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Estrogen, Progesterone, and You
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NATURAL PROGESTERONE

Estrogen, Progesterone, and You

"Female Problems," "Women's Issues," "Girl Troubles." These are just a few of the phrases that describe health problems unique to women. These problems include yeast infections and the discomforts of menopause and premenstrual syndrome (PMS). Today, more and more women are learning that a number of these problems may be related to two hormones: estrogen and progesterone.

Estrogen

Estrogen is a female hormone that is mostly produced in the ovaries. Estrogen is not a single hormone, but rather a class of hormones. The three most important estrogen compounds are estradiol, estrone, and estriol.

Estrogen is probably best known for its role in the development of female sexual characteristics and in the regulation of female reproductive functions, but its scope is much larger. Estrogen is a very powerful hormone, so powerful that there are some 300 receptors in body tissue that will accept it. This means that a large share of a woman's body is affected by and responds to estrogen. High, low, or fluctuating levels of estrogen will be felt throughout the entire body.

A girl's body begins to produce higher levels of estrogen as early as eight years old in response to messages originating in the brain that the body is ready for sexual development. Estrogen levels gradually increase until, by the age of 11 or 12, there is enough estrogen (and other hormones) for the development of breasts and for menstruation to begin. With this increase of estrogen, a young woman may feel as if she has "lost control" of her body: acne may appear, hair may become oily, and she may experience mood swings from day to day.

At a certain point, generally when women are in their early 30s, estrogen production begins to slow. Most women do not notice this decrease until about 10 years later, when estrogen production has slowed considerably and women enter what is known as perimenopause.

Menstruation becomes less regular, the appearance and feel of skin and hair may change, and many women suffer severe mood swings_similar to those they might have had when estrogen production began 30 years earlier.

Estrogen Dominance

A number of health practitioners believe that too much estrogen_known as estrogen dominance_can result in side effects and ill health. Estrogen dominance can be caused by overproduction of the hormone, or by a deficiency of progesterone, another hormone that acts as a balance to estrogen (see next section). Estrogen dominance may also be more prevalent today because of the synthetic estrogen used in our foods and the many chemicals prevalent in our environment that have estrogen-like effects. According to Raymond F. Peat in Nutrition for Women, among the side effects of estrogen dominance are face puffiness, night feet-swelling, excessive uterine bleeding, PMS symptoms, increased fat storage, low blood sugar, and memory loss.

Progesterone

Like estrogen, progesterone is made in the ovaries. Progesterone production begins rising at ovulation and increases rapidly until it reaches an average production of about 22 milligrams per day. If an egg is not fertilized, progesterone production (as well as that of estrogen) falls quickly. This initiates the menstrual flow. Progesterone is necessary for the survival of a fertilized egg, the resulting embryo, and the fetus throughout gestation. It is also the precursor of other steroid hormones including cortisol, aldosterone, estrogen, and testosterone. Taking progesterone will not create an excess of any of these other hormones; rather, progesterone acts to balance or neutralize them.

Progesterone has many other functions, among them protecting against breast fibrocysts, helping the body use fat for energy, and helping to normalize blot clotting and blood sugar levels. Today, many health professionals claim that the symptoms associated with PMS andmenopause are due not so much to estrogen alone, but rather to an overabundance of estrogen coupled with a deficiency of progesterone.

PMS

What role might progesterone play in PMS? We should look first at progesterone's role in the menstrual cycle. The menstrual cycle begins as the body prepares itself for a possible pregnancy. Estrogen levels begin to climb, sparking the buildup of the uterine wall in preparation for the possible reception of a fertilized egg. At the same time, an egg begins to develop in the ovaries. About 12 days later, the estrogen level peaks and falls back just as the developing egg matures. Then, ovulation occurs (the egg is sent to the womb), and the cells remaining in the ovaries become the corpus luteum. The corpus luteum produces progesterone, which also helps prepare the body for a potential fertilized egg. If the egg is not fertilized_if pregnancy does not occur_the estrogen and progesterone levels fall. This triggers menstruation, the shedding of the uterine wall_the menses. The cycle then starts again.

But progesterone might have another role: It may block many of the possible side effects of estrogen. Without adequate progesterone production to offset estrogen production, estrogen dominance occurs. As we have seen, this may lead to many of the symptoms of PMS.

What to do?

Before we can determine how to handle PMS symptoms, we should find out why there is an estrogen dominance. There could be a number of reasons.

Estrogen can be overproduced due to obesity. The obvious solution is to lose weight through diet and exercise. Exercise may be particularly helpful, and some women say that this alone helps decrease their PMS symptoms. Another reason for estrogen dominance may be the liver's inability to break down estrogen. This could be due to a diseased liver or lack of nutrients. The vitamin B6 and mineral magnesium are necessary for the break down of estrogen in the liver.

Sugar may also have a role in the PMS equation. According to a study in the Journal of Reproductive Medi cine (83: 28), women with PMS consumed three times as much refined sugar as those in other groups in the study. Sugar consumption may affect PMS because sugar increases the excretion of magnesium.

Other ways to help break down estrogen through diet are to consume high-fiber foods (fiber helps move estrogen out of the body) and to reduce consumption of animal fats. An article in the British medical journal The Lancet (81:2) notes that women with high-fiber, vegetarian-like diets have fewer PMS symptoms than those with low- fiber, high animal fat diets.

The flip side to too much estrogen is too little progesterone, which also results in estrogen dominance. Stress can contribute to this. However, a number of studies have shown that healthy eating increases progesterone production. Specifically, beta carotene and vitamin C appear to aid progesterone production. Finally, you might consider progesterone supplements. You should use only natural progesterone, as synthetic progestins may cause problems.

Menopause

When a woman's body begins to notice the decrease in estrogen (at around age 40), the brain tells the ovaries to make more estrogen. However, the ovaries no longer have the ability they once did. They do try, however, and this results in large fluctuations in estrogen levels. And once again, because estrogen affects large portions of the body, these ups and downs are felt in a number of ways. Symptoms include differences in intensity and duration of menstrual periods, hot flashes, and intense emotions. (It is not clear whether estrogen withdrawal is directly related to mood swings.)

About 85 percent of women experience some symptoms related to menopause, lasting up to five years. However, not all women experience the same symptoms or the same degree of intensity. Larger women may have fewer symptoms because fat cells manufacture estrone, one of the forms of estrogen.

According to John Lee, M.D., progesterone also plays a role in the symptoms women may feel during menopause. He contends that these symptoms appear not so much because estrogen production slows, but because progesterone production stops. According to Dr. Lee in his book Natural Progesterone, this results in "_ the gamut of hormone imbalance symptoms seen in perimenopausal and menopausal women "

What to do?

Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT) have long been the answer to the symptoms associated with menopause. However, they have drawbacks. The links between ERT and endometrial cancer are firm, and the "solution" to this_therapy using both estrogen and a synthetic progestin_is under fire for increased incidences of breast cancer.

More natural ways to help balance hormones and relieve menopausal symptoms do exist. Massage, acupuncture, and shiatsu (a Japanese massage) may help by relieving stress. Stress can make menopausal symptoms worse. A healthy diet, as always, can be beneficial. To combat hot flashes, avoid spicy foods, alcohol, and chocolate. To lower the risk of heart disease and osteoporosis (the risk for these increase for women after menopause), eat low-fat and calcium-rich foods. You should also consider eating foods that contain phytoestro-gens, which are weak estrogens found in plant sources, such as soy and wild yam. (There are fewer menopausal symptoms in cultures where large amounts of soy products are consumed.) Herbs have been used for centuries in China to treat menopausal symptoms, as they often con- tain some of the same phytoestrogens as soy products. These herbs include dong quai, sarsaparilla, red clover, and damiana. Exercise is also suggested by both conventional and alternative practitioners. Finally, natural progesterone can help. The same caution applies here as applies to using progesterone for PMS; be sure you use natural progesterone.

Osteoporosis

Estrogen and progesterone also contribute to osteoporosis. Estrogen is often used to fight osteoporosis after menopause because a lack of estrogen speeds up bone loss. However, Dr. Lee theorizes that progesterone is more important than estrogen in treating osteoporosis. Dr. Lee points out that bone loss in women starts in their 30s, before estrogen production has slowed too much. At this time, however, progesterone levels are falling, due to periods when ovulation does not take place (unovulatory periods). Thus, the bone loss may be due more to a lack of progesterone than a lack of estrogen. Dr. Lee also points to studies that indicate that there are receptors for progesterone in the osteoblasts, the cells involved in new bone formation.

In a summary of his own report on osteoporosis reversal (original report published in the June 1990 issue of the International Clinical Nutrition Review), Dr. Lee states that, in a program including small amounts of estrogen and a 3 percent progesterone cream, "a 5-10 percent increase in bone mineral density was found to be routine during the first year." In Natural Progesterone, Dr. Lee states that "Postmenopausal osteoporosis is a disease of inadequate osteoblast-mediated new bone formation secondary to progesterone deficiency. Progesterone restores osteoblast function. Natural progesterone hormone is an essential factor in the prevention and proper treatment of osteoporosis."

Dr. Lee also mentions that any osteoporososis treatment program should include a diet high in green vegetables with adequate levels of beta carotene, vitamins C and D, zinc, calcium, and magnesium; and adequate exercise. Red meat, carbonated beverages, and alcohol should be avoided.

Attitude changes?

Historically (and unfortunately still today), PMS and menopause have often been dismissed as "psychological," "inconsequential," or "to be learned to live with." Many health professionals have not taken these problems seriously, or have treated them in ways that could possibly cause harm to the patient. The outlook is improving, however. There is greater recognition of the seriousness of these complaints, and women are educating themselves about estrogen, progesterone, and their affects on the body. There is a healthy debate on both the merits and demerits of ERT and HRT, and on the role of estrogens "at large" in our environment on estrogen levels and estrogen dominance. This means that there is more information available, but with this comes more choices. Study the information and make your choice.

The Cancer Connection

Estrogen has been linked to endometrial cancer after menopause. According to Dr. Lee, the only known cause of endometrial cancer is unopposed estrogen. (By unopposed estrogen, he means that a woman makes some form of estrogen and nothing else.) Too much estrogen leads to an abnormal buildup of cells on the uterine lining (the endometrium). This is known as hyperplasia, which can lead to endometrial cancer. (This is not a problem before menopause because the endometrium buildup is sloughed off during menstruation.)

The answer to endometrial cancer was Hormone Replacement Therapy, which combines estrogen and a synthetic progestin. This triggers the menstrual cycle, and the tearing down on a monthly basis of the cells built up in the endometrium. However, these synthetic progestins had their own problems: side effects such as fluid retention, nausea, insomnia, and depression, but more importantly, increased risk of breast cancer.

Natural progesterone, progestin, or wild yam?

There is much confusion about progesterone. Natural progesterone is produced by extracting the phytoestrogen (plant estrogen) diosgenin from a natural source and converting it to progesterone. At this point the changes stop; nothing else is done to alter the product. Side effects are rare with natural progesterone. Those observed are occasional feelings of euphoria and slightly altered timing of the menstrual cycle. Many people believe that wild yam extract is a natural progesterone. This is not true. Wild yam contains diosgenin, which is a phytoestrogen (plant estrogen) with progesterone-like effects. However, it is not converted to progesterone.

A synthetic progestin is often derived from progesterone or testosterone, but then it is altered by introducing a new atom. This inhibits progesterone metabolism and prolongs its activity. There is a long list of contraindications and side effects that accompany synthetic progestins. They include abnormal menstrual flow or cessation, fluid retention, nausea, insomnia, jaundice, depression, fever, masculine characteristics, weight fluctuation, and allergic reactions. When used during pregnancy, synthetic progestins can result in abnormal formation of the sexual organ in the fetus. There have also been links to breast cancer.

Suggested Reading

Lee, John, M.D. Natural Progesterone. (Available from BLL Publishing, P.O. Box 2068, Sebastopol, CA 95473.)

Lee, John, M.D. What Your Doctor May Not Tell You About Menopause. NY: Warner Books. 1996 (Telephone 1-800-759-0190)

Coney, Sandra. The Menopause Industry: How the medical establishment exploits women. Alameda, CA: Hunter House Publishing. 1994.

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