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A Woman’s Guide to Healthy Hormones

A Woman’s Guide to Healthy Hormones

This short guide is going to discuss the “ins and outs” of hormones in women. That is, we are going to discuss the safe and effective addition of hormones to the body, and metabolism, or how our body removes hormones. As a primer, it is important to understand that hormones are our body’s messenger. They are the chemical message that one part of the body secretes to notify another part of the body that it needs to grow, divide, or produce a certain protein. As women age, there is a sudden drop in the body’s production of these messengers that we term “menopause”. This precipitous drop in hormones results in a failure of the body to maintain itself adequately on the cellular level, and often results in a myriad of symptoms that impact a woman’s quality of life. 

There are 3 main sex hormones that need to be addressed in females, these are estrogen (the most potent of which is called estradiol), progesterone, and testosterone. Of these 3 hormones, only progesterone is safe to be taken by mouth. This presents a problem, as many women have been prescribed oral estrogen products such as estradiol tablets, or “conjugated estrogens” such as Premarin or Prempro to address their menopausal symptoms. When you swallow estrogen, that estrogen floods the liver all at once, and the liver breaks that estrogen down to molecules that look similar to the original estradiol, but actually have a dramatically different message when they interact with our cells! 

Our liver is an amazing organ that serves to detox our body from drugs and chemicals that are present in our foods and prescriptions. Though the liver is excellent at what it does (detoxing) it is also nonspecific in its activity, a nice way of saying that it is “dumb”. Your doctor prescribed estradiol, NOT the breakdown product of estradiol! The hepatic metabolism of estradiol results in faulty chemical messages that are not safe for you. The other oral estrogen products Premarin and Prempro are actually a worse situation. At least if you have been prescribed estradiol tablets, that estradiol is actually identical to the estradiol the human body produces… the “conjugated estrogens” are not human hormones at all, they are actually extracted from horse urine. Pregnant Mare Urine = Pre-Mar-In.

Testosterone undergoes similar metabolism when swallowed, however the end result is that the hormone is rendered inactive. It does not work! This brings us to our first key:

  1. Do not swallow estrogen or testosterone

Our second key involves progesterone. During the normal menstrual cycle in a younger woman, there is a beautiful interplay between estrogen and progesterone. They work together in a delicate balance to prepare the body for reproduction, and reset the cycle if fertilization does not occur. Most postmenopausal women are not interested in procreating, but the goal of hormone replacement is to balance the hormones. While estrogen gets most of the press and the attention, progesterone is just as vitally important to quality of life as estrogen. In the body, progesterone serves as an “off switch” to the building signals of estrogen. When the ratio between these two is thrown off, symptoms erupt. 

Many women who are undergoing hormone replacement therapy that have had a hysterectomy have not been prescribed progesterone as a part of their post-surgical care. This is because one of progesterone’s main functions is to protect the uterus, and if the uterus is removed, you don’t need progesterone, right? WRONG – progesterone has MANY other functions in the body aside from uterine protection. There are progesterone receptors in many different cells, this proves it is vital to hormonal wellness.

Progesterone is safe to take by mouth, and often has a calming, anti-anxiety effect when swallowed. For this reason, many prescribers tell their patients to take their progesterone capsule at night. Many women are able to kill two birds with one stone this way – they get help sleeping, while also addressing their hormone deficiency. Progesterone is also available as a cream, implantable pellet, and sublingual dosage form. Our second key:

  • If you are on estrogen, it must be balanced with progesterone

Thirdly and perhaps most importantly: you need to be treated as an individual. Your specific care needs and goals must be addressed by your provider and your pharmacy. Hormone replacement is highly customizable, and is all about getting the right drug in the right dose via the rightroute of administration to meet your specific situation. If you have small kids at home, a cream may not be the best decision for you, as it can transfer from you to the child. If you have a busy work schedule and are forgetting to take your morning dose of medication, a pellet may be a great option for you as you will not have to worry about remembering to take your dose. If you are highly sensitive to medications a simple sublingual solution may be the best option for you as we are able to adjust the dose, sweeteners, and flavorings to meet your specific needs.

  • Work with your doctor and compounding pharmacy to find the rightdrug in the rightdose via the rightroute for you!