Progesterone for Mental Health

Progesterone for Mental Health

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

The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the symptoms of schizophrenia and bipolar disorders to include scattered thinking, memory problems, confusion, behavioral changes, depression, anxiety disorders, unstable emotions, uncontrollable anger, low motivation, and changes in appetite. Many psychiatrists rely on the DSM’s description of symptoms as a way to diagnose mental disorders. They attempt to describe and categorize aberrant behaviors before applying an assortment of treatments that may include antipsychotic drugs, behavior modifications, counseling, or institutionalization. Often, the goals of treatment are to return patients to society, but may not include a “cure.”

Recent studies suggest hormones–specifically, progesterone—may offer some solutions not found in standard treatments. According to Doris King, each of the DSM’s symptoms for schizophrenia and bipolar disorder can be traced back to a deficiency of progesterone. In her book, Curing Bipolar Disorder and Schizophrenia, King claims that she was able to turn around her diagnoses of both these disorders.[i] She bases many of her arguments on writings by the late Dr. John Lee, which stress the importance of maintaining normal progesterone levels.

Could Progesterone Be the Key?

Dr. Lee recommended supplementing progesterone in doses that reflect the amount of hormone the body should normally produce.[ii] However, King maintains that people who have a long history of progesterone depletion—as in the case of patients with schizophrenia or bipolar disorder—need much more progesterone, stating simply, “When you have bipolar disorder or schizophrenia, your brain doesn’t have the progesterone it needs to function properly.” She introduces the idea of a loading dose, using progesterone in doses 3-4 times higher than Dr. Lee’s recommendation, until the body’s deficit is restored. During King’s recovery from bipolar disorder she used high doses of progesterone for four months.

Niacin and Schizophrenia

Another progesterone-related angle to schizophrenia is through treatment with niacin. Niacin aids in the synthesis of the sex hormones estrogen, testosterone, and progesterone. Dr. Abram Hoffer spent his career successfully treating patients with schizophrenia with high doses of niacin, a B vitamin.[iii] Niacin taken in high doses may normalize adrenaline metabolism. Dr. Hoffer identified an oxidized metabolite of adrenaline, which he named adrenalchrome, as being responsible for the hallucinogenic effects present in schizophrenia.

Progesterone and Adrenaline Imbalance

In his book, Adrenaline Dominance, Dr. Michael Platt writes that the medical field often ignores the effects of excessive production of adrenaline by the adrenal glands.[iv] Adrenaline is part of our “fight or flight” response, which may make us shaky, hyperactive, superhumanly strong, and intensely aware. A problem occurs when adrenaline is consistently overproduced, leading to symptoms associated with ADHD, anger, depression, PTSD, bipolar disease, addictions, and more. According to Dr. Platt, progesterone, produced in both the adrenal glands and sex organs, is the natural balancing hormone for excess adrenaline.

Nerve Damage Research and Other Breakthroughs

The myelin sheath wraps itself around nervous system tissue as a protective shield. If the myelin sheath is damaged, nerve conductivity is lost. Led by Natalya Uranova, Russian scientists have published research linking damaged myelin sheaths to both schizophrenia and bipolar disorder.[v] They examined the nervous system tissue of deceased patients who had these disorders, identifying myelin damage in these patients. In another study, Michael Schumaker et al. concluded that progesterone can be independently produced by myelin tissue and can be used in myelin repair strategies.[vi]

Conclusion

Mental health has become a large focus of today’s healthcare, as researchers strive to identify the genetic and environmental influences on mental health. While sex hormones have long been associated with changes in mood—such as anxiety and depression found in PMS or menopause—we can now turn our attention to the hormonal influences on other psychiatric disorders such as schizophrenia, bipolar disorders, and more. As research continues, progesterone may emerge as a key factor in developing treatments to recover and optimize mental health.

Additional Resources:

For more information on mental health and hormones visit our Mental Health Resources page.

Progesterone for Mental Health 2018-04-09T13:58:51+00:00

Hormones and Reproductive Health

Hormones and Reproductive Health

Written by Michelle Violi, Pharm.D. – Women’s International Pharmacy

 

Couple expecting babyWhat would we do without the human reproductive system? True, we might have fewer hormonal ups and downs, but it wouldn’t be long before humans would no longer populate the earth. Let’s take a closer look at how this very important system works in both women and men.

The Female Reproductive System

A woman’s reproductive system is delicate and complex. In order for conception to occur, it is important for a woman’s hormones to be balanced and her organs and tissues healthy. Hormones such as estrogen and progesterone play leading roles; however, there are many other hormones that are important players in the intricate process that is the female reproductive system.

Immediately following menstruation, estrogen levels begin to rise, causing the lining of the uterus to thicken. At ovulation an egg is expelled from the ovary into the fallopian tube where it travels to the uterus. After ovulation occurs, progesterone is produced from the corpus luteum, which forms in the ovary from which the egg was released.

Progesterone causes the uterine lining to become secretory and ready for the egg to implant should fertilization occur. If fertilization occurs, the fertilized egg implants in the uterine lining. The corpus luteum continues to produce progesterone until the placenta takes over its production in the second trimester of pregnancy. If fertilization does not occur, the corpus luteum breaks down, estrogen and progesterone levels fall, menstruation occurs, and the cycle begins anew.

The Male Reproductive System

A man’s reproductive system is no less complex. The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone.

FSH and LH are produced by the pituitary gland located at the base of the brain. FSH is necessary for sperm production (spermatogenesis), and LH stimulates the production of testosterone, which is necessary to continue the process of spermatogenesis. Testosterone also is important in the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, and sex drive.

Hormonal Effects on Fertility

Infertility issues are very complicated and have many possible causes, including hormone imbalances or deficiencies. The following are just a few ways hormones play a role in fertility.

Hypothyroidism, or low thyroid function, can affect fertility due to menstrual cycles without ovulation, insufficient progesterone levels following ovulation, increased prolactin levels, and sex hormone imbalances. In a study involving 394 infertile women, 23.9% had hypothyroidism. After treatment for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year.

Luteal phase deficiency (LPD) is a condition of insufficient progesterone exposure to maintain a normal secretory endometrium and allow for normal embryo implantation and growth. Progesterone is used in patients who experience recurrent miscarriages due to LPD. In addition, studies have shown progesterone can reduce the rate of preterm birth in certain individuals.

Conclusion

The human reproductive system is delicate, complex, and affects the overall health of women and men. Hormones serve an important role in maintaining harmony and promoting fertility in this intricate system. Because of this, achieving hormonal balance is a crucial component to supporting reproductive and overall health.

  • Lessey BA, Young SL. Yen & Jaffe’s Reproductive Endocrinology. 7th ed. Amsterdam, The Netherlands: Elsevier; 2014. https://www-clinicalkey-com.ezproxy.library.wisc.edu/#!/content/book/3-s2.0-B978145572758200010X?scrollTo=%23hl0000927 Accessed July 3, 2017
  • https://my.clevelandclinic.org/health/articles/the-male-reproductive-system Accessed July 3, 2017
  • Liedman R, Hansson SR, Howe D, et al. Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects. Gynecol Endocrinol. 2008;24:508-513. Accessed April 11, 2017.
  • Hassan SS, Romero R, Vidyadhari D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38:18-31.
  • Barda G, Ben-Haroush A, Barkat J, et al. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound Obstet Gynecol. 2010;36:743-748.
  • Mesen TB, Young SL. Progesterone and the luteal phase. Obstet Gynecol Clin North Am. 2015;42(1):135-151.
  • Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012 Jan-Jun; 2(1):17-19.
Hormones and Reproductive Health 2017-12-05T12:33:07+00:00

Ovulation is Crucial

Ovulation is Crucial to Women’s Health

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

ovulation is crucial to women's healthMany of us, including medical practitioners, think that if we are having monthly, regular periods, then our reproductive system is healthy. Dr. Jerilynn Prior believes we haven’t studied ovulation closely enough. She details her position in a series of newsletters from the Centre for Menstrual Cycle and Ovulation Research (CEMCOR). Dr. Prior estimates that, among regularly menstruating women whose cycles have been normal for 10-30 years after menarche (one’s first period), one third do not ovulate. She suggests that ovulation is “a missing link in preventing osteoporosis, heart disease and breast cancer.”

Let’s Start at the Beginning

Let’s refresh our memories with a little physiology review. Ovulation is the release of an egg from an ovary. Once the egg leaves the ovary, the corpus luteum (a temporary endocrine gland) forms in the ovary and begins to produce progesterone. The egg travels down the fallopian tube to the uterus where it can be fertilized by sperm. If fertilization does not occur, the egg is swept from the uterus along with the thickened lining of the uterus during a woman’s monthly period, also known as menstruation.

The release of the egg at mid-cycle and the formation of the corpus luteum are necessary for the abundant production and release of progesterone, which is the hallmark of the second half of the menstrual cycle known as the luteal phase.

As a young girl reaches menarche, estrogen influences her body. Breasts start to develop and body fat is redistributed, rounding the body’s contours gradually into a “womanly” shape. However, ovulation doesn’t start immediately and therefore, neither does the release of progesterone. It could be as long as a year before ovulation actually starts, and only after ten years does ovulation occur 95% of the time. One indicator that ovulation has begun, Dr. Prior explains, is the size of the areola around the nipple. When ovulation starts the areola becomes larger and darker.

Ovulation may be disturbed by stress, emotional upset, inadequate nutrition, and over-exercising without adequate food intake. Dr. Prior writes that there are two types of ovarian disturbances. One is an anovulatory cycle when no egg is released by the ovary. The other is luteal phase defect when an egg is released but there is insufficient progesterone produced by the corpus luteum in the ovary, leading to a shortened luteal phase. Both ovarian disturbances result in an inadequate production of progesterone.

Testing for Ovulation

No test actually “sees” the egg being released from the ovary, so medical practitioners have developed tests that use indirect methods to detect when ovulation has occurred.

  • One test requires a daily ultrasound of the ovaries to track the formation of the pre-ovulation cyst on the ovary and the eruption that occurs when an egg is released.
  • Another test involves taking a biopsy of uterine tissue, which can show cell proliferation caused by estrogen exposure and cells that have matured under the presence of progesterone.
  • Blood tests can verify that progesterone levels are rising to expected levels during the luteal phase.
  • Ovulation predictor kits, available online and at drug stores, test for a release of LH (luteinizing hormone) from the pituitary gland (a precursor to ovulation), but do not establish that ovulation has actually taken place.

In Dr. Prior’s studies, she documented the effectiveness of monitoring molimina to predict ovulation. Molimina is the set of symptoms that appear before the menstrual period that indicate ovulation has occurred. These symptoms include:

  • The onset of pain high up in the underarm region
  • Fluid retention
  • Mood sensitivity
  • Appetite increase

These symptoms may be mild and not reach the severity of PMS symptoms. Dr. Prior notes that nipple pain and general pain in the breast indicate high estrogen levels, but not necessarily ovulation. If a woman has no awareness of an oncoming period, ovulation has probably not taken place.

Another way to track ovulation is to monitor body temperatures first thing in the morning. The progesterone produced following ovulation acts on the hypothalamus and increases body temperature. Temperatures will be above average for 10-16 days if ovulation has occurred. To monitor body temperatures, use a digital thermometer to record readings every day. Add up all the temperatures for the month and divide by the number of days to get the average temperature, and then count how many days have been above average.

Ovulation and Our Health

Few researchers have tracked the effects of ovulation and its related hormones on the body over the course of a lifetime, but Dr. Prior shares findings from a number of studies addressing specific aspects of women’s health, as well as her conclusions from this information.

  • A recent study demonstrated that the greatest increases in bone density for young women don’t occur until about one year after menarche, when ovulation starts and progesterone is produced from the ovaries. Progesterone has been seen to be active at the bone building sites, the osteoblasts. On the other hand, menstrual cycles without ovulation, especially during the perimenopause years, may account for increased bone loss.
  • For many years, researchers have observed that both estrogen and progesterone can contribute to breast cell growth and proliferation. However, initial observations were usually only made over a day or two. After a few days in cell cultures, estrogen continues to stimulate cell growth, but progesterone contributes to breast cell maturation and differentiation. These mature cells are less prone to become cancerous in the presence of progesterone.
  • A common myth about heart disease is that it is the same disease in women as in men. For example, cholesterol levels in women do not appear to correlate with heart disease as they do in men, and taking a daily aspirin for preventing a heart attack may work for men but not for women. It was thought that estrogen prevented heart disease because HDL levels were increased with adequate estrogen levels, but repeated studies demonstrate that this is a myth.
  • Progesterone may affect heart health in a number of ways. It may decrease blood pressure, and it doesn’t appear to be associated with clot formation. While restriction of blood flow in the arteries can increase heart attack risk, progesterone may reduce this risk by increasing blood flow as well as or better than estrogen. Progesterone also appears to help prevent insulin resistance and obesity, two important cardiovascular risk factors. Cycles without ovulation and progesterone production, therefore, could be considered a risk for heart disease.

What can we do to support ovulation and progesterone production? Reducing stress and a healthy, balanced diet are good first steps. In order to detect if ovulation is occurring, monitor pre-ovulatory days for symptoms, chart morning temperatures, or use ovulation predictor kits. If ovulation isn’t occurring, progesterone levels may become depleted. In this case, progesterone may be supplemented to achieve optimal levels. Dr. Prior recommends 300 mg of progesterone used in a cyclic fashion (use for two weeks, stop for two weeks) to restore progesterone lost from lack of ovulation.

As it turns out, we can’t assume everything is well just because we are having a monthly period. Much is going on behind the scenes. However, as stated above, we can pay attention to what our body is trying to tell us. By listening to our body, we can keep our body strong and healthy for years to come.

Ovulation is Crucial 2017-12-12T15:35:51+00:00

Healthy Sleep and Rest

Healthy Sleep and Rest

Written by Gina Besteman, RPh, & Michelle Violi, PharmD – Women’s International Pharmacy

One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect healthy sleep. healthy sleep

Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. It’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea.

The role of estrogen in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin, and acetylcholine in the body. It has also been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs, and increase total sleep time. Low estrogen levels may lead to hot flashes, which can also affect sleep.

Cortisol is a hormone produced by the adrenal glands in response to stress. It normally peaks in the early morning followed by a slow decline throughout the day and night. However, chronic stress can alter healthy cortisol production and lead to sleep problems if cortisol is low in the morning and increased in the evening and at night.

Melatonin is a hormone produced by the pineal gland in the brain that regulates sleep and wakefulness. Normally, melatonin levels begin to increase in the mid to late evening, remain elevated throughout the night and drop in the morning. In general, melatonin levels decrease with age and melatonin production can be shut off by bright light. If melatonin levels are disrupted, sleep may be disrupted as well.

In addition to hormones, sleep can be affected by a number of external factors. It is important to maintain proper sleep hygiene as follows:

  • Avoid napping during the day
  • Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
  • Exercise can promote good sleep, but avoid vigorous exercise too close to bedtime
  • Food can be disruptive right before sleep
  • Ensure adequate exposure to natural light during the day
  • Establish a regular relaxing bedtime routine
  • Associate your bed with sleep
  • Make sure that the sleep environment is pleasant and relaxing and free from light pollution, e.g., lighted alarm clock faces, street lights through open windows, and cell phones/tablet devices
  • Eichling PS. Evaluating and Treating Menopausal Sleep Problems. Menopause Management. Sept/Oct 2002.
Healthy Sleep and Rest 2017-12-14T15:01:55+00:00

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller

Book Review – An M.D.’s Life-Saving Health Solutions by James A. Schaller

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

Although not apparent from the title of this book, An M.D.’s Life-Saving Health Solutions: A Gynecologist’s Advice, Dr. James Schaller shares some very interesting thoughts about hormones from his long clinical practice in obstetrics and gynecology. He writes in an engaging fashion, almost like you were sitting in his office and having a conversation with him.

He is very clear that progestins (which he calls castrating drugs) are not progesterone. He calls the large Women’s Health Initiative (WHI) study ill-conceived and and says it fails to answer the question that that they sought. The question asked by the study was “Can hormones delay the onset of chronic disease in women?” Because the study used only Premarin and Premarin with medroxyprogesterone (progestin), we only learned that the synthetic or non-human identical hormones do not delay the onset of chronic disease in women.

Dr. Schaller discusses the relationship between hormone balance and body fat at great length. He states ideally, a woman should have about 22% body fat. Less than 13% body fat and low estrogen at menopause is a real concern because there is not enough fat to allow for adequate estrogen storage. Consequently, very thin women have more sensitivity to swings in estrogen which occur throughout the cycle or in perimenopause. “Fat cells store, produce and release estrogen. The number of fat cells affects all hormonally-related effects,” Dr. Schaller claims.

Very thin women can experience stopped monthly periods because there is not enough estrogen available to build up the endometrium. Recall that cycling begins in a young woman who has at least 13% body fat. These women are also at higher risk for osteoporosis.

On the other hand, women who are overweight with more than 30% body fat, store plenty of estrogen in their fat cells. They have a life-long imbalance in progesterone needed to balance the estrogen they accumulate and store. Periods may also stop for obese women but they will likely experience abnormal bleeding.

It is important women understand normal ovarian function. Young girls usually experience pain during the first one to two days of their periods indicating that an ovulation has occurred. After a vaginal delivery this pain may stop. Pain can also occur at mid cycle or two weeks before bleeding begins. This pain can be stabbing or a dull ache and represents the pain of the follicle bursting through the ovary wall. He recommends avoiding strenuous activity when this happens. The ovaries can actually sway with rigorous exercise and prevent healing of the rupture in the ovarian wall.

Dr. Schaller’s book contains many more practical hints. He warns against using psychoactive drugs, medications that have an effect on mood, behavior, or thinking processes, for PMS when progesterone addresses the underlying issue and is less expensive too. He says statins are very dangerous. He notes that cholesterol-lowering drugs do not save lives but actually increase mortality and produce depression and memory problems.

Dr. Schaller is accepting of some doses of NSAIDS (non-steroidal anti-inflammatory drugs) for ovulation pain; however, he says using NSAIDs in excess can cause serious problems because of their potential for gastric ulceration. Drugs which are used for excess stomach acid actually prevent absorption of critical nutrients and bisphosphonate drugs used for osteoporosis interfere with normal bone metabolism.

It was a privilege to read this book and reap the benefits of the observations of a physician in practice for over 40 years. I am sad to see our medicine system turning into one which allows patients only a few minutes with a practitioner and uses treatment plans based on algorithms instead of treating people like individuals and tapping into the vast stores of knowledge and experience from physicians such as Dr. Schaller.

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller 2018-01-22T10:56:17+00:00

A New Treatment Program to Improve Memory Loss

A New Treatment Program to Improve Memory Loss

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

In spite of hundreds of clinical trials over the past ten years, Alzheimer’s disease (AD) has no effective treatment. AD affects 5.4 million Americans, predominately females. It is estimated that women have a greater chance of developing AD than breast cancer.

Research supports the theory that an imbalance in brain nerve cell signals causes this disorder. Specific signals make nerve connections to cement memories while others allow irrelevant memories to be lost. This signaling system becomes imbalanced so that new memory connections are inhibited while more information is forgotten. Reversible metabolic processes may be involved in the early stages of AD.

Dr. Bredeson and his colleagues at UCLA believe that a comprehensive, personalized approach is the best way to treat memory loss. They have developed a program that optimizes diet (no simple carbohydrates, gluten, or processed foods), utilizes meditation and yoga, and emphasizes the importance of sleep, hormones, good oral health, and exercise. Patients may use supplements as well as medium chain triglycerides like coconut oil or Axona.

The researchers believe that free T3 and T4, estradiol, testosterone, progesterone, pregnenolone, and cortisol need to be optimized. Nine out of ten patients in this pilot program had cognitive improvement.

Additional Resources:

For more resources from Women’s International Pharmacy, see our Mental Health Resources page.

A New Treatment Program to Improve Memory Loss 2018-04-04T15:44:16+00:00

Book Review – Adrenaline Dominance by Michael E. Platt, MD

Book Review – Adrenaline Dominance: A Revolutionary Approach to Wellness by Michael E. Platt, MD

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

We know what a surge of adrenaline feels like. It is the hormone that gives us the strength for “fight or flight.” Our hearts beat harder, stronger, faster. Blood is diverted from less important things like digestion to our muscular tissue. Thought processes seem to happen at lightning speed. There are many stories of superhuman feats performed under extraordinary circumstances with surges of adrenaline.

Dr. Michael E. Platt has written his book Adrenaline Dominance because he feels that practitioners and their clients lack understanding of this very important hormone. He finds that knowing how adrenaline functions enables him to successfully guide his patients towards wellness.

Adrenaline is produced by an inner part of the adrenal glands. Dr. Platt explains that there are two reasons for adrenaline to be released: One reason is in response to stress as described above, and the second reason is to ensure that the brain has received enough sugar (glucose). The body uses adrenaline to help create more glucose from protein as well as stimulate the release of glucose stored in the liver. Consequently, as glucose releases, insulin releases. These two hormones are intimately involved with adrenaline.

Dr. Platt organized his book according to “The Good, the Bad and the Ugly,” the classic Clint Eastwood western, to illustrate that adrenaline has both desirable and undesirable effects. He believes that right-brained creative thinkers acquire those qualities from plenty of adrenaline ensuring lots of glucose to the brain. Superb athletes also get their edge from adrenaline. These are “good” mental and physical effects of generous amounts of adrenaline.

It starts to get “bad” when adrenaline output is too generous or our bodies don’t have the ability to moderate the high adrenaline. High adrenaline can be tied into depression, anxiety, irritable bowel syndrome, hypertension, diabetes, obesity, headaches, restless leg syndrome, addictions, and bedwetting. It gets “ugly” when syndromes such as fibromyalgia, interstitial cystitis, road rage, autism, or post-traumatic stress disorder appear.

Progesterone, which is also produced by our adrenal glands, is the natural modifier of excess adrenaline. Dr. Platt recommends progesterone in men and women, as well as children. Along with progesterone, Dr. Platt guides his patients with their food choices. Dr. Platt recognizes the relationship between glucose and insulin and claims the timing and types of foods ingested can make significant changes in the presentation of excess adrenaline.

It is not difficult to imagine the ramifications of adrenaline being out of balance since Dr. John Lee introduced us to the concept of “estrogen dominance.” Many practitioners surprisingly don’t recognize the significance of progesterone in moderating both the effects of estrogens and adrenaline. Thanks to Dr. Platt, we can raise our awareness on an ever enlarging picture about hormone balance. He reveals his evidence and thinking in great detail in his book, which is sure to expand every reader’s thinking about our bodies.

  • Platt ME. Adrenaline Dominance: A Revolutionary Approach to Wellness. Michael E. Platt, MD; 2014.
Book Review – Adrenaline Dominance by Michael E. Platt, MD 2018-04-03T16:34:47+00:00

How Hormones Interact with Receptor Sites

How Hormones Interact with Receptor Sites (and the Relation to Breast and Prostate Cancers)

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

There is no shortage of information and opinions concerning hormone treatments or the “best” way to test for hormone deficiencies, not to mention how to use hormones or confirm if a hormone intervention is working. However, upon reading Dr. Edward Friedman’s book, The New Testosterone Treatment: How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer’s, it occurred to me that hormone receptors are really THE thing we should examine. Regardless of the testing method, the specific hormone, or its intended result, all hormone action occurs at the receptor sites.

What are Receptors?

Receptors are protein structures designed to snag passing hormones. Receptors for hormones that poke through the cell membrane are called membrane receptors. Other receptors are inside the cell (intracellular receptors) in the cytosol, and more receptors are in the cell nucleus. The number of receptors is not stagnant, and varies according to nutrients and the environment.

Once a receptor captures a hormone, that cell receives instructions for an action, such as cell replication, manufacturing other proteins, moderating cell activity, and programming abnormal cell death. A single hormone can produce action within minutes of binding. Receptors manipulate the cell’s action by upregulating or down-regulating the production of proteins.

Hormones Have Affinities

Conventional practitioners insist that as long as a hormone receptor receives a hormone–whether it is identical to the human hormone or not–all hormones and hormone-like substances should be considered equal. This thinking completely ignores the research identifying different affinities for different hormone receptors. As an example, the hormone estriol is generally considered a weak estrogen. This is because the binding of estriol on a receptor, in comparison to estradiol binding on the same receptor, produces less response.

In sharp contrast, the receptors for estrogen in the urinary tract, bladder, and vaginal tissue have a much greater affinity for estriol. A study published in the New England Journal of Medicine demonstrated dramatic differences in effectiveness in treating urinary tracts in elderly women with recurrent infection. Clinically, estriol also shines when treating vaginal dryness, outperforming estradiol and other estrogens.

Receptors are Promiscuous

Even though receptors have affinities, they are not very discriminating about binding and can be affected by synthetic hormones as well as “the real thing.” Receptor activity can be blocked or accentuated. For example, medroxyprogesterone acetate, a progestin rather than real progesterone, not only interferes with progesterone receptors but can block testosterone and cortisol receptors too. Because testosterone has such a positive effect on potential breast and prostate cancer (see below), this could help explain why this synthetic hormone is so frequently associated with increases in breast cancer, as reported in the Women’s Health Initiative study.

A Hormone Receptor Model

Dr. Friedman, a theoretical biologist, describes the hormone “big picture” and also offers a theory on what he calls the Hormone Receptor Model. He believes that his model answers questions about how breast and prostate cancer initiate, and how this information can be used to target very specific treatment based on bioidentical hormones (particularly testosterone) to change the course of these diseases. Dr. Friedman states that breast and prostate cancer are fundamentally identical in their causes, presentation, and progression.

Introducing Bcl-2

Bcl-2 is a protein produced by hormone stimulation in the cell nucleus of cancer cells. This protein is of high importance in the discussion of breast and prostate cancer. Cancer cells are immortal; they escape the normal program for cell death called apoptosis. The Bcl-2 protein shields cancer cells from their normal cell destruction.

Estrogen Receptors

Estrogen Receptor Beta (ER-Beta) stimulation has a positive result, which is that the production of the Bcl-2 protein is down-regulated, thus depriving cancer cells of their immortality. Moreover, it also has an anti-inflammatory effect.

Estrogen Receptor Alpha (ER-Alpha) increases inflammation and the production of the Bcl-2 protein. When breast cancer tissue is examined and reported as estrogen receptor positive, that information is incomplete. We need to know the concentrations of the different estrogen receptors. A dominance of ERBeta receptors is good. One feature of cancer cells is that the further the cancer progresses, the more ERAlpha receptors are available.

Types of Estrogen and Their Binding Properties

Estradiol binds to both alpha and beta receptors with equal strength. Estrone binds to alpha receptors five times more tightly than to beta receptors, and estriol binds to ER-beta 3.2 times more tightly than it will bind to ER-alpha. So, the amount of Bcl-2 being produced is dependent upon which estrogen is binding, how strongly it is binding, and the concentration of each type of receptor. Hence, estrone is considered to be potentially more pro-cancer, while estriol is considered to be potentially more anti-cancer.

Progesterone Receptors

Progesterone Receptor B diminishes the production of Bcl-2 when activated, thereby also depriving cancer cells of their immortality. Fortunately, Receptor Bs tend to predominate, making the presence of progesterone typically more anti-cancer than pro-cancer.

Progesterone Receptor A increases Bcl-2 and stimulation of this type of receptor is associated with BRCA1 and BRCA2 mutations. According to Dr. Friedman, the few women with these mutations also have increased numbers of Progesterone Receptor A. In turn, this leads to an increased Bcl-2 production protecting cancer cells. He outlines a different strategy to use in this situation (please refer to Dr. Friedman’s book for more detailed information).

Androgen Receptors

The membrane androgen receptor behaves differently in men than it does in women. In women, stimulation of this receptor causes a decrease in Bcl-2; in men, it causes an increase in Bcl-2. In both men and women, stimulation of the intracellular androgen receptors decrease Bcl-2 and also causes the production of other anti-cancer proteins. However, if there is a shortage of testosterone to stimulate the intracellular receptors, the shortage favors more cancer cell growth.

Dr. Friedman’s Synopsis

The above summary is a very simplistic synopsis of Dr. Friedman’s views on hormone receptors and their role in diseases. A synopsis of Dr. Friedman’s treatment program includes the following:

  • He suggests that Vitamin D (which is a hormone) should always be considered first and foremost with a diagnosis of breast or prostate cancer. There is no downside to ensuring that vitamin D levels are optimized, and activation of the vitamin D receptor helps destroy cancer cells. (Please see our newsletter Vitamin D: The Sunshine Hormone for more information.)
  • He states that ample amounts of testosterone are very protective against both breast and prostate cancer.
  • He advises on the use of aromatase inhibitors to hamper the conversion of testosterone to estrogens, which can lead to more activation of ER-alpha receptors.
  • He believes that estriol is underutilized, and that it could be supplemented generously to shift stimulation to the ER-Beta receptors. Premarin®, with its predominance of estrone, clearly is a therapy that shifts the stimulation to the ER-Alpha receptors.

Dr. Friedman offers some very thought-provoking ideas about using bioidentical hormones in the treatment of breast and prostate cancer. Although his theory is not yet tested, some practitioners have already begun incorporating elements of it.

A study recently published by Dr. Rebecca Glaser illustrates strong evidence for the idea that testosterone can be protective, and perhaps even effective as a treatment for breast cancer. She recently presented the results of 1,268 women who were receiving testosterone treatment along with an aromatase inhibitor. Although her study is designed for ten years, she is already observing a dramatic decrease in breast cancer incidence in her study group, as compared to other studies and population statistics, at the five-year mark.

Dr. Friedman feels that his methods are not intended to be a “cure” but a means to control cancer. He claims that the only side-effect is that, instead of suffering from the disfigurement and secondary effects of cancer surgery, radiation, and the debilitation of hormone deprivation and chemotherapy drugs, restoring hormones to more youthful levels will yield a zest for life while living with cancer.

How Hormones Interact with Receptor Sites 2018-04-26T11:12:08+00:00

Bioidentical Progesterone vs. Synthetic Progestins

Bioidentical Progesterone vs. Synthetic Progestins

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

There is nothing that bothers bioidentical hormone proponents more than to have the scientific community categorize bioidentical progesterone with synthetic progestins. In 2002, the Women’s Health Initiative (WHI) study found a slight increase in breast cancer risk for women using conjugated equine estrogens (CEE) with medroxyprogesterone acetate (MPA). In spite of the fact that the study authors cautioned that their results did not necessarily apply to bioidentical progesterone, the popular press has put progesterone in the same category with MPA ever since.

More recent studies support the fact that, contrary to popular belief, MPA and progesterone do not have the same breast cancer risk. Two of these studies occurred in France, where bioidentical hormones are widely used. A study published in 2008 found that, of the 2,354 cases of invasive breast cancer found among 80,377 postmenopausal women, estrogen plus progesterone hormone therapy did not increase the risk of invasive breast cancer while estrogen plus synthetic progestins did. A later study published in 2013 supported these findings.

Progesterone may indeed be beneficial in protecting women against breast cancer. A breast cancer cell-line study supports the theory that progesterone actually causes the destruction of specific breast cancer cells. Another study found that progesterone reduced estradiol-induced growth of female breast tissue when applied 10-13 days before breast surgery. Still another study found that women with progesterone blood levels = or > 4ng/ml before breast cancer surgery had the best survival rate.

It is time that we stop espousing quasi-science by equating bioidentical progesterone with synthetic progestins. They are not the same and never will be.

  • Rossouw JE, et al. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women’s Health Initiative Randomized Controlled Trial. JAMA. 2002 Jul 17;288(3):321-33.
  • Fournier A, et al. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study.Breast Cancer Res Treat. 2008 Jan; 107(1): 103-111. Epub 2007 Feb 27.
  • Cordina-Duverger E, et al. Risk of Breast Cancer by Type of Menopausal Hormone Therapy: a Case-Control Study among Post-Menopausal Women in France. PLoS One. 2013 Nov; 8(11):e78016. doi: 10.1371/journal.pone.0078016. eCollection 2013.
  • Formby B, Wiley TS. Progesterone Inhibits Growth and Induces Apoptosis in Breast Cancer Cells: Inverse Effects on Bcl-2 and p53. Ann Clin Lab Sci. 1998; 28(6):360-369.
  • Chang KJ, et al. Influences of percutaneous administration of estradiol and progesterone on human breast epithelial cell cycle in vivo. Fertil Steril. 1995 Apr; 63(4):785-793.
  • Mohr PE, et al. Serum progesterone and prognosis in operable breast cancer. Brit J Cancer. 1996 Jan 16; 73:1552-5.
Bioidentical Progesterone vs. Synthetic Progestins 2018-04-03T11:05:28+00:00

Ingrid Edstrom’s Proactive Breast Wellness Program

Ingrid Edstrom’s Proactive Breast Wellness Program

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

 

Our current medical system has been designed to take our hands and give us direction when disease has become evident, but it has left us sadly wanting when it comes to prevention. Finding and accessing the information necessary to prevent disease is difficult and time consuming. And, even if we do find it, interpreting it and understanding it may take some help.

Thankfully, a comprehensive compilation of what we currently know about keeping our breasts free from disease, including breast cancer, is available as an engaging multimedia presentation offered by Ingrid Edstrom, FNP, MEd, CTT. The Proactive Breast Wellness Program is her magnus opus and a labor of love.

A nationally certified family nurse practitioner, Edstrom combined her nursing degree with a minor in clinical nutrition. She also earned a master’s degree in Health Education, and has completed clinical training programs at the Mind Body Medical Institute. Ingrid Edstrom has skillfully combined all of her educational and clinical skills, and gift wrapped them in a delightful presentation so that we would have the resources we need to keep our breasts healthy.

Edstrom includes information about the various effects that hormones have on the breasts, the type of diet and foods that can be used to improve breast health, and the environmental issues affecting the breast. She even includes a meditation so that listeners can help reduce high cortisol, making us aware of the emotional and spiritual aspects of dealing with our breasts and our bodies.

The Power of Progesterone

Edstrom’s presentation covers a complete program for breast health, but let’s just focus in on one section she calls “The Power of Progesterone” as a sample. She states that after age 35, many women cease having ovulatory cycles, even though they continue to bleed regularly. This lack of ovulation increases the estrogenic dominance by 100 times. Add on the burden of many environmental exposures to estrogen-like compounds (which she also covers extensively) and the normal counter balance of progesterone for estrogen is greatly diminished.

Quoting Dr. John Lee, Edstrom maintains that progesterone should be used for breast cancer protection, during breast cancer treatment, and after breast cancer treatment. She also cites Dr. Susan Love, a breast surgeon, who recommends that any breast surgery should be done on days 13 through 28 of the menstrual cycle (progesterone levels are higher then) or, if that is not possible, progesterone cream should be applied to the breasts for two weeks before the planned surgery. Published studies have documented better outcomes when progesterone plays a role.

Edstrom discusses the problems with artificial progestins and brings up the issue of California’s mandatory cancer warning labeling on the over-the-counter progesterone products. She points out that California rule makers depended upon compilations of studies that primarily involved progestins, and then concluded erroneously that the required warning should pertain to progesterone as well. Progesterone, itself, has not been proven to be a carcinogen but instead offers protection. She cites the studies that demonstrate this.

Edstrom also discusses various dosage forms at length and details her preferences. She gives practical hints on how to use different dosage forms and offers some clinical suggestions. For example, she recommends that progesterone creams not be applied to the abdomen because this application may have the most significant effect in slowing gut motility. She learned from compounding pharmacists that progesterone cream applied directly to dense or thickened areas of the breasts may have the best results. She likes to use progesterone drops prepared with organic jojoba oil, and warns that progesterone is in suspension in this dosage form and should therefore be shaken very thoroughly before using to ensure proper dispersion.

Screening Methods

A cornerstone of Edstrom’s presentation, as well as her clinical practice, is the use of breast thermography as a tool for early warnings of issues presenting in the breast. Thermography is not an invasive test but captures the subtle differences in the temperature of the skin in a color scale. As might be imagined, the hot spots indeed appear as yellow to red colors, while normal temperatures appear in the blue and green ranges. The temperatures and color differences show areas of increased metabolic activity in the breast tissue long before a mass that could be palpated would form or would appear on a mammogram. This imaging allows for early interventions and also allows for a measure of the success of the interventions.

While mammograms are firmly entrenched in our medical system, there are some negative aspects with this type of testing. Mammograms introduce radiation (a known carcinogen) into our bodies. Mammograms do not prevent breast cancer and are not the best tool for an early warning. Both false negatives and false positives are common. Mammograms can actually damage or spread cancerous cells because of the high pressure applied to breasts in order to obtain the imaging. Breasts that are lumpy or have thick tissue present problems for accurate diagnoses with mammograms.

Thermography, on the other hand, measures physiologic changes rather than physical. As a cancer tumor develops, new blood vessels are formed feeding the tumor. This enhanced metabolic activity is easily detected with thermograms. Additionally, the increased metabolic activity can show up three to eight years before a tumor has actually developed. A suspicious thermogram can be followed up with an MRI, and neither of these diagnostic techniques subjects the body to radiation.

Edstrom thinks that thermography may replace mammography as the primary early screening tool in the not too distant future. She says that other screening methods are also being developed, such as a way to test fluid expressed from the nipples for cancer cells, and a saliva assay to test for a protein linked to breast cancer.

A Proactive Approach

As the incidence of breast cancer has steadily risen, we probably all know someone who has been affected. Ingrid Edstrom’s Proactive Breast Wellness Program is information that every one of us can use and benefit from, whether we are worried about breast cancer, are undergoing breast cancer treatment, or need to know how to prevent a reoccurrence.

If Ingrid Edstrom can be successful in her proactive approach to breast health, then the pink ribbon campaigns will become history. Just imagine the progress that would be made if women gathered in their neighborhoods, or their book clubs and coffee shops, and listened to presentations like this together, with the chance to discuss and disseminate the valuable information she offers. Let’s change the campaign from “breast cancer awareness” to “breast health awareness.” We encourage you to take advantage of Ingrid’s gift to us!

We were pleasantly surprised to see that Edstrom references several of our Connections newsletters when she covered the topic of hormones and balance. She also links to a collection of abstracts on hormone therapies that we compiled and published. Please feel free to explore these resources for additional information that may contribute to your breast health awareness.

Ingrid Edstrom’s Proactive Breast Wellness Program 2018-04-02T16:49:13+00:00