Hormone Series: Estrogen Replacement Therapy: Estrogen 3 of 3

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Dr. Aaron Hartman

February 15, 2022


Bioidentical hormone therapy is a popular topic. There are many conversations and opinions on how to treat imbalances and who might be a good candidate for bioidentical hormones.
After addressing diet and lifestyle, as we discussed in the previous post, perhaps now you’re considering bioidentical hormones.
When considering estrogen replacement therapy, it’s important to think about the risks of too much estrogen, which can increase the likelihood of estrogen-related cancers. In general, I do not like to use estrogen replacement therapy in women who have a history of breast cancer, ovarian cancer, or uterine cancer.


Topical Estrogen Therapy

First, let me say that estrogen should always be supplemented topically through the skin, also known as transdermal hormone replacement. Taking synthetic or bioidentical hormones orally can cause many problems. Most of the side effects we hear about, such as breast cancer, blood clots, and strokes, all revolve around oral administration of synthetic estrogens. Even bioidentical oral estrogens can cause these issues.
The problem with oral estrogen supplementation is that dosing levels must be so high – usually eight to 10 times as much as is needed – to make it past the liver. The liver then breaks the estrogen down, creating metabolites, which are inflammatory, pro clotting and pro cancer. So when supplementing estrogen it is important to do so topically.
Oral estrogen replacement can have various side-effects including:

  • High blood pressure
  • High triglycerides
  • Gall stones
  • Liver enzyme elevation
  • Reduced growth hormone
  • Increased carb cravings
  • Increased inflammation
  • Increased sex hormone binding globulin (lowers testosterone)


Your Hormones Need a Holiday Too

Every woman throughout her cycling period has a natural break from estrogen for about a week out of every month. The time of the month during your period when you’re bleeding is a “hormone holiday”. When giving women supplemental hormones in the menopausal years, we mimic the hormone holiday by skipping weekends, taking off one day a week, or doing something similar to help replicate this natural cycle.
While pellets and long-term injectable therapies are convenient, they do not allow for hormone holidays, which is a a big drawback as it can be detrimental to long-term health.

Test! Don’t Guess!

How you can figure out if you’re getting overdosed on or underdosed using hormone therapy? Ideally you want to test, test, test – don’t guess! I frequently see women who come to my clinic with symptoms of excessive or low estrogen. During testing we sometimes find that they actually have the opposite imbalance than what their symptoms indicated, but their symptoms were due to an imbalance with other hormones.
So, this discussion is meant to be helpful as a general guide, but when dosing hormones we should always test to determine if there is an imbalance relative to other hormones or if there is an actual deficiency. This is an important distinction to make. When we just dose to symptoms, hormones can easily be overdosed and, in the long run, these women are not helped but harmed.

Signs and Symptoms of Elevated Estrogen from Supplementation:

  • Cervical dysplasia (Increased risk for cervical cancer)
  • Decreased interest in sex
  • Elevated risk of breast cancer
  • Heavy menstrual cycles
  • Low thyroid
  • Mood swings
  • Panic attacks
  • Swollen breasts
  • Increased autoimmune disease risk (especially lupus and rheumatoid arthritis)
  • Weight gain (especially around the middle)


Benefits of Estrogen Replacement Therapy

After all of these side effects and complications around estrogen therapy, you might wonder why we would even supplement with hormones. Why don’t we just leave them alone?
There are many therapeutic benefits from using hormone therapy, including improving the numerous functions from our first post on estrogen. We can use estrogen therapy to lower the risk of different autoimmune diseases. High levels of estriol (E3) has even been found in trials to help treat multiple sclerosis. Estrogen therapy has been shown to Improve cognition, bone loss, heart disease, cataracts, macular degeneration, and also increase a woman’s general sense of well-being. These are all reasons why someone might consider using hormones.


Ultimately, my recommendation is to work with a practitioner that will test and not guess, use the hormonal hierarchy, help you work on healing your gut, and then finally move to hormone therapy if needed. These are my basics for estrogen hormonal therapy and what to consider when looking for treatment options.

Next Time

We will continue to talk about different kinds of hormones and how they interrelate, so be sure to keep reading and learning about other hormones and how they relate with your health and well being.
Thanks a lot, take care, and be well.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.


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