Can Estrogen Help Migraines?

Can Estrogen Help Migraines?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Forty percent of women and 20% of men experience migraine headaches in their lifetime. Up to 60% of female migraine sufferers have headaches associated with menstruation. According to the International Headache Society, menstrual migraines without aura (a pre-headache visual, sensory, motor or verbal disturbance) can begin two days before to three days after bleeding starts.

Possible triggers include a decrease in estradiol, release of inflammatory substances from the uterine lining, low magnesium, decreases in certain brain chemicals like serotonin and GABA, dehydration, suspected foods and insufficient sleep. Some migraine specialists believe that a decrease in estradiol levels is the most likely trigger.

According to Dr. E. Anne MacGregor, raising premenstrual estradiol levels can help to avert or minimize the effect of these migraines. Maintaining estrogen in a range of 45-75 pg/ml may reduce the intensity and frequency of migraine headaches. Estradiol 1.5mg gel, applied six days prior to bleeding and continued through day 2 of menses, has been shown to effectively decrease the number of migraine days in some women. Extending this time period beyond day 2 and tapering the dose may help prevent “withdrawal” headaches caused by stopping estradiol abruptly. Progesterone may also help decrease these headaches because progesterone helps regulate pain and pain perception through GABA receptors in the brain.

Additional Resources:
Can Estrogen Help Migraines?2018-04-02T17:23:55-05:00

Book Review – The Pill Problem by Ross Pelton, RPh, CCN

Book Review – The Pill Problem: How to Protect Your Health from the Side Effects of Oral Contraceptives by Ross Pelton, RPh, CCN

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

In 1981, Barbara Seaman published Women and the Crisis in Sex Hormones and warned us emphatically about the dangers of using synthetic hormones, particularly in the form of birth control pills. Before oral contraceptives were approved, there were only studies involving small numbers of women and, although the FDA is supposed to give its stamp of approval for safety and efficacy, it was clear from the beginning that oral contraceptives are not safe. Women have died as a result of using oral contraceptives and yet, at the time, it was argued that women also die from pregnancy and delivery.

Fast forward to the present and we find that not only are oral contraceptives still being offered to young women (in fact, over 100 million women, thus making it a very lucrative business), but now women struggling with hormone imbalances at menopause are also being offered oral contraceptives as a solution!

It is unfortunate that in the few short minutes that are usually allotted for a visit with a medical practitioner, not much information can be shared about the breadth of health issues associated with oral contraceptives. And, it is even more unfortunate that some practitioners may not be fully aware of or realize the whole gamut of potential issues.

Pharmacist Ross Pelton is known for his extensive writing about the nutrient depletion that occurs when using various pharmaceuticals. His most recent book, The Pill Problem, is completely dedicated to the health problems associated with “The Pill.” He describes in great detail the myriad of health issues induced by the nutrient depletion associated with taking oral contraceptives. And, similar to other pharmaceuticals, because the depletion takes place over time, the problems that emerge are not always linked to the medication.

Pelton identifies the following health problems, and their associated depletions, as attributable to oral contraceptive use:

  • Energy depletion: Oral contraceptives deplete the B vitamins and co-Enzyme Q 10, all of which are involved in cellular energy production.
  • Blood clots: The depletion of magnesium, which could be made worse by also taking calcium supplements, can lead to life-threatening blood clot formation. This occurs not only with oral contraceptives but with other estrogens as well.
  • Birth defects: Folic acid (one of the B vitamins) is the nutrient needed to prevent neural tube defects.
  • Atherosclerosis: B vitamin depletion can also create abnormalities in homocysteine levels, which have been associated with the buildup of plaque in the arteries.
  • High blood pressure: Low magnesium and co-enzyme Q 10 can both contribute to elevated blood pressure.
  • Heart attacks: The heart is a muscle and, like all muscles, will go into spasm when magnesium is inadequate.
  • Cancer: Both selenium and folic acid have cancer protective properties.
  • Osteoporosis: Both calcium and magnesium are needed to create healthy bones. Without enough magnesium, calcium is not absorbed.
  • Immune System deficiencies: Both vitamin C and selenium are needed for white blood cell production. Zinc is also depleted and is needed to protect against all sorts of pathogens.
  • Depression: Deficiencies in B6, folic acid, B12, and tyrosine contribute to the significant amount of depression typically associated with oral contraceptives. Tyrosine is needed to make thyroid hormones, as well as the neurotransmitter hormones norepinephrine and dopamine.
  • Sleep disorders: The deficiency in B6 compromises the ability to make both serotonin and melatonin.
  • Candida overgrowth: The imbalances in hormone induced by oral contraceptives leads to a high risk of candida related issues. Candida overgrowth can impair the digestive tract, cause chronic sinus problems, and recurrent vaginal infections and discomfort.
  • Migraine headaches: The cyclic changes in oral contraceptives may be a trigger for migraine headaches. Additionally, depletions in magnesium, co-enzyme Q 10, and vitamin B2 may contribute to migraine headaches.
  • Fluid retention and weight gain: These effects can vary with individuals and the type of oral contraceptive used. High estrogen causes increases in kidney renin and angiotensin, which in turn increases water and salt retention. Weight gain from oral contraceptives can be as much as five pounds per year.
  • Sexual disturbances: Oral contraceptives can cause diminished interest, dry vaginal tissues and loss of orgasm. In addition, because sex hormone binding globulin (SHBG) increases, it interferes with testosterone and DHEA activity, potentially leading to painful intercourse.

Pelton explains that, because these effects do not occur shortly after swallowing just one or two pills, and because many practitioners do not know or take the time to describe the negative effects of oral contraceptives, many women may not make the connection that their health issues are directly tied to using “The Pill.”

The detailed information available in Ross Pelton’s book will help women and their practitioners understand the potential dangers and unintended health effects of taking oral contraceptives. Armed with this knowledge, women can work with their practitioners to either supplement for the losses they know will occur with oral contraceptive use, or they can choose alternative methods of birth control or menopausal symptom relief.

Book Review – The Pill Problem by Ross Pelton, RPh, CCN2018-04-05T13:25:22-05:00

Treating Multiple Sclerosis with Sex Hormones

Treating Multiple Sclerosis with Sex Hormones

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

 

Multiple sclerosis (MS) is an autoimmune disorder characterized by inflammation and nervous system degeneration. Both estrogen and testosterone exhibit anti-inflammatory and neuro-protective effects when administered to MS patients in studies.

Male MS patients were treated with 100 mg of transdermal testosterone daily. At the end of the twelve month treatment period, cognitive performance improved while brain atrophy diminished. When female MS patients were treated with 8 mg of oral estriol daily for six months, evidence of lesions on MRIs decreased while brain function increased.

In addition, female MS patients are often plagued with chronic urinary tract infections (UTIs). Intravaginal estriol significantly decreases UTIs in postmenopausal women.

Further studies regarding hormones in the treatment of MS are ongoing.

  • Gold SM, Voskuhl RR. Estrogen and Testosterone Therapies in Multiple Sclerosis. Prog Brain Res. 2009; 175:239-251.
  • Raz R, Stamm WE. A Controlled Trial of Intravaginal Estriol in Postmenopausal Women with Recurrent Urinary Tract Infections. N Engl J Med. 329(11):753-756.
Treating Multiple Sclerosis with Sex Hormones2018-04-05T10:58:22-05:00

Book Review – The Hormone Cure by Sara Gottfried, MD

Book Review – The Hormone Cure by Sara Gottfried, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Dr. Gottfried has a revolution in mind—one that may lead to better health for many women. In The Hormone Cure, she not only means to sort out the complexities of hormone balance and make it understandable, she offers solutions and numerous resources to help you attain it.

She covers so much ground that it is difficult to come up with something that Dr. Gottfried misses in this book. She begins by helping you sort out potential hormone imbalances with vivid questions such as:

  • “Increased abdominal circumference, greater than 35 inches (the dreaded abdominal fat, or muffin top—not bloating)?”
  • “Vaginal dryness, irritation, or loss of feeling (as if there were layers of blankets between you and the now-elusive toe curling orgasm)?”

She then walks you through the various hormone dysfunctions or irregularities, and describes the “Gottfried Protocol” specific to each.

Dr. Gottfried goes on to explain that each hormone issue is not independent of other hormone issues and (unlike how she was taught in medical school) combined hormone therapies addressing all of the hormone issues should be used together for the best result, rather than addressing one issue at a time. She further describes the common patterns or trends of hormone issues that she sees in her practice.

In addition, Dr. Gottfried explains how you should present symptoms and talk with practitioners to get the help you want, including treatments and/or prescriptions. She includes a glossary of the terms she uses, in case you are not familiar with the medical terminology, and also provides additional resources for getting tested (even at home) and for finding a practitioner who can help you.

Dr. Gottfried wants to help you create healthy habits, and to use journaling or technology to keep you on task. She offers diet suggestions, many of which tend toward an almost Paleolithic eating style. She discusses insulin and glucose levels at length, and covers many of the issues and health problems associated with insulin resistance. She also covers the problems associated with mercury toxicity in food and dental amalgams, and explains how hormone levels are affected. Questions surrounding environmental estrogen mimics (i.e., xenoestrogens) and eating soy are also covered.

Recognizing that non-medical approaches can also help achieve hormone balance, Dr. Gottfried recommends the HeartMath system for training yourself to reduce abnormally high cortisol levels due to stress, or using the alternate nose breathing from yoga traditions for the same result. (Dr. Gottfried embraces the practice of yoga and is a teacher herself.) She also suggests other tools that may help you along the journey, including Dr. Martin Seligman’s website authentichappiness.com, which contains questionnaires for assessing your own strengths and happiness.

Dr. Gottfried doesn’t intend to drop you once you have finished her book. She wants to continue to be your coach, and she has gathered up the power of social media: websites, webinars, blogs, emails, referrals, and references so you can continue your journey with her.

Her writing style is engaging and fun, which may lead some to think that Dr. Gottfried’s book is just a lot of fluff (her being a yoga teacher and all!). But, she is a scientist and medically trained at Harvard University, with over 20 years of medical practice and having treated more than 10,000 women. For inquiring minds, she has included a lengthy reference section that should convince even the most skeptical of her credibility.

Some practitioners have not been willing to address the complex problems of hormone dysregulation because they were not taught how to do so in medical school. Learning about balancing multiple hormones may seem daunting to them. However, this book is written in such an organized, simple, and yet scientific fashion, that Dr. Gottfried may well be knocking down some of the barriers preventing women from receiving the help they need to optimize their health. We say, bring on the revolution!

  • Gottfried S. The Hormone Cure: Reclaim Balance, Sleep and Sex Drive; Lose Weight; Feel Focused, Vital, and Energized Naturally with the Gottfried Protocol. New York, NY: Scribner; 2014.
  • Seligman MEP. Authentic Happiness. authentichappiness.com
Book Review – The Hormone Cure by Sara Gottfried, MD2018-04-10T14:37:51-05:00

How Do B Vitamins Affect Estrogen Metabolites?

How Do B Vitamins Affect Estrogen Metabolites?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

As estrogen breaks down in the body, some by-products are considered to be more beneficial than others. For example, 2-hydroxyestrogen metabolites are believed to help guard against breast and prostate cancers. However, this protective effect occurs only after a process called methylation, which takes place in the liver.

To fuel the methylation pathway, the body must have adequate amounts of methionine, which is found in meat, fish and dairy products. In addition to maintaining a low stress level, adequate amounts of magnesium, B6, B12, folate (B9), SAMe, MSM, and betaine also help the liver perform this life-saving function.

Due to genetics, some individuals simply do not methylate well. Testing of estrogen metabolites is available through hormone testing labs.

How Do B Vitamins Affect Estrogen Metabolites?2018-04-09T14:46:27-05:00

Endometriosis, Yeast, and Hormones

Endometriosis, Yeast, and Hormones

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Wayne Konetzki, MD, a member of the American Academy of Environmental Medicine (AAEM), has observed that most women with endometriosis have allergies to Candida albicans. He has also discovered that these same women may have sensitivities to luteinizing hormone, as well as to estrogen and progesterone.

Dr. Konetzki claims that Candida albicans yeast may have either progesterone and/or estrogen receptors on their cell walls. Increased hormone blood levels may cause yeast to overgrow, which then exacerbates endometriosis symptoms.

Endometriosis symptoms often diminish with anti-yeast treatment, which of course includes eliminating sugar from the diet. Endometriosis sufferers who are hypersensitive to hormones may also benefit from the desensitization techniques used by AAEM practitioners.

Endometriosis, Yeast, and Hormones2018-04-05T12:12:56-05:00

Endometriosis Q&A

Endometriosis Q&A

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

March has been designated Endometriosis Awareness Month, so it seemed fitting to interview Mary Lou Ballweg, founder of and Executive Director for the Endometriosis Association. Here are the questions we posed to her:

How did the Endometriosis Association come into existence?

The Endometriosis Association was founded in 1980 after I was bedridden for quite a long time. While ill, I promised myself and the universe that I would do something once I got back on my feet—I couldn’t be the only woman in the world with endometriosis. In fact, the conservative estimate of the number of women and girls with endometriosis now (2013) is 89 million.

It seems like there has been a lot of progress in the last ten years. Specifically, dioxin exposure has been identified as a cause.

Much progress has emanated from the Association’s discovery 20 years ago that dioxin was able to cause endometriosis. In fact, that discovery involved the Harlow Primate Laboratories in Madison, WI.

How can you detoxify from dioxin?

Detoxification is a very complex subject. We usually encourage women to work with healthcare practitioners who have experience in detoxifying as, typically, our women with endometriosis and related diseases are exquisitely sensitive to these toxins—releasing them from their stores in fat and elsewhere can make a person very sick if not done carefully and correctly. Avoiding these toxins is very critical—we covered this topic extensively in our last two books, The Endometriosis Sourcebook and Endometriosis: The Complete Reference for Taking Charge of Your Health.

Is there more endometriosis in some geographic areas than others?

Yes, we have noted that there seems to be much more endometriosis in some areas of the country compared to others (the Great Lakes area, San Francisco Bay area, the entire northeast US, Brazil, Japan, China) but clusters are impossible to prove at this time since the majority of those with endometriosis are not diagnosed for a range of reasons.

Do you feel that young women should do a laparoscopy to get a diagnosis or is there something recommended that is less invasive?

Unfortunately, at this point, endometriosis it is not considered to be conclusively diagnosed unless a laparoscopy is done. Research is underway to find blood, urine, or saliva diagnostic tests. Because endometriosis is also an immune system disease, laparoscopy can only show lesions, which are probably sequelae, the end result of the disease process. If we as women would take our health more seriously, long before it got to that point, perhaps we could avoid years of pain and suffering that all too often go undiagnosed.

It appears that women with endometriosis can actually be allergic to their own hormones. What hormones are involved? What is the procedure for reversing the allergy problems? Is this type of treatment easy to access?

Environmental medicine physicians have shown that individuals can indeed be allergic to their own hormones. Women with endometriosis are often allergic to progesterone and/or luteinizing hormone. Utilizing allergy desensitization techniques can be very helpful. The practitioners with the most experience are environmental medicine physicians who have special training. (See the American Academy of Environmental Medicine website for more information.)

What is the role played by an overgrowth of Candida? Do women with endometriosis need to address this?

The issue of Candida albicans is more complex than meets the eye. We have followed the issue of microbiota imbalance (the beneficial—and some harmful—microorganisms that occupy our bodies, particularly in the intestines) since the early 1980s when we discovered that many of our board members and leaders greatly improved their health by working to improve the balance of the microbiota in their bodies. Details on addressing this important problem are covered in the “Immunotherapy” chapter in Endometriosis: The Complete Reference for Taking Charge of Your Health.

Many drug treatments center on using synthetic progestins. How often do women and their practitioners choose to use progesterone instead, and what problems might they face? Can they reverse the endometriosis with progesterone?

Synthetic progestins are frequently used to treat endometriosis because they are promoted by pharmaceutical companies. It is important to note that progestin is not the same as natural progesterone and has somewhat different effects. Many women on synthetic progestin report significant side effects. If they are allergic to progesterone (as allergy tests can show), they often will not tolerate natural progesterone either unless they are first desensitized. There is no single treatment that reverses endometriosis—this complex disease requires a whole range of approaches.

Are there other hormone abnormalities?

Yes, hormone abnormalities, as well as numerous immune abnormalities, are part of endometriosis. Seven autoimmune diseases have been solidly linked to endometriosis, as well as a number of cancers. This information, including important preventative ideas, is covered in-depth in our latest book, Endometriosis: The Complete Reference for Taking Charge of Your Health.

Many of our clients seek help with hormones because they have experienced surgical menopause. We always recommend a balanced and bioidentical hormone approach. Do you have any words of caution for us on the type of advice we might give these women?

I think the most important caution for any woman facing surgical menopause because of endometriosis is to sort through her particular situation carefully, hopefully with a knowledgeable and experienced healthcare practitioner. We cover surgical menopause in our latest book but, unfortunately, there is very limited information based on science and clinical research on this topic. It seems that after hysterectomy and removal of the ovaries, gynecologists tend to think the disease is done, although recent research shows that that is not always the case. We do caution women about phytoestrogens as some have had a recurrence of their endometriosis with use of soy and other products that are estrogenic. Plastics used in food and beverage packaging and elsewhere are also a surprisingly potent source of estrogenic substances.

Diet and supplementation seem to make a big difference. Would you comment on this?

A whole range of approaches can make a huge difference in the health of women with endometriosis, along with other healthy approaches, including balancing hormones that are often out of balance in endometriosis, desensitizing to allergies, maintaining a healthy environment that minimizes allergens and toxins, and (very importantly) focusing on healthy nutrition.

We have covered nutrition extensively in our books, beginning with our very first book back in the 1980s. There are some special precautions women with endometriosis need to take. The topic is too large to cover in a short article but material is available from the Association.

The most heartbreaking part of your book is the years of suffering some women go through before they get a diagnosis they can work with. Young women seem to have very few resources for understanding what is going on with their bodies. They typically would not be the ones reading our newsletters, so how can we help get this message out to their mothers, aunts and grandmothers?

I would encourage every woman to be supportive of other women, particularly young women and girls who may be experiencing symptoms of endometriosis, and not understand what is happening and/or not have the resources and support to get diagnosed. Incapacitating pain during menstrual periods (I would actually say any pain) is not normal. Menstruation is an ongoing normal bodily function and as such should not be painful—we would not say, for instance, that painful bowel movements or urination is normal. It is the taboo and stigma around menstruation that has allowed so many to suffer. Please, mothers, grandmothers, aunts, every woman, help the young women and girls around you.

Are there any other comments you would like to add?

One of our members named endometriosis “the disease that keeps on giving.” That is an apt description. We strongly encourage women and girls to take charge of their health so that they can live life to the fullest. Reading up on the disease, talking to others with it, being a member of the Association—all of these will help women and girls avoid the “easy” fix that is all too often offered by surgeons and others, and rather help them develop real health that can sustain them, in spite of endometriosis and related health problems.

For more information, please contact:

Endometriosis Association, International Headquarters
8585 North 76th Place, Milwaukee, WI  53223  USA
Ph:  414-355-2200; 1-800-992-3636
Fx:  414-355-6065
www.EndometriosisAssn.org

Endometriosis Q&A2017-12-11T14:27:00-05:00

Dyspareunia (Painful Intercourse)

Dyspareunia: Painful Intercourse

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

The word dyspareunia is a general medical term referring to painful sex. Terms such as vulvodynia, vestibulodynia, and vaginitis refer to types of dyspareunia, and also indicate the origin of the pain.

Most of us usually don’t pay much attention “down there” until something goes awry. The issues can be a complex blend of emotional, psychological, and physical origin, thereby encompassing more than one medical specialty. Sometimes proper diagnosis and treatment of a physical condition can help emotional and psychological issues fade away, and vice versa.

Painful sex was the focus of the November 2012 meeting of The International Society for the Study of Women’s Health. Many of the case studies presented were about women who had consulted with many different practitioners, all of whom were unable to piece together the relevant information for proper diagnosis and treatment.

A critical aspect of proper diagnosis is the patient being familiar with and using proper terminology. Here’s a brief review for the purpose of this discussion: The vulva consists of the clitoris, urethra (for emptying the bladder), the opening to the vagina and the bit of tissue that surrounds the opening to the vagina, which is called the vestibule. The labia (lips) majora and minora fold around the opening to the vagina. The perineum is the tissue that extends from the opening of the vagina to the anus, which is the opening to the rectum. (For more information, please see the diagram in our newsletter on vaginal health titled Starting a Conversation About Vaginal Health)

One fairly common source of pain is the perineum tissue, which may sometimes tear and/or be cut and later stitched during childbirth. However, the part that tends to be the most troublesome and the source of the most pain is the vestibule.

Located on the inner side of the labia minora is Hart’s Line, which marks a transition between vaginal tissue and vestibular tissue. The vestibule is not made up of the same type of tissue as the rest of the vaginal area; it is the same tissue as that found in the urethra. Of particular interest is that this vestibular tissue requires adequate amounts of estrogen and testosterone to be healthy. Also of interest is that this tissue supplies the majority of the secretions that lubricate the area for sex.

Whether or not the vestibule is the source of pain can be detected by a simple cotton swab test. This involves touching the tip of a moistened cotton swab to the vestibular tissue and noting whether this touching elicits or increases the pain. Touching different parts of the vestibule can elicit different responses.

Causes for pain arising from the vestibule can include an excess number of nerve endings present since birth, nerve damage from childbirth, episiotomy (cutting the perineum), or accidents. Treatments vary from topical anesthetics to antidepressants, depending on the cause.

Pain can also stem from muscle spasms in the pelvic floor, which in turn causes problems with nervous system tissue. Treatments for muscle spasm include drugs such as Valium or muscle relaxants, physical therapy, or even hypnosis.

Dr. Irvin Goldstein maintains that the use of birth control pills is the greatest cause of vestibular pain. The interference of the synthetic hormones in birth control pills results in a deficiency of estrogen and testosterone in the vestibular tissue. Treatment consists of using preparations containing both of these hormones to restore the tissue to health. However, the type of cream or ointment used is key to avoiding or minimizing additional trauma to the painful area. Anti-inflammatory hormones, which are sometimes prescribed, provide little benefit. It is also important to stop any medications that may be interfering with the proper uptake of hormones to this tissue.

Dr. Deborah Coady has several suggestions to promote the health of the genital area. She advises against using soaps in the genital area because they are too drying, and avoiding creams containing benzocaine, alcohol, parabens, perfumes and propylene glycol. She also suggests wearing cotton underwear, changing it two or three times per day, and sleeping without underwear. She cautions against using minipads and recommends using hypoallergenic sanitary napkins.

To hydrate the area and reduce irritation due to friction, Dr. Coady suggests applying non-irritating products such as Aquaphor® healing ointment, vitamin E in grapeseed oil, or edible oils such as olive oil, safflower oil or coconut oil.

This discussion covers just a few important points to help begin the conversation about this sensitive topic. If you or someone you know is dealing with painful sex, please see the references below for more detailed information.

Dyspareunia (Painful Intercourse)2018-04-09T12:19:28-05:00

From WHI to KEEPS: Two Studies on the Effects of Estrogen Therapy

From WHI to KEEPS: Two Studies on the Effects of Estrogen Therapy

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

The much heralded (and widely criticized) Women’s Health Initiative (WHI) was the largest study involving women’s health to date. It investigated differences between the two most frequently prescribed hormone therapies at that time: Premarin, composed of conjugated equine estrogens, and Prempro, a combination of Premarin and the progestin medroxyprogesterone—none of which are bioidentical to the hormones produced by the human body. To much alarm by the media, the WHI study was halted after increased incidences of breast cancer and heart disease among participants. As a result, many people came to view all hormone therapies as suspect, leaving perimenopausal women with few other options for symptom relief.

Fortunately, a group of researchers at the Kronos Longevity Research Institute recognized an opportunity to improve on the WHI study and, in partnership with the National Institute on Aging at the National Institute of Health, initiated KEEPS, the Kronos Early Estrogen Prevention Study.

A four-year project, KEEPS involved women between the ages of 42 and 58, who were within three years of menopause. The two arms of the study evaluated 1) markers of cardiovascular risk and 2) effects on memory and mood, among three groups of participants:

  • One group received oral conjugated equine estrogens (Premarin) at a dose of 0.45 mg/day, which is lower than the dose in the WHI study
  • A second group used a Climara patch dispensing 50 mcg/day of bioidentical estradiol, equivalent to the estradiol produced by the ovaries
  • A third group did not receive any estrogen therapy

All three groups also received micronized oral progesterone (Prometrium) cyclically. This is equivalent to the progesterone produced in the human body, unlike the progestin used in the WHI study.

The KEEPS team released initial results at the annual meeting of the North American Menopause Society in October 2012. The highlights concerning cardiovascular markers included:

  • Those in the estrogen groups reported improvements in hot flashes, night sweats, mood, and sexual function, with no changes in atherosclerosis progression and no significant changes in blood pressure
  • Bone density also improved with estrogen therapy
  • Oral conjugated estrogens had some effects on lipid profiles, but transdermal estradiol was neutral in that aspect
  • Insulin sensitivity improved with the transdermal estradiol

Results from the ancillary Cognitive and Affective Study arm of KEEPS at the University of Wisconsin were also encouraging. Their data demonstrated that hormone therapy had positive effects on global cognition, verbal and visual memory, executive functioning, mood, and quality of life. Participants also reported significant improvements with regard to depression, anxiety and tension, according to lead researcher Dr. Sanjay Asthana.

Both arms of the KEEPS project resulted in good news for perimenopausal women. In essence, the preliminary data suggests that hormone therapies—especially bioidentical hormones—can provide significant symptom relief without posing additional cardiovascular risk. 

From WHI to KEEPS: Two Studies on the Effects of Estrogen Therapy2018-04-09T13:01:36-05:00

Chronic Pain and Its Link to Hormones

Chronic Pain and Its Link to Hormones

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Relief from chronic pain is one of the top reasons that people seek medical attention, and the abuse of prescription pain relievers is at an all-time high. This begs the question: what is causing all this pain? And, furthermore, is resorting to addictive and potentially dangerous narcotics the only answer?

We believe that the link between hormone imbalances and the prevalence of chronic pain deserves further exploration. Consider these findings:

  • Thyroid: Dr. Mark Starr, who has specialized in pain treatment, had issues with chronic pain himself, along with numerous symptoms of hypothyroidism, and he suspected the two might be related. Working with his mentors, they confirmed that his thyroid levels were indeed low, despite “normal” lab test results. Dr. Starr started thyroid hormone therapy and soon also became pain-free. Upon further scrutiny of his patients seeking pain relief, he found that 98% of them also exhibited signs of hypothyroidism, which he determined needed to be addressed first. He also observed that many of his patients presented with a type of autoimmune hypothyroidism. These patients tended to be gluten intolerant and highly allergic, and had to be treated with bioidentical T3 (liothyronine) and T4 (levothyroxine) rather than whole thyroid gland to successfully address their pain and hypothyroid symptoms.
  • Cortisol: Dr. William Jefferies suggests that the pain associated with rheumatoid arthritis may be very closely linked to hormone disturbances in his book, Safe Uses of Cortisol. As evidence, he points out that arthritis symptoms tend to disappear during pregnancy, when many hormone levels are high; that women with a history of infertility or a reduced menstrual timespan have a stronger likelihood of developing arthritis; and that women are more prone to arthritis after natural or surgical menopause.Dr. Jefferies notes that, although high doses of synthetic cortisol derivatives such as prednisone have been effective for relieving pain, it is a poor choice for long-term treatment due to the side effects. Instead, he recommends using bioidentical cortisol or cortisone in small physiologic doses to achieve safer pain relief.
  • Estrogens: In Bioidentical Hormones 101, Dr. Jeffrey Dach provides numerous citations regarding the treatment of osteoarthritis with estrogens. He points out that the conventional medical treatment for osteoarthritis is pretty grim, typically starting with Tylenol and non-steroidal anti-inflammatories such as ibuprofen and pain relief creams; followed by painful injections of steroids into the joints and physical therapy; and finally, when the pain becomes unbearable, joint replacement is proposed as the last option. Dr. Dach cites studies that demonstrate osteoarthritis pain as a result of estrogen deprivation, as well as animal and human studies showing the benefits of restoring estrogen.
  • Progesterone: Accompanying the decline of estrogens is a corresponding decline in the production of progesterone. Adequate progesterone levels encourage the normal production of collagen, which is needed for structural support and promotes the normal growth and maintenance of connective tissue, bone, and soft tissue. According to Dr. Ross Hauser, this may explain why supplementing progesterone in postmenopausal women can help relieve chronic pain.
  • Testosterone: Dr. Forrest Tennant states that a testosterone deficiency is increasingly recognized as a concern in both men and women who suffer chronic pain. This finding is not too surprising given that adequate testosterone must be present to bind the body’s own pain-relieving compounds to their receptors, and also for the transport of hormones in the brain, including dopamine and norepinephrine. Testosterone is also necessary for the maintenance of muscles and bones, as well as for healing and controlling inflammation. A lack of testosterone results in poor pain control, depression, sleep loss, and general loss of energy. The stress of chronic pain can also create or exacerbate a testosterone deficiency by overworking the hypothalamus and pituitary glands so much that they stop signaling the body to produce more testosterone. Ironically, narcotic-type drugs can also suppress testosterone production by disrupting the hypothalamus, adrenal glands, and sex organs, and diminishing the pain tolerance even as more pain medications are used. Dr. Tennant has also seen some success treating pain with human chorionic gonadotropin (HCG), another anabolic hormone that is most often associated with fertility and pregnancy. He believes the pain relief may be mediated through HCG’s ability to influence the thyroid gland, adrenal glands, and sex organs to produce more hormones.
  • Vitamin D: According to the Mayo Clinic, non-specific neuromuscular pain may be linked to low levels of vitamin D, and therefore they recommend screening all people with such pain. This type of pain is not relieved by anything else except Vitamin D supplements. (Remember that Vitamin D, in spite of its name, is also a hormone related to the sex and adrenal hormones.)
  • Oxytocin: Dr. James Howenstine suggests that oxytocin, a hormone from the pituitary gland typically associated with orgasm and nursing, shows promise in treating the pain associated with fibromyalgia but that further studies are needed.

It is clear that many different hormones play various roles in keeping our bodies functioning well—and possibly pain-free. So, when dealing with chronic pain, it makes sense to speak with your healthcare practitioner about the possibility that a hormone imbalance may be an underlying issue. Could a hormone imbalance be part of the problem? Or, better yet, could hormones be part of the solution?

Chronic Pain and Its Link to Hormones2018-04-09T12:07:02-05:00