11/11/2015. Calm Your Hormones! OR EVERYTHING YOU SHOULD KNOW ABOUT HORMONE THERAPIES

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Leonard Spencer
6 years ago
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PACKAGES WITH A BIG IMPACT Key Components of Overall Health Chemical substances produced in

They are powerful molecules They interact with each other.

cell and interact inside the nucleus The action can be direct or indirect The interface and

hormones interact with cortisol (stress hormone) and insulin (glucose regulator) They are

1 Jill Earl CNM,CRNP Calm Your Hormones! OR EVERYTHING YOU SHOULD KNOW ABOUT HORMONE THERAPIES Hormone Production &Utilization LITTLE PACKAGES WITH A BIG IMPACT Key Components of Overall Health Chemical substances produced in the body that control and regulate the activity of certain cells or organs. They are powerful molecules They interact with each other. They can interact with the cells on the surface at receptor sites OR Enter directly into the cell and interact inside the nucleus The action can be direct or indirect The interface and result can be a single direction, or can form a cascade of action Women s Health Your sex hormones interact with cortisol (stress hormone) and insulin (glucose regulator) They are made by pregnenolone, the memory hormone They interact with thyroid hormones (metabolism) Hormone levels influence each other and change over time Environment, diet, toxins and life stage are all factors 1

A few good hormones ALSO KNOWN AS THE SEX HORMONES Estrogen Estrone (E1) Estradiol (E2) Estriol (E3) Progesterone Testosterone stor Estrogen NAMED FOR THE OESTRUS CYCLE The primary female sex hormone

2 A few good hormones ALSO KNOWN AS THE SEX HORMONES Estrogen Estrone (E1) Estradiol (E2) Estriol (E3) Progesterone Testosterone stor Estrogen NAMED FOR THE OESTRUS CYCLE The primary female sex hormone Develops secondary sex characteristics breast development thickens endometrium part of cycle regulation FSH and LH regulate the production in ovulating women Circulating estrogen will decrease FSH and LH Presence in the first 14d of cycle inhibits ovulation Estrogen con t Produced primarily in the ovaries, corpus luteum and placenta All three estrogens are produced from androgens through enzyme action E2 produced from testosterone and E1produced from androstenedione Androstenedione is made in the theca interna cells (in the ovary) from cholesterol Your body has receptor sites everywhere! There are more than 400 known functions 2

Low estrogen levels Smokers Low Fat Diets Common symptoms: Acne Anxiety Arthritis Chronic fatigue Decrease in memory decrease in libido Depression PCOS palpitations infertility panic attacks thinner

3 Low estrogen levels Smokers Low Fat Diets Common symptoms: Acne Anxiety Arthritis Chronic fatigue Decrease in memory decrease in libido Depression PCOS palpitations infertility panic attacks thinner skin vaginal dryness vulvodynia osteoporosis/osteopenia incontinence Thin endometrial stripe High estrogen ESTROGEN EXCESS / ESTROGEN DOMINANCE Includes most women with estrogen imbalance Over production of estrogen Progesterone/estrogen ratio imbalance Xenoestrogens(environmental bombardment) Common symptoms: bloating cervical dysplasia decreased libido headaches fatigue heavy periods hypothyroidism insomnia irritability panic attacks mood swings fibroids edema weight gain ESTRONE (E1) Derived from E2 Main estrogen post menopause Reserve source of estrogen Converted to E2 in ovaries Routine alcohol consumption increases ovarian E1 3

ESTRADIOL (E2) Strongest form of estrogen Main estrogen in the body before menopause Mostly made in the ovaries High levels associated with increased risk of breast & uterine cancer ESTRIOL (E3) Less

4 ESTRADIOL (E2) Strongest form of estrogen Main estrogen in the body before menopause Mostly made in the ovaries High levels associated with increased risk of breast & uterine cancer ESTRIOL (E3) Less stimulating to breast & uterine lining Does not promote breast cancer It is an adaptogen, adapting to the specific environment Does not protect bone, heart or brain like E2 Does help bone a little and cholesterol There are two types of receptors ER ALPHA AND ER BETA ERα increases cell growth, proliferation ERβ decreases cell growth, helps prevent breast cancer E2 equally activates both receptors E1 activates ERα selectively 5:1 E3 activates ERβ selectively 3:1 E3 has 20-30% affinity for ERs compared to E2, therefore cleared rapidly from the cell E3 at concentration is equivalent to E2 4

5 ERα and ERβ con t Receptors ERα and ERβ are similar and respond in comparable ways. Phytoestrogens have a greater affinity to ERβ. The regulatory domains differ between the receptors and is beyond the scope of this talk. Synthetic estrogen MOST COMMONLY RX D HT IN THE USA Premarin is a mixture of estrone, sodium equilin sulfate, and components such as 17-alphadihydroequilin,17 alpha-estradiol, and 17 beta-dihydroequilin. Equilin and equilenin are horse estrogens. There are other additives and coatings. Synthetic estrogens contain many estrogens that do not fit into human receptors, and it is unknown what happens to them. Synthetic estrogen CON T The estradiol your body makes is eliminated from your body through urine within a day. Equilin, derived from the urine of horses, has been shown to persist in the body for 13 weeks. Human enzymes are designed to metabolize human estrogen, not horse s. 5

On to Progesterone! BEST KNOWN AS THE PREGNANCY HORMONE Important in menstruation, pregnancy and the formation of embryos. Made in the ovaries until menopause. Performs many functions in the body!

6 On to Progesterone! BEST KNOWN AS THE PREGNANCY HORMONE Important in menstruation, pregnancy and the formation of embryos. Made in the ovaries until menopause. Performs many functions in the body! Balances estrogen helps sleep Helps build bone prevents anxiety Helps bladder function Relaxes smooth muscle in the gut and blood vessels Signs of progesterone imbalance YOU CAN HAVE TOO MUCH OR TOO LITTLE High P4 Only happens if taking too much or too much pregnenolone leaky bladder ligaments relax backaches Leg aches hip pain Progesterone deficiency Many causes: low LH increased saturated fats stress high sugar intake decreased thyroid hormone 6

7 Synthetic progesterone PROGESTIN Does not have the same structure as the body makes Does not reproduce actipons of natural progesterone does not balance estrogen interferes with body s production of progesterone Attaches to multiple receptor sites, nopt just PR Stops the protective effects estrogen has on heart and causes spasms of arteries Synthetic P4 CON T Studies have shown progestin increase risk of breast CA by 800% when compared to estrogen alone An article in JAMA discussed the risk of developing breast CA was predicted to rise by 80% after 10 yr of using estrogen &/or progestin Cardiologist Stephen Sinatra MD,FACC has found progestins cause cardiac SEs including SOB, fatigue, chest pain and HTN Menopausal estrogen-progestin replacement treatment and breast cancer risk JAMA, 2000;283: progestin THE GOOD, THE BAD The good: does help build bone helps thyroid function protects against fibrocystic disease normalizes zinc and copper levels proects the uterus from cancer The bad: acne increased appetite and wt gain depression hair loss decreased libido increased LDL breast tenderness 7

8 Natural progesterone Same chemical structure as the body makes Made from yams or soy Disogenin, a plant steroid, can be turned into an exact duplicate of human progesterone Has all the important good effects of progesterone and no serious SEs. Most common SEs: Dizziness Fatigue nausea Effects of Progesterone Balances estrogen & fluids in cells Decreases rate of cancer on all PR Does not change the good effects of estrogen on blood flow Enhances thyroid Calming Cycle regulation Messages body to maintain conception More good stuff PROGESTERONE RULES! Short half life Lowers BP, relaxes smpooth muscle Normalizes/improves libido Natural antidepressant Increases metabolic rate & scalp hair as well Anti-inflammatory Prevents menstrual migraines Promotes myelination and protects nerves from injury Lowers cholesterol 8

Natural progesterone DOSING TIDBITS Can be taken orally or transdermal SL is a form of transdermal For insomnia take the oral Prometrium is micronized in a base of peanut oil Absorption rate for oral

compounded, be sure label says USP progesterone or it may lack enzyme for conversion If exact dosing is required, do SL or injectible Testosterone THE MASCULINE HORMONE An androgen, usually seen as

9 Natural progesterone DOSING TIDBITS Can be taken orally or transdermal SL is a form of transdermal For insomnia take the oral Prometrium is micronized in a base of peanut oil Absorption rate for oral increases with age Adrenaline blocks progesterone receptors Transdermal progesterone Hormones are all lipophilic Subcu receptors get loaded over time, so rotate sites If commercial cream, not compounded, be sure label says USP progesterone or it may lack enzyme for conversion If exact dosing is required, do SL or injectible Testosterone THE MASCULINE HORMONE An androgen, usually seen as the male hormone b/c it stimulates male secondary sex characteristic Estrogen stands in opposition- a balancing act Made in the adrenal glands and ovaries Production decreases with age Only 1% of circulating testosterone is free and bioavailable, the rest is bound to SHBG 9

10 testosterone CON T Inhibits bone catabolism Decreases body fat, increases muscle mass Increases libido Elevates norepinephrine in the brain Testosterone imbalance Androgen dominance is the most common hormonal disorder in women PCOS Signs and symptoms: anger agitation fluid retention hirsutism insulin resistance infertility irregular menses Testing and Dosing SOME QUICK FACTS Serum progesterone WNL: before ovulating/after menopause 1ng/ml mid cycle- 5-20ng/ml pregnant- 1 st ng.ml 2 nd rd

11 Estrogen levels (E2) During menses 45 ng/ml Ovulation peaks near 400pg.ml Pregnancy- up to 100x higher After menopause pg/ml (optimal is pg/ml) Testosterone levels Females yr <7-75 ng/ml 19 yr ng/ml Average adult male 270-1,070 ng/ml Average adult female ng/ml Dosing QUICK AND DIRTY. Remember dosing can be usual amounts but will always be evaluated individually in the patient! Bioidentical preparations are compounded by the compounding pharmacist according to your orders. These can be shipped to patient. 11

12 Beginning dosages for common problems: Menstrual migraines d Endometriosis rec d salivary testing to determine E2 dominance Progesterone 200mg-400mg ½ troche BID Menopause Syndrome Biest 1-2mg/Progesterone 200mg ½ troche SL BID daily or cyclic PPD PP insomnia Progesterone 400mg SL daily Fibroids progesterone 200mg qd or cyclic PCOS progesterone 200mg ½ troche BID cyclic Premature Ovarian Decline Premature Ovarian Failure No menses, FSH >20 mlu/ml Needs Biest 0.5mg/Progesterone 200mg cyclic +heat + TCM herbs Many women can achieve menstruation and ovulation 12

13 Luteal phase infertility progesterone 200mg ½ troche SL BID on day of cycle Patient should have been monitoring ovulation to insure correct timing The 3 P s PCOS metformin progesterone 200mg ½ troche SL BID cyclic PMDD usually progesterone mg SL qd or cyclic day Look at testosterone levels and estrogen levels, can be low PMS progesterone 200mg troche ½ SL BID d of cycle A little more about PMS SOME WOMEN HAVE LOW E2, NORMAL P4 If the progesterone is not effect give phytoestrogens and/or herbs: Angelical sinensis (Dong Quai) Borage oil EPO Ginko Black Cohosh Vitex agnus castus 13

14 A few good resources Clinical Gynecologic Endocrinology and Infertility 2010 by Marc A. Fritz MD and Leon Speroff MD What You Must Know About Women s Hormones By Pamela W Smith, MD,MPH Thank you for attending! Any Questions? My contact info: jille_99@yahoo.com Wellspan Family Health Georgetown (717)

8605 SW Creekside Place Beaverton, OR Phone: Fax: Samples Collected. Samples Received 06/21/2017

TEST RESULTS Ordering Provider: Getuwell Clinic Patient Name: Patient Phone Number: 555 555 5555 Gender Female DOB 6/9/1978 (39 yrs) Menses Status Pre-Menopausal 8605 SW Creekside Place Beaverton, OR 97008