred less frequently. Depressive moods were abolished in 24% of the cases and were reduced in severity in another 33%. Reductions in forgetfulness, loss of concentration, irritability, and heart palpitations also were recorded. The number of patients who experienced migraine headaches dropped by two thirds. Even subjective improvements in the quality of the subjects’ skin, as noted by both the patients and physicians, were reported. All of this occurred without notable side effects.
While many women will get complete relief with estriol supplementation, some will need to add small amounts of the more potent estrogens. Two of the most popular prescription estrogen formulas are Bi-Est and Tri-Est. Bi-Est consists of bioidentical estriol and estradiol. The most common version of this formula is 80% estriol and 20% estradiol, though the amount of each hormone can be titrated at a compounding pharmacy to provide maximal symptom relief. Tri-Est consists of 80% estriol, 10% estradiol, and 10% estrone. These creams are usually applied on the inner thigh or inner upper arm, though they are sometimes inserted vaginally. The site of application should be changed on a daily basis to maximize absorption.
“These bioidentical hormones are much better than those that are isolated from the urine of pregnant mares or synthesized so they can be patented,” Dr. Wright notes. “However, even with bioidentical molecules, you will get into problems if you take too much. If you are utilizing triple estrogen therapy, you should take no more than 2 mg of estriol, 0.25 mg of estradiol, and 0.25 mg of estrone per day. If you are using bi-estrogen, it’s still advisable to limit your amount of estradiol to 0.25 mg daily unless a follow-up test shows you definitely need more. These moderate doses will allow you to get the benefits of estrogen replacement without the risks inherent in prescription drugs. As with progesterone, there should be a lull every month to match the body’s natural cycle and to prevent long-term receptor down-regulation.”
DHEA: Additional Anti-Aging Benefits
Dehydroepiandrosterone, or DHEA, is another hormone that declines during the aging process. It is produced in women in the adrenal gland and brain. Youthful levels begin to drop around the age of 30, and most women have a deficiency of this vital hormone by the age of 40. The rate of decline varies for each person, so blood testing is essential to determine the appropriate supplementation dosage. Deficiencies of DHEA have been correlated with numerous age-related conditions, including chronic inflammation, immune dysfunction, depression, rheumatoid arthritis, increased risk for certain cancers, excess body fat, cognitive decline, osteoporosis, and some complications of type II diabetes.13
Despite the findings of hundreds of peer-reviewed studies, the benefits of DHEA replacement therapy are still not recognized by mainstream medicine, which prefers to steer women to estrogen-related prescription drugs. Nevertheless, given that youthful levels of DHEA can decline as much as 95% by age 85, the case for bioidentical hormone supplementation is clear.
Advancing age results in an increase in inflammatory cytokines, which are destructive cell-signaling chemicals that contribute to many degenerative diseases. Rheumatoid arthritis, a disease that overwhelmingly strikes women, is a classic autoimmune disorder in which excess levels of cytokines play a significant role in inflammation. Studies have shown that DHEA is an important component in the treatment of rheumatoid arthritis because of its ability to lower levels of the pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha, and to protect against their toxic effects.14,15 Interleukin-6 also plays a role in promoting bone loss and joint deterioration, and aberrantly high levels of this cytokine are associated with atherosclerosis, Alzheimer’s disease, and some cancers.16 DHEA’s ability to reduce inflammation makes it safer and more effective in the long run than the corticosteroids usually prescribed by mainstream physicians.
DHEA supplementation has other advantages for older women. A six-month trial at the University of California at San Diego found that 50 mg of DHEA daily increased physical and psychological well-being in women by 84%.17 Another study found that DHEA supplementation produced significant elevations in insulin-like growth factor.18 Deficiencies of this factor contribute to a loss of lean body mass, excess fat accumulation, neurological impairment, and age-related immune dysfunction. Additional benefits of DHEA include inhibition of abnormal blood platelet accumulation,19 improved mood and libido,20 and increased skin protection against environmental contaminants.21
“Unlike progesterone and estrogen, DHEA production does not follow the menstrual cycle, so there is no need to cycle your daily dosage,” says Wright. “DHEA has many benefits for life extension, so if a woman hasn’t started supplementing by then, she will need to start at menopause. The average dose I recommend for women is 10-15 mg of oral or transmucosal DHEA daily. I have found that this is sufficient to provide the immune-boosting and cancer-preventive effects of this multifaceted natural hormone.”
The Life Extension Foundation recommends regular blood testing of DHEA-sulfate levels to ensure that women remain within the optimal range of 350-430 mcg per dL. However, because DHEA can convert to estrogen, supplementation is contraindicated for women with hormone-receptive breast cancer.
The Importance of Testosterone
While often considered a man’s hormone, testosterone is essential to women as well. This hormone is produced in women’s ovaries and adrenal glands at about one tenth the level as in men. Testosterone is important for maintaining sexual interest and function, and provides many other health-enhancing benefits. As with men, testosterone concentrations in women begin to decline around the age of 30. By the time they reach menopause, some women have very low levels of testosterone. These deficiencies are a key predictive factor for heart disease in women who have had hysterectomies.22 A lack of this hormone can also promote breast cancer. A study in 2003 found that testosterone inhibits breast cell growth, much like progesterone’s protective effect on the uterus.23
“Testosterone is an important part of a hormone replacement program for women,” Dr. Wright explains. “It promotes bone development and muscular strength while improving the libido and fighting cancer. Women with congestive heart failure have also found that this hormone increases cardiac strength.”
Several studies have shown benefits from testosterone supplementation in women. A study published in the New England Journal of Medicine found that a transdermal testosterone patch containing only 300 mcg provided significant improvement in sexual function, mood, and general well-being in women who had had their ovaries removed.24 Additional research by Dr. Susan Davis at the Jean Hailes Foundation in Australia has shown that testosterone supplementation improves sex drive, arousal, and frequency of sexual fantasies in pre- and postmenopausal women.25 Her investigations also show that testosterone is important in maintaining a woman’s energy level and sense of well-being regardless of age.26
“Natural testosterone levels peak at ovulation and reach a nadir during menstruation, so I test at different times to see how much of a cycle there is,” adds Dr. Wright. “Also, because of possible testosterone dominance [a period in some older women when progesterone and estrogen levels are low and testosterone is still relatively high], replacement dosages vary considerably among individual women. Supplementation should follow the same monthly cycle as estrogen. I recommend the transmucosal route of administration for all hormones.”
The aging process is hard enough for women without their also having to cope with preventable declines in hormone levels. Once women realize the differences between bioidentical hormones and the now-disgraced synthetic drugs, the choice should become clear. Women can prolong the quality of their lives by replacing the natural hormones that their youthful bodies produced in abundance. When accompanied by a sound supplement regimen and a sensible diet and lifestyle, hormone replacement allows women to maximize their longevity and be healthy enough to enjoy it as well.
Editor’s note: Women with estrogen receptor-positive breast cancer should not use any form of estrogen. Some doctors are still concerned that even natural bioidentical estrogen and testosterone could induce breast and other cancers by stimulating excess cellular proliferation.
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