Hormone Replacement Therapy one size does not fit all

The decision to take or not take estrogen is a personal one.  At this point, there is not any evidence that taking estrogen starting AT menopause is dangerous to your heart.  It may slightly increase your risk of breast cancer, especially if you have high blood sugars.  I recommend you carefully optimize your health and then decide about estrogen based on your comfort level.  There is no evidence that it is dangerous to begin estrogen and then stop.  We DO know from several studies that it is not a good idea to start estrogen after having been off of it for several years.

Natural hormones come from a natural source.  Pregnant mare urine is the most common natural source of estrogen.  It is natural but not the same as your body's own estrogens.  Premarin contains hormones your body does not make. 

Bio Identical hormones, by contrast, are not natural.  They are synthesized in a lab, often using plant products as a starting point.  Bioidentical estrogens, while they are not natural are more familiar to your body that natural estrogens.  These estrogens have not been and perhaps will not be studied as well because they cannot be patented.

There is currently not enough evidence to say that one form of estrogen is better that another.  We do have enough evidence to know to avoid premarin.  The authors of the study discrediting Premarin were careful to say that other estrogens might not be problematic.

Estrogen can be Taken:


Another decision about hormone replacement is what ratio of the three human estrogens to use.  There are no studies to guide this choice.

 Estrone (E1) is the estrogen most commonly found in increased amounts in post-menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.

Estradiol (E2), the principal estrogen found in a woman's body before menopause is produced by the ovaries. It is most effective for the symptomatic relief of hot flashes, genitourinary symptoms, osteoporosis prophylaxis, psychological well being and possible reduction of coronary artery disease.

Estriol (E3) is the weakest of the three major estrogens. In fact, it is 1000 times weaker in its effect on breast tissue. Estriol is the estrogen that is made in large quantities during pregnancy and has potential protective properties against the production of cancerous cells. Estriol is also the estrogen most beneficial to the vagina, cervix and vulva. In cases of vaginal dryness, topical (applied to the skin) estriol is the most effective and safest estrogen to use. For women with recurrent urinary tract problems,  estriol is the best choice.   Estriol is not available in most drug stores, although it has been used widely in Europe for over fifty years.  Estriol cannot be patented it, so it does not tend to interest the pharmaceutical industry. It is available through compounding pharmacies.

Biest is a combination of two estrogens: estriol and estradiol. It is most commonly found in a ratio of 80:20, estriol to estradiol. This combination allows for all of the protection of estriol while providing the cardiovascular and osteoporosis benefits along with the hot flash relief of estradiol.

Triest is a combination of three estrogens: estriol, estradiol and Estrone. It is most commonly found in a ratio of 80:10:10, estriol, estradiol, and Estrone. This combination is very popular and contains all of the three major circulating estrogens. It is slightly weaker in its effect when compared to Biest. However, this can be compensated for by increasing the strength or by slightly changing the ratios.

Progesterone is produced by the ovaries and the adrenal glands in women and, in smaller amounts, in the testes and the adrenal glands in men.
It  plays is important  in brain function and is often called the "feels good hormone" because of its mood enhancing and antidepressant effects. Optimum levels of progesterone can mean feelings of calm and well being, while low levels of progesterone can mean feelings of anxiety, irritability and even anger. Current research shows that progesterone may help maintain the nervous system, the sense of touch, and motor function.

Testosterone -often considered a male hormone or androgen, women also produce small amounts of testosterone. Testosterone works differently in the bodies of men and women, but it plays a very important role in the overall health and well-being of both sexes. Often called the "hormone of desire" because of its powerful effect on libido, testosterone is also important in building strong muscles, bones, and ligaments as well as increasing energy and easing depression. Low levels of testosterone have been known to cause fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.
As with all of the hormones, testosterone must be dosed properly to be effective without causing unwanted side effects. The dose in women is generally one-tenth that used in men. Testosterone cannot be taken orally.   We are still learning about the role of testosterone in women's health