FEMALE HORMONE MODULATION THERAPY

The Epidemic Deficiency of Progesterone

Throughout mature life, Women will experience a gradual loss of another critical hormone, progesterone. This decline becomes significant as Women get closer to menopause. Symptoms of a progesterone deficit include preMenstrual discomfort, night sweats, and hot flashes, along with a loss of the sense of well-being (depressed feelings). During and after menopause, natural progesterone synthesis often grinds to a halt, setting the stage for a host of menopausal miseries and degenerative diseases.

Scientific studies indicate that progesterone may have potential in the hormonal prevention of breast cancer. At a recent scientific conference, persuasive evidence was presented showing that the correct use of natural progesterone could result in a significant reduction in the risk of breast cancer. Progesterone has many beneficial properties, such as the activation of natural killer cells, but one factor of special relevance is that progesterone diminishes the production of a cancer-causing form of estrogen called 4-hydroxyestrone, while increasing the production of cancer-preventing estriol. In other words, estrogen may be made safe through the concomitant use of progesterone, particularly when taken in natural forms.

In addition to making people feel better, progesterone may help to prevent the mental decline that occurs with aging. Progesterone has been shown to increase neuronal energy production and to protect brain cells.

Progesterone and Estrogen Prevent Osteoporosis

Interestingly, the combined effects of these two critical hormones lead to the prevention of bone loss at all ages, though progesterone deficiencies appear to be a more significant factor as Women age.

There are two types of bone regulating cells. The osteoclasts function to dissolve older bone and leave tiny unfilled spaces behind. The osteoblasts then move into these spaces and produce new bone. This process of dissolving older bone mass by osteoclasts and new bone formation by osteoblasts is the mechanism for the repair and continuing strength of bone.

Like all living cells, osteoblasts and osteoclasts require hormonal guidance to properly function. Osteoblasts depend primarily on progesterone and testosterone, while osteoclasts need estrogen-like hormones including the active ingredients in soy. In the absence of these hormones, osteoblasts and osteoclasts cease to function properly and rapid deterioration of the bone occurs. Osteoporosis can occur when osteoclasts dissolve more bone than what the osteoblasts are able to replace.

Estrogen regulates the activity of osteoclasts, which results in a slowing of dissolving older bone. Progesterone, on the other hand, promotes the production of osteoblasts, which are required to effect new bone formation. Natural progesterone has been shown to stimulate the new bone formation required to prevent and reverse osteoporosis (Heersche et al. 1998).

Osteoporosis can be caused by mineral and vitamin deficiencies, corticosteroid drugs, poor eating habits, lack of exercise, too much cortisol, and too little testosterone (two other important hormones). The major influence on age-associated bone deterioration, however, would appear to be a severe deficiency of ovarian-secreted estrogen and progesterone.

An Anti-Aging Hormone

In 1994, the Life Extension Foundation introduced a natural progesterone cream to help prevent osteoporosis, menopausal symptoms, depressed feelings, and breast cancer. Over the last year, a number of studies have appeared indicating that topically applied progesterone cream works better than what was originally published.

Three years ago (1998), the FDA approved a clinical study entitled, "Use of Natural Progesterone Cream in the Prevention of Osteoporosis: A Randomized Double-Blind Placebo Controlled Trial." This ongoing study is being conducted by Dr. Helene Leonetti, M.D., of the Bethlehem Obstetrics Clinic in Bethlehem, PA.

A double-blind study is one in which the researchers are unaware of which group is given the substance being studied or placebo. The Women being studied are in the immediate postmenopausal phase (1 to 5 years after menopause), which is when bone loss is most rapid. After the first year, the positive effects of progesterone became so apparent, that the doctors overseeing the study were "unblinded." In other words, it became apparent to the doctors which Women were receiving progesterone compared to the placebo. The Women in the progesterone group experienced the disappearance of lumps and bumps in their breasts, were less depressed, and had fewer hot flashes and better bone densities (though the time interval was too short for this to be significant). An important point was that no Women using progesterone cream experienced loss of bone density, while the placebo group showed slight bone loss. However, as the study continued to completion, although Women continued to have improved subjective symptoms as mentioned above, the bone densities did not change significantly (Leonetti, H.B., personal communication). Although these results have yet to be published, Dr. Leonetti theorized that the lack of statistical significance may have been partly because the Women were all in early menopause when bone loss is at its highest. It is during this period of early menopause when the estrogen deficiency causes the greatest amount of bone loss. Perhaps the bone protecting results of progesterone would have been better if the subjects had been given appropriate doses of nutrients (such as magnesium, zinc, copper and manganese), along with exercise and low-dose estrogen to those Women who were truly estrogen-deficient. One should not expect progesterone by itself to protect against the age-related loss in bone density.

Anasti et al. (2001) also studied the effect of transdermal and vaginal natural progesterone on the uterine lining. These healthy post-menopausal Women took conjugated estrogen alone for 14 days, followed by either transdermal or vaginal natural progesterone or placebo in combination with the estrogen for another 4 weeks. Endometrial biopsies of all Women showed a statistically significant decrease in uterine lining thickening (hyperplasia) compared to the placebo cream. This may be very important for Women who have to take equine estrogen, in terms of the protective effect of progesterone on the endometrium, once thought to be provided by synthetic progestogens (see comment by Leonetti et al. 1999, p. 2).

Dr. John Lee (1996), one of the world's foremost experts on progesterone therapy, has found studies showing that 20 times more progesterone is concentrated in brain cells than blood serum levels. He postulates that progesterone may help prevent mental decline in the elderly and that recovery after brain trauma is better if progesterone levels are higher.

Dr. Lee also has pointed out that progesterone has been shown to increase brain cell energy production while suppressing hyper-excitotoxicity. "Excitotoxicity" occurs when too much (or too little) of neurotransmitters such as glutamate is released from brain cells. This type of toxicity is now considered a cause of brain aging and degenerative neurological disease. Life Extension members are taking supplements such as methyl cobalamin and vinpocetine to help prevent nerve cell damage caused by excitotoxicity. It now appears that progesterone also protects against this type of brain cell damage.

Progesterone May Prevent Breast Cancer

A large base of evidence suggests that progesterone is protective against, as well as a potential treatment for, breast cancer (Cowan et al. 1981). A study by Chang (1995) showed transdermal estradiol increased cell proliferation rate by 230%, while transdermal progesterone decreased the cell proliferation rate by over 400%. A combination estradiol/progesterone cream maintained the normal proliferation rate. This is direct evidence that estradiol (a potent estrogen) stimulates hyperproliferation of breast tissue cells and progesterone prevents hyperproliferation.

A second study by noted researcher Bent Formby was published with insightful results (Formby et al. 1998). To determine the biologic mechanism of why progesterone inhibits the proliferation of breast cancer cells, a variety of cancer cell lines with different receptors and different expression of genes were exposed to progesterone. Exposure to progesterone induced a maximal 90% inhibition of cell proliferation in T47-D breast cancer cells and no measurable response in MDA-231 progesterone-receptor negative breast cancer cells. Further research along the same lines should be able to specify exactly when progesterone therapy would be most effective (Formby et al. 1998).

Previous retrospective studies have shown that Women undergoing breast cancer operations during the luteal phase of the Menstrual cycle (the span between ovulation and the start of Menstruation), when progesterone is higher, have much longer survival times (Cooper et al. 1999; Badwe et al. 2000; Macleod et al. 2000). Angiogenesis (new blood supply) is essential for tumor growth and vascular endothelial growth factor (VEGF) is one of the most potent angiogenic factors. Heer et al. (1998) suggest that since progesterone seems to lower VEGF expression, its lowering could possibly decrease the potential for tumor spread. Mohr et al. (1996) reported that Women with a progesterone level of 4ng mL-1 or more at the time of their breast cancer surgery had a significantly better survival rate at 18 years than those with a lower serum level of progesterone. In those Women with good progesterone levels at the time of their surgery, it was revealed that approximately 65% were surviving 18 years later, whereas only 35% of the Women with low progesterone levels survived (Mohr et al. 1996).

A study done by Cowan et al. (1981) showed that the incidence of breast cancer was 5.4 times greater in Women with low progesterone than in Women who had good progesterone levels. Some final evidence confirming progesterone-protective effects on breast tissue comes from a study by Foidart et al. (1998b). Either a placebo gel, an estrogen gel, a progesterone gel, or a combination estrogen/progesterone gel was applied to Womens breasts for 14 days prior to breast surgery. After surgery, the breast tissue was analyzed and it was found that estradiol increased breast cell proliferation and that progesterone greatly decreased proliferation (Foidart et al. 1998b).

As Dr. Lee (1996) explains, "The goal of progesterone supplementation is to restore normal physiologic levels of bioavailable progesterone." That is why testing saliva or blood progesterone levels is important, especially for premenopausal Women who are using progesterone cream to alleviate preMenstrual syndrome (PMS) symptoms. In Women whose doctors are prescribing excess amounts of supplemental estrogen, the administration of progesterone may enable the dose of estrogen to be reduced, since progesterone restores sensitivity to estrogen receptors on cell membranes. Saliva tests are available to ascertain progesterone and other hormone levels in the body. (The Life Extension Foundation offers a female chemistry panel that measures hormone levels, various blood components, and homocysteine. Call 800-208-3444 for more information.)

Potential Dangers of FDA-Approved Synthetic Progesterone Drugs

The issue of synthetic versus natural hormones is as important with progesterone as it is with estrogen. Just as the pharmaceutical industry created their dangerous estrogen drug Premarin, they produced a pseudo-progesterone named Provera. As with Premarin, the warning label on Provera is full of dangers including the possibility of birth defects, breast cancer, blood clots, fluid retention, acne, rashes, weight gain, and depression. Such drugs as Provera are classified as "progestins," not as progesterones. The side effects of Premarin and Provera may be the main reason Women stop taking their replacement hormones, and are definitely the reason that HRT has such a questionable and spotty reputation.

An alternative to artificial progestins is the option of using natural progesterone products. Products like the Life Extension Foundation's ProFem use progesterone derived from soybeans. Not only are such soy-based or wild yam-based natural progesterones far safer than synthetic drugs, they are as easily utilized as the real progesterone manufactured within the human body. The preferable forms of natural progesterone are creams that are rubbed in to appropriate areas. This route of administration bypasses the liver and allows hormone delivery to the place where it is needed the most. For example, progesterone cream applied to the breasts slows cell proliferation and eases breast pain. As to safety, according to Northrup (www.drnorthup.com), "There is virtually no danger of overdose." (Note that a woman cannot simply eat wild yams or wild yam products. The human body does not have the means of converting plants into progesterone molecules. Processing is a requirement, although processed phytohormones are still "natural.")

In addition to the established and dangerous progestins such as Provera, the FDA has approved a drug called Prometrium, which is an oral pill containing 200 mg of natural progesterone to be taken daily. This is overkill because your liver will go into overdrive trying to excrete this acute, overabundant supply of progesterone. Most of this oral progesterone drug that is not detoxified by the liver will be unavailable for cellular use. Progesterone cream is better utilized and much more economical. Dr. Foidart, in another study on transdermal replacement hormone therapy, states that avoidance of the "first passage effect" (through liver) is ensured by the transdermal application of hormones and probably explains the superiority of this route of hormone administration (Foidart et al 1998a). Transdermal progesterone cream has now been well researched, and shows and anti-proliferative effect, on the uterine lining (Anasti et al. 2001). It is also excellent for the resolution of vasomotor symptoms such as hot flashes as shown in a double-blind study by Leonetti from the Department of Obstetrics and Gynecology, St. Luke's Hospital in Bethlehem, PA (Leonetti et al. 1999). Although it has been suggested by Lee (1996) that transdermal progesterone cream is effective in the treatment of osteoporosis, this single study only used single photon absorptiometry and so may be unreliable.

Natural progesterone should not be confused with the synthetic FDA-approved progestins that cause many side effects. Synthetic progestins do not provide the broad spectrum of benefits that have been documented for natural progesterone.

Hormone Deficiencies: DHEA

DHEA is a precursor of estrogen and testosterone, so taking DHEA might raise the levels of these hormones. DHEA is a good starting place for hormone modulation in the aging female.

While there have been contradictions in the research on DHEA, it appears to be a true rejuvenative hormone to at least a moderate degree, improving mood, neurological functions, immune system functioning, bone growth, energy, and feelings of well-being. In a review of research, Morales et al. (1995) reported that DHEA, given until the patient's blood levels matched those found in their teenage years, resulted in "remarkable improvement of physical and psychological well-being in both genders. This finding in addition to the absence of side effects provides great promise for the replacement strategy." It should be noted that because DHEA may raise estrogen levels, the Life Extension Foundation recommends that it be taken with melatonin to provide a safeguard against breast cell proliferation. (Melatonin is a pineal hormone with multiple benefits and no significant side effects. Most importantly, it appears to protect against breast cancer.)

Though Women usually have less DHEA than do men, both sexes lose it at about the same rate, suggesting that it is an age-related decline, not just a result of menopause. Peak levels are typically reached when Women are in their third decade of life, following which they begin to lose approximately 2% per year (Wright et al. 1997). As with all hormones, blood levels are only one criterion to establish in supplementation. The ultimate goal is individual functioning. Tode et al. (1999) has shown that levels of the stress hormone cortisol increase while levels of DHEA decrease in postmenopausal Women with climacteric syndromes. When they gave daily oral administration of 6 g of red Korean Ginseng, a significant decrease in the ratio of cortisol/DHEA was found indicating a positive effect of Korean Ginseng on fatigue, insomnia, and depression associated with menopause (Tode et al. 1999).

Caution: Women with estrogen-dependent cancer should consult their physicians before beginning DHEA therapy. Individuals with existing liver disease (such as viral hepatitis or cirrhosis) might consider taking DHEA sublingually (under your tongue) or using a topical DHEA cream to reduce the amount of DHEA entering the liver. DHEA is converted by the liver into DHEA-s (dehydroepiandrosterone sulfate). Those with liver disease should carefully monitor liver enzyme levels to make sure that DHEA therapy is not making liver disease worse.

Lack of Libido Is Not Just in Your Head

Most of the discussion of loss of sexual desire has centered on the problems of menopause. Yet this problem is far more common in Women of all ages than is recognized, largely because of the societal pressure on Women to be sexual and from their individual needs to please their partners. Many of the situations thus have psychological roots and are beyond the intent of this protocol. However, hormones play a significant and often undiscovered role.

Research with menopausal Women has been the origin of much of our knowledge in this area. Davis (1998) points out that while using androgens with postmenopausal Women successfully increases their sexual desire, the bigger picture is that androgen levels fall significantly throughout the reproductive years and probably affect desire from an early age (Longcope 1998; Gelfand 1999). It has been shown that circulating levels of androgens play an important role in psychologic and sexual changes that occur in menopause, whether naturally or surgically induced. Although estrogen replacement often seems to accommodate these changes, some Women however, need more. Results from clinical studies show that a combination of estrogen and androgen replacement provided greater improvement in psychologic (e.g., fatigue, lack of concentration, and depression) and sexual function (e.g., inability to have an orgasm and decreased libido), than estrogen alone in some Women (Sarrel 1999). In addition, research by Braunstein, reported as a Reuters Health news release, indicated that testosterone delivered through a transdermal patch increased Womens perception of orgasmic pleasure. Some androgens in particular (DHEA and DHEA-sulfate) decline steadily from early adulthood (Longcope 1998). Other androgens show more decline closer to menopause. Treatment with androgens is safe and effective for these dysfunctions when given at low levels and paired with progesterone (Slayden 1998). Many Women lose their sexual desires after giving birth. Many of these sexual problems are directly tied to general postpartum depression. The goal is to modulate the estrogen-progesterone balance to reach earlier, healthier levels, reducing as many negative postpartum outcomes as possible, including loss of libido. Also available as treatments are antidepressant medications, the most successful of which are the SSRIs (specific serotonin reuptake inhibitors) such as Prozac, Zoloft, and Paxil.

Hormone Modulation

The process of achieving proper female hormonal balance is not a one-step procedure. This protocol will describe a series of events that will optimize the benefits available to all Women who empower themselves in their personal health care. It is possible to take shortcuts in regulating hormones, and many positive outcomes may be achieved even without careful modulation. However, it is recommended that these concerns be addressed as much as possible.

Both natural and synthetic hormones come with synthetic instructions: the dosages specified on the labels are for the "average" woman, one who doesn't exist. While these dosages may achieve much of the symptom relief these products advertise, it would be unusual to realize optimal hormone modulation for all the hormones discussed using only the amounts listed. While this protocol will offer dosages to be taken, these should be considered as starting points, not as final goals. The individualization that offers the greatest amount of long-term health improvement is based on testing and feedback.

People do not regulate the temperature in their homes by simply setting the air conditioning thermostat on a "recommended" number and leaving it there indefinitely. They check the actual temperature, assess their own comfort levels, and make adjustments for time of day and season of the year. If we are this careful with air conditioning, why would we be reluctant to adjust such a critical matter as hormone level? Adjustment only can be achieved by self-evaluation and testing before and after hormone-affecting supplements are taken. Despite labels recommending "one capsule a day," only personal symptom change and blood level differences can determine what actually works well. Most of this testing takes place at the initiation of supplements, though periodic reevaluation is a necessity. Testing before any supplements are taken is called "baseline" measurement, and may be invaluable in the future. When new medical problems arise, knowing these earlier baseline standards allows for more accurate diagnosis and treatment. Testing may be performed in several ways.

Blood Testing

This measurement technique has the advantage of widespread established technology and standards, plus the capability of being done by mail. (The Life Extension Foundation offers such a service.) It is critical to remember that different labs have different standards. For example, Laboratory A has methods of testing that lead it to declare that a given hormone for a 30-year-old, non-pregnant woman has a "normal range" of 4 to 7. Laboratory B may use different specimen collection methods or measurement techniques, and declares the "normal range" of scores to be between 3.2 and 6.4. One lab's standards should not be used to evaluate testing by another source. In addition, it is impossible to give a representative sample of all the possible optimal or even average scores because these figures change based on age, pregnancy status, menopausal status, the particular day within each woman's Menstrual cycle, and time of day. For example, cortisol norms may have substantial differences based on whether the sample was taken in the morning or the afternoon. In the end, each woman must compare her current scores with the average scores for a desired age from the same lab's norms.

Saliva Testing

This measurement technique does not have the standards that blood testing enjoys, but it is available by mail order and offers a degree of convenience. Standards are important when attempting to emulate the results of published studies. Some argue that saliva testing is more accurate than blood testing; others disagree.

Urine

The use of the 24-hour urine test may be the most accurate form of measurement because hormones are secreted in "bursts" rather than steadily throughout the day (Wright et al. 1997). By collecting a full day's worth of urine, a woman gets a more complete picture of her actual levels. The shortcoming of this test is the difficulty involved in its collection: every drop of urine must be gathered during the 24-hour period.

When evaluating the effectiveness of either a new supplement or a change in dosage of an ongoing supplement, it is recommended that testing intervals of 45 days be used. Because some hormones gradually convert into other hormones (known as a "cascade"), waiting 45 days ensures accuracy.

Making Choices That Are Right for You

While a positive doctor-patient interaction always is beneficial, such cooperation is even more important for Women dealing with hormonal issues. Some Women insist on having female health care providers, fearing that their PMS or menopausal complaints may be dismissed too easily or treated too routinely. Their fears are sometimes warranted, but the key to choosing and keeping a physician is finding someone (male or female) who listens and includes you in the health feedback loop. Symptom improvement may be accomplished with minimal effort, but achieving true hormone modulation requires time and patience.

The selection of hormone modulation goals is a complex decision based on personal philosophy, resources, time, and fortitude. Philosophically, a woman must strike a personal balance between acceptable methods and acceptable outcomes. Choices involve types of hormones used, their sources, the costs, side effects, desired results and both short- and long-term benefits and risks. In addition, there is a choice to be made in terms of outcome priorities: is symptom reduction sufficient by itself or are optimal blood levels also required? Is it more important to use only plant hormone sources or to change blood hormone levels back to those of a younger age? These are the types of decisions to be made by each woman.

This protocol now offers generalized recommendation concerning the modulation of hormones. The choices presented will include, whenever possible, the most natural forms of supplements available.

Priming the Hormonal Pump

Before individual sex hormones are supplemented it is suggested that a "priming" procedure be used. This priming is based on the "cascade" effects of DHEA as it gradually converts into all of the other hormones. To protect against the possible over- conversion of estrogen, Women should add melatonin, indole-3-carbinol and soy extracts as a cancer safeguard. The priming dosages are as follows:

DHEA, 15 mg once or twice daily.
Melatonin, 3 mg at bedtime.
Mega Soy extract, one 135 mg capsule twice a day (110 mg of soy isoflavones).
Indole-3-carbinol 200 mg, twice a day for most Women. Women weighing over 180 pounds may need as many as four capsules to adequately saturate cells.

This simple hormone priming may bring hormones back to the desired levels and eliminate any symptoms. If this does not occur, specific recommendations are now made for individual hormone adjustment. Remember, wait 45 days before testing to determine the effect of each new supplement or new supplement dose. Also make sure you get a DHEA-S serum level before and during supplementation.

Estrogen Supplementation

A product called Natural Estrogen contains plant-derived phytoestrogens and nutrients that have been shown to favorably alter estrogen metabolism in the body. The recommended initial dose is one capsule of Natural Estrogen, twice a day. While postmenopausal Women may start at any time, premenopausal Women should begin on the fifth day of their Menstrual cycle. It is recommended that Women already taking estrogen drugs such as Premarin should wean themselves off the synthetic hormones gradually over several months as follows, using equivalent amounts of Natural Estrogen:

First month-Natural Estrogen every other day, previous medication every other day.
Second month-Natural Estrogen 2 days in a row, previous medication for 1 day.
Third month-Natural Estrogen 3 days in a row, previous medication for 1 day.

Thereafter, take Natural Estrogen in the cyclic pattern described above. Please note that Natural Estrogen provides the same amount of phytoestrogens as MegaSoy, so most Women will not need to take MegaSoy Extract if they are taking Natural Estrogen. If Natural Estrogen plus the previous doses of pregnenolone, DHEA, and melatonin do not achieve adequate symptom relief and blood levels, the use of estriol is recommended. The dosage for estriol, the safest form of estrogen, is between 2 and 8 mg a day, based on the ratio of 2 mg of estriol to 0.6 mg of Premarin. Again, trying and evaluating different dosages is the way to achieve the important goal of taking the least amount of estrogen that attains the desired blood or symptom level. Estriol creams in varying potencies may be tried for localized problems like vaginal dryness and thinning.

Should estriol alone not achieve a woman's goal, the next step is the utilization of a compound estrogen drug such as Tri Est, the medication described earlier as having three forms of estrogen in the same proportion found in human females. Typically, Women are prescribed 1.25 mg of estriol twice daily for mild menopausal symptoms. Stronger symptoms may require double the dosage. If Tri Est is not adequate, it is possible to have a cooperative physician order individualized estrogen mixtures from formulary pharmacies. In this way, if the Tri Est with only 20% of the more dangerous estradiol and estrone fails to alleviate symptoms, a drug may be made with 40 or 60% estradiol. This is still a better choice than the standard medications with 80% estradiol. This graduated protocol is appropriate for any situation requiring supplemental estrogen. A natural product such as Natural Estrogen is recommended for PMS, menopause, and hormonally related health concerns related to estrogen deficit.

Progesterone Supplementation

The steps for progesterone supplementation are the same for both situations in which progesterone is needed to balance estrogen and those specifically calling for progesterone because it is the treatment of choice.

Natural progesterone appears more beneficial than synthetic "progestin" drugs that are often prescribed to balance the negative effects of synthetic estrogen drugs. Natural progesterone in the form of transdermal creams is extremely safe. Overdoses have not been reported.

The Life Extension Foundation's ProFem and similar products offering natural forms of progesterone should be the starting (and hopefully final) type of treatment.

The recommended starting dosages are as follows:

For severe osteoporosis
First jar: 1/2 teaspoon morning and night
Second jar: 1/4 teaspoon morning and night
For premenopausal Women and Women with PMS-A,C, and H
Days 1 to 14 of cycle: no application
Days 15 to end of cycle: 1/8 to 1/4 teaspoon daily
For postmenopausal Women
Apply 1/8 to 1/4 teaspoon daily

An alternative to artificial progestins is the option of using natural progesterone products. Not only are such soy-based natural progesterones far safer than synthetic drugs, they are as easily utilized as the real progesterone manufactured within the human body. The preferable forms of natural progesterone are creams that are rubbed into different areas of the skin. This route of administration bypasses the liver and allows hormone delivery to the place where it is needed the most.

Dosages should be adjusted/increased as required when attempting to balance estrogen levels. The cream should be massaged into soft tissue areas such as breasts, underarms, and inner thighs on a rotating basis to avoid the over-saturation of cells.

DHEA Supplementation

DHEA is a precursor of estrogen and testosterone, so taking DHEA might raise the levels of these other hormones. It has been recommended previously in this protocol that DHEA is a good starting place for hormone modulation because of this ability. (See Priming the Hormonal Pump above.)

At the start of the section, it was recommended that Women utilize a starting dose of 15 mg once or twice a day. Since DHEA is a precursor of testosterone as well as estrogen, many woman find both hormones will rise to more youthful levels by supplementing DHEA alone. As needed, Women may adjust DHEA dosages to 25 mg twice daily. On a cautionary note, Women with reproductive cancers should not take DHEA. In fact any woman with a family history of ovarian cancer, or a high score on an ovarian cancer blood screening test known as CA 125, should avoid all androgen supplements. As always, the best judge of dosage level is a test of blood level. The objective of DHEA supplementation is to achieve the blood levels that are considered normal for a 20- to 30-year-old woman (Mortola et al. 1990; Ceresini et al. 2000). A DHEA blood test will greatly assist in proper dosing.

Hormone Modulation: Supportive Lifestyle and Nutrients

Every hormone discussed in this protocol is influenced by both environmental and nutritional factors. Here are some of the most important of these factors:

Stress. There are strong correlations between excessive stress and such problems as adrenal insufficiency, lack of Menstrual cycle, PMS, vaginitis, urinary incontinence, bone loss, and infertility.
Smoking. Obviously, the link between cancer and smoking is well documented. Less well known is smoking's connection to bone loss, cervical dysplasia, miscarriage, and Alzheimer's disease.
Exercise. The obvious connection here is to osteoporosis. But lack of regular exercise plays a role in adrenal disease, cardiopulmonary disorders, loss of libido, and Menstrual problems.
Obesity. Some Menstrual disorders are found more often in overweight Women. In fact, a diet that lowers body fat may lower estrogen levels as well.
Nutrition. Here are some areas in which dietary supplements play an important role in the development and treatment of hormonally related diseases:
Vitamin E. Research at Johns Hopkins Medical School demonstrated 600 IUs a day of vitamin E raised both estriol and progesterone levels in a group of Women with fibroid breast disease. Both estriol and progesterone help to protect against estrogen's possible tumor-creating effects (London et al. 1981).
Calcium, magnesium, and vitamin D3. Any Women with bone loss should supplement her diet with at least 1000 mg of elemental calcium, 600 mg of elemental magnesium, and 400 IUs of vitamin D3 a day. A product such as Bone Assure contains the necessary amounts of these nutrients. For more information on this topic, please refer to the Osteoporosis protocol in this book.
Antioxidants. The addition of such antioxidants as vitamin C, vitamin E, CoQ10, grape seed-skin extract (proanthocyanidins) and alpha-lipoic acid may be of great assistance when treating a number of the disorders in this protocol, including cardiac problems and cancers.
Fats. Diets high in saturated fats lead to heart disease, cancers, and an imbalance in the eicosanoid hormones (an important factor in fibroid cysts.) In contrast, diets high in essential fatty acids help to balance eicosanoids. Omega-3 essential fatty acids are unsaturated fats from cold water fish (salmon, tuna, mackerel and herring for example), perilla or from flax, evening primrose or borage oil provide gamma linolenic acid (GLA), an important anti-inflammatory fatty acid. A good portion of your diet should come from soybeans. Other eicosanoid imbalance links include uterine cramps, pelvic pain, and breast pain. There are supplements that provide both the essential fatty acids from fish oil (DHA-EPA) and GLA.
High-potency B-complex vitamins. Various B vitamins have been examined by researchers. Abraham (1983) found vitamin B6 to be helpful in reducing Menstrual cramps. More recently, Mills (1996) showed that supplementing the B-complex group in Women with endometriosis produced a significant decrease in symptoms.
Bioflavonoids. Supplements of this member of the vitamin C complex appear to actually inhibit excessive estrogen synthesis (Kellis et al. 1984).

Summary

The need to modulate the relative levels of the primary female hormones is of critical importance throughout life. Beyond the well-publicized hormone replacement therapy for menopausal symptoms, such disorders as PMS, endometriosis, several types of cancer, sexual dysfunctions, fibroid tumors, osteoporosis, cardiac disease, and Alzheimer's disease are closely related to hormonal imbalances. Many disorders are linked to either excessive or deficient estrogen levels, particularly as they compare to the amount of progesterone available. Not only should hormones be modulated regularly, but natural sources for hormone supplementation should be used. Synthetic and nonhuman analogue hormones carry with them unwanted, even deadly side effects. Hormone modulation requires individualization, and works best when carefully monitored through laboratory testing. Both lifestyle and nutritional variables play an important role in hormone modulation.

Estrogen is an anti-aging hormone that provides many beneficial effects throughout the body. The major drawback to conventional estrogen replacement therapy is the increased risk of certain cancers. FDA-approved estrogen drugs have other adverse side effects that preclude many Women from effectively using them. Natural plant extracts provide the body with safe and possibly more effective estrogen replacement.

Menopause is not just an estrogen deficiency. Numerous hormone imbalances threaten the health of menopausal Women. The published literature has identified several plant extracts that favorably modulate hormone balance in aging Women.

The decline in progesterone production is correlated with increased bone loss and increased risk of cancer. Many of the effects associated with normal aging can be attributed to a progesterone deficiency, so progesterone replacement therapy may be another missing link to solving the human aging process. The beneficial effects of natural progesterone have now been shown in Women and men. Progesterone protects against many of the detrimental changes of aging, and the only downside is that too much can make a person feel sleepy or even euphoric. Please note that it usually takes 2 to 4 weeks for topically applied progesterone to build up to sufficient levels in the body to cause noticeable effects.

Individual symptomatic improvement and blood analysis of estrogen, progesterone, testosterone, prolactin, luteinizing hormone, and follicular stimulating hormone (FSH) by a physician can help determine how well natural hormone modulation therapy is working.

The proper intake of hormone-modulating plant extracts, phytoestrogens, DHEA, natural progesterone, and other natural hormones may provide significant health benefits to the aging female.

The following nutrients and drugs are suggested to restore hormone balance in aging Women or Women with symptoms of an imbalance:

1. ProFem (a natural progesterone cream): Apply topically to the skin (follow directions as outlined in this protocol).
2. Natural Estrogen (a soy-based phytoestrogen formula): Take one capsule, 2 times a day.
3. DHEA: Take one 15-mg capsule a day in the am on an empty stomach. See precautions above.
4. Mega Soy extract: one 135 mg capsule twice a day.
5. Melatonin: Take 2 to 3 mg only at bedtime.
6. Indole-3-carbinol: 200 mg, twice daily.
7. Vitamin E: 600 IU daily.
8. Vitamin C: 2.5 to 6 g as a prophylactic dosage.
9. Vitamin D3: 400 IU daily.
10. Complete B Complex: 3 capsules daily in divided doses.
11. Calcium: 1000 mg daily; Magnesium: 600 mg daily in a combined dose to prevent bone loss.
12. Ipriflavone may be considered in place of calcium/magnesium to prevent bone loss: 200 mg, 3 times daily.
13. Dong Quai may help relieve menopausal symptoms: 1000 mg daily.
14. CoQ10: 100 to 200 mg daily for those over 40.
15. Mega GLA (containing borage oil): 300-600 mg daily.
16. Mega EPA (containing the essential fatty acids EPA and GHA): 1400 mg daily.
17. Consider estriol or TriEst if menopausal symptoms are not alleviated by nonprescription therapies. Blood or saliva testing may also indicate the need for additional estrogen or progesterone. Blood or saliva testing after 45 days is mandatory to verify you are taking the proper dosages.

For more information: Contact the National Institute on Aging, (800) 222-2225.

Product availability: Natural Estrogen, ProFem progesterone cream, DHEA, Mega Soy Extract, indole-3-carbinol, vitamin E, vitamin C, vitamin D3, Complete B Complex, calcium, magnesium, melatonin, CoQ10, Mega GLA, Mega EPA, perilla oil, borage oil, and black cohosh

Female Hormone Protocol (1)

These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease