Restoring patient wellness. Building physician practices.

Osteoporosis

Because estrogen controls the functioning of osteoclasts and osteoblasts in bone tissue, the hormone also influences the rate of absorption and deposition of calcium. Estrogen deprivation following menopause results in increased activity of osteoclasts that exceeds the capacity of osteoblasts to deposit needed calcium. Under these conditions osteopenia and ultimately osteoporosis occur.
Administration of glucocorticoids has become an increasingly prevalent treatment modality in conventional biomedicine, yet prolonged use of these powerful drugs often accelerates bone loss, leading to osteopenia and increased incidence of fractures.
Both endogenous and exogenous cortisol excesses are well-established causes of osteoporosis. Increased cortisol levels have been associated with calcium malabsorption, as well as osteoporosis in oophorectomized women. Higher cortisol levels in athletes with exercise-related amenorrhea have also been correlated with significantly lower bone mineral density.60 One investigator postulated a possible link between lower limb stress fractures in young female athletes and hypersecretion of cortisol.61
Melatonin is thought to regulate calcium metabolism by stimulating the activity of the parathyroid glands and inhibiting both calcitonin release and prostaglandin synthesis. Thus, a decline in melatonin levels may be an important contributory factor in the development of post-menopausal osteoporosis. One investigator has even suggested using oral doses of melatonin combined with light therapy for prophylaxis and treatment of post-menopausal osteoporosis.

Conventional Medical Treatment [SH]

Polycystic Ovary Syndrome

Typical conventional treatment of PCOS includes oral contraceptives, progestins, androgen antagonists (spironolactone), and glucocorticoids (prednisone). Limited effectiveness and significant side effects are common. Surgery (wedge resection) is typically reserved for those who fail to respond to pharmacological treatment. Adhesions that form after surgery may prevent future pregnancy.

PMS

A number of pharmaceutical agents are typically employed for PMS, although often with limited success. Hormonally, oral contraceptives are prescribed, but, in many women, they actually aggravate existing symptoms or create new PMS symptoms. Anxiolytics, antidepressants, and lithium have been prescribed to manage the psychological manifestations of PMS, while diuretics have been prescribed for water retention symptoms. NSAIDS are prescribed for the pain of uterine cramping.

Endometriosis

Typical conventional treatment for endometriosis may include surgical excision of the endometrial tissue and drug therapy to suppress ovarian function. Pharmaceuticals employed include oral contraceptives, progestin, danazol, and GnRH agonists. Side effects of these medications may include PMS symptoms, hirsutism, menopausal symptoms, liver dysfunction, and deep vein thrombosis. Total abdominal hysterectomy, with or without salpingo-oophorectomy, is reserved for patients with intractable pain who have completed child bearing

Menopause

Conventional treatment of menopause typically involves the use of hormone replacement therapy (HRT). The most commonly prescribed and studied HRT combination is estrogen in the form of equine estrogens (Premarin) and medroxyprogesterone acetate (Provera).
There has been much controversy over the risk factors associated with these types of hormone replacement strategies. Recent studies do indicate an increased risk of breast cancers with combination HRT therapy, especially after prolonged use (4 to 5 years). Conventional HRT is also associated with increased risk of gallbladder disease, asthma, uterine fibroids, hypertension, blood clots and liver disease.

Naturopathic Medical Treatment and Prevention

Polycystic Ovary Syndrome (PCOS)

Diet and Lifestyle

Weight reduction and improvement of insulin resistance is critical to the treatment of PCOS, especially in overweight and obese women. The diet should focus on removing high glycemic foods and possibly all grains. Similar treatments as for insulin resistance will benefit PCOS.
Short-term dietary intervention studies have consistently shown that weight loss can normalize reproductive fitness and hyperandrogenism and improve metabolic variables in overweight women with polycystic ovary syndrome (PCOS). Consuming fat as 30% of daily caloric intake, reduced saturated and trans fats, increased fiber, and polyunsaturated fat intake have ben shown to be effective

Lifestyle Treatments for PCOS

• Exercise moderately for 30 min/day
• Establish an energy deficit of 500-1,000 kcal/day for weight loss
• Reduce psychosocial stresses
• Stop smoking
• Consume alcohol moderately
• Consume caffeine moderately
• Use castor oil packs 3 to 5 times a week over the abdomen

Nutritional Supplements

Nutrients that reduce prolactin secretion, such as vitamin B-6, magnesium, and GLA may benefit PCOS. Choline, inositol, and methionine (lipotrophics) assist the liver in hormone breakdown. Vitamin D-2 and calcium supplementation led to normalization of menstrual cycles within 2 months in 7of 13 patients with PCOS. In a study of 238 patients with PCOS and ovarian dysfunction, the use of inositol support a beneficial effect improving ovarian function in women with oligomenorrhea and polycystic ovaries.62

Botanical Medicines

Botanicals that inhibit prolactin, such as chaste berry (vitex agnus castus), and those with progesterogenic effects (also chaste berry) are useful in PCOS. Botanical medicines that inhibit the conversion of testosterone to DHT (the hormone that causes acne and male pattern baldness), such as saw palmetto (serenoa repens), can be used to control the virilization seen with PCOS. Saw palmetto also inhibits the binding of DHT at the cellular level.63
In vitro studies of nettle root (urtica urens) have shown it to be an up-regulator of sex hormone-binding globulin (SHBG), in part due to the lignans found in the root. Most circulating androgens are bound primarily to SHBG, and when bound, hormones, such as testosterone, are considered biologically inactive. It is believed that with PCOS, SHBG levels are decreased and androgens circulate more freely and are more active. Thus, nettle root is indicated to treat the virilization of PCOS. Flax seeds also stimulate SHBG production, in addition to stimulating ovulation, and are also indicated for PCOS. Liver cleansing and liver support herbs are indicated as well.

PMS

Diagnosis

A wise course of treatment for PMS focuses on the root causes of the condition. Therefore, proper patient evaluation is critical.64 The following diagnostic considerations and evaluation will aid in developing a naturopathic PMS protocol for each individual patient:

• PMS Questionnaire: PMS questionnaires are available to assess the category or categories of PMS symptoms present.
• Hormone Testing: FSH, LH, estradiol, progesterone, TSH.
• Basal Body Temperature Chart for at least one month: this helps to identify ovulatory cycle, follicular and luteal phase lengths, and possible menstrual cycle irregularities (such as biphasic cycles).
• Differential Diagnosis: Rule out hypothyroidism, pelvic inflammatory disease, endometriosis, dysmenorrhea, and ovarian pathologies such as PCOS

 

Diet and Lifestyle

A diet high in meat, saturated and trans fats, simple carbohydrates, and salt all seem to increase the intensity of PMS symptoms. It has been shown that vegetarian women have less circulating free estrogen than non-vegetarian women; a diet that focuses on wholesome food with low saturated fat may, therefore, significantly reduce or even eliminate PMS symptoms.
Xanthines (found in tea, colas, coffee, and chocolate) should also be restricted as they act as xenoestrogens. Phytoestrogens have been shown to have a generally beneficial effect on PMS symptoms. Alcohol, and any foods shown to cause an allergic reaction or intolerance should also be avoided, especially for the 2 weeks before the period. Regular aerobic exercise generally benefits PMS.

Clinical Nutrition

Vitamin B-6: A number of clinical studies have confirmed that vitamin B-6 helps PMS by acting as a cofactor that aids the metabolism of estrogen in the liver. Magnesium is also a cofactor in estrogen metabolism and relieves muscle (uterine) cramping. Indole – 3 – carbinole (I3C), found in brassicas, assists the liver in metabolizing estrogens.

Calcium: Calcium supplementation was studied in one clinical trial of 497 women and improvement was noted in mood, fluid retention, food cravings and cramping.

Evening Primrose Oil: Evening primrose (Oenothera biennis) oil is an excellent source of GLA, an essential fatty acid, which, as a precursor to prostaglandins, helps regulate hormone cycles. Research has shown that GLA benefits PMS related depression, mood swings, fluid retention and breast tenderness.

Vitamin E: Vitamin E supplementation has been shown to reduce the breast tenderness of PMS. The supplement 5-HTP raises serotonin levels. Low serotonin is associated with the depression and anxiety of PMS.

Botanical Medicines

Chaste berry (Vitex agnus castus): This herb has a balancing effect on progesterone and prolactin, both of which are implicated in PMS. Chaste berry has a long history in European herbal medicine as a treatment for PMS. In a one study of Vitex versus the antidepressant Prozac, it was found that Vitex was more beneficial for the physical complaints of PMS, whereas Prozac proved more beneficial for the psychological symptoms. Improvements from Vitex are usually noted within two menstrual cycles.

Milk Thistle (Silybum marianum): This herb aids liver cytochrome P450 detoxification of estrogens.

Cramp Bark (Viburnum opulus): Cramp bark alleviates menstrual cramping acutely.

Wild Yam (Dioscorea villosa): Wild yam benefits PMS by improving estrogens/progesterone ratio and as an antispasmodic.

Dong Quai (Angelica sinensis): Dong quai relaxes smooth muscle and reduces breast tenderness.

Dandelion (Taraxacum officinalis): Dandelion leaf reduces water retention.

Passionflower (Passiflora incarnata): Passionflower relaxes the CNS and improves restlessness, irritability, and insomnia.

Bio-identical Hormones

Bio-identical Progesterone: This is usually administered as a transcutaneous cream. It is a stronger therapy typically reserved for those women with severe or intractable PMS. Natural progesterone can also be given sublingually, vaginally, rectally as a suppository, orally, or intramuscularly. Progesterone is usually taken from the day after ovulation (day 15 approximately) until the period begins.
Synthetic progestins, such as medroxyprogesterone acetate (Provera), generally are not as effective as bio-identical progesterone in treating PMS, and their use may result in side effects such as fluid retention, breast tenderness and mood irregularities

Melatonin: Melatonin, a hormone secreted by the pineal gland, is another hormone that may benefit PMS if supplemented. Melatonin lowers estrogen and helps with insomnia. Therefore, taken at night before bedtime, melatonin will typically not only result in more restful sleep, but also help to normalize the circadian rhythm, including the normal rhythm of hormone secretions.

Endometriosis

An anti-estrogenic diet designed to minimize endogenous and exogenous estrogens is indicated.65 Avoidance of saturated and trans fats, adequate essential fats, and avoidance of chemical pesticides, herbicides, and plastics that mimic estrogen are important. Incorporation of organic fruits and vegetables, especially those that aid in the detoxification function of the liver (such as dandelion and bitter greens, beets, brassicas, apples, cherries) is recommended.
Avoidance of sexual intercourse during menstruation is warranted, as retrograde endometrial lining flow is considered a potential etiology. Applying a warm castor oil pack to the lower abdominal area may relieve pain and increase circulation during painful periods. Exercising regularly and using relaxation techniques to lower stress will help with hormone balancing.

Clinical Nutrition

Vitamin B-6 and magnesium act as cofactors that aids the metabolism of estrogen in the liver and are indicated. Indole – 3 – carbinole (I3C), found in brassicas, also assists the liver in metabolizing estrogens. D-glucarate is available as a supplement and also supports this process.
Since a healthy balance of flora in the large intestine prevents the recycling of excess estrogens, proper fibre intake such as supplemental ground flax seed, as well as a probiotic supplement, is also indicated. Intestinal fungal overgrowth, or the overgrowth of pathogenic bacteria, needs to be addressed if present.
Nutrients that support a healthy vascular system, such as vitamin C and bioflavonoids, may help by improving circulation.

Botanical Medicines

Botanicals that have progesterogenic effects (such as chaste berry) are useful in the treatment of endometriosis. Once again, botanicals that aid in the liver mediated detoxification of hormones are indicated. There are also reports that circulatory tonics, such as hawthorne berry (Crataegus oxycantha) are beneficial, possibly by reducing capillary fragility. A traditional herbal formula known as Turska’s Formula, has also shown benefit. Turska’s formula contains aconite, gelsemium, bryonia, and phytolacca. Because these herbs can be toxic in high doses, this formula should be used only as directed by an experienced healthcare provider.

Bio-identical Hormones

Bio-identical progesterone, usually administered as a transcutaneous cream, is a stronger therapy typically reserved for those women with more severe symptoms. Natural progesterone can also be given sublingually, vaginally, rectally as a suppository, orally, or intramuscularly. Low dose progesterone treatment for endometriosis can be given throughout the period, stopping only on the days of menstrual flow.

Menopause

Although pre-, peri-, and post-menopausal women can experience significant changes in their health with the ending of menstruation, many of the symptoms associated with this period of a woman’s life can be overcome or modulated with botanical, nutritional, and lifestyle interventions.66 For those women who have more severe symptoms or do not respond to the above treatment low dose transdermal bio-identical hormones may be considered. Menopause is not a disease, but a normal life transition, and the symptoms do for the most part diminish with time.
Effective assessment provides important information to practitioners regarding the determination of which dietary changes, nutritional supplements, or lifestyle changes may be beneficial, and whether the use of bio-identical hormone replacement is warranted and not contra-indicated. Individualized treatment can be then be implemented based on patient signs and symptoms, family history, and diagnostic tests.
The essence of naturopathic treatment of menopause is to find an appropriate combination that balances the hormones and thereby improves the symptom picture for the individual patient. In other words, treatment is very much individualized depending on the case presentation.

Menopause Treatment Factors

• Personal and family history of breast, uterine, ovarian cancers, osteoporosis, cardiovascular disease, liver disease, fibrocystic breast disease, and gallbladder disease
• Severity and impact of symptoms including vasomotor, emotional, insomnia, urinary, cognitive, musculoskeletal, and libido
• Severity of signs including atrophic vaginitis, cardiac dysrhythmias, irregular menstruation, polymenorrhea, metrorrhagia, and menorrhagia
• Evaluation of laboratory test/scans for LH, FSH, serum estrogen (E2), DHEA,
• dyslipidemia, osteoporosis, and calcium balance

 

Diet and Lifestyle

Phytoestogens: Increasing phytoestrogens in the diet can help alleviate some of the symptoms of menopause. Phytoestogens are a diverse group of chemical compounds that act as hormone regulators; they have a mild estrogenic activity yet also block endogenous estrogens. In this way they up-regulate deficiency states and down-regulate estrogen excess.
Soy is probably the best known nutritional source of phytoestrogens. Soy has been shown to reduce hot flashes, increase bone density, improve lipid profiles, and inhibit reproductive cancers.

Low-fat, Low-glycemic Diet: A diet low in saturated and trans fats, adequate in essential fats, avoiding high glycemic foods, and regular aerobic and weight bearing exercise can help prevent the negative effects of menopause on serum lipids and bone density.

Nutritional Supplements

Vitamin E (800-1200 iu/day) and Evening Primrose Oil (2000-3000 mg/day) may be helpful in treating the vasomotor symptoms. A bone building formula containing calcium, magnesium, zinc, boron, strontium, vitamin D, and vitamin K can help treat and prevent osteoporosis. A supplement of omega 3 fatty acids, nicotinic acid or inositol hexaniacinate can benefit serum lipid levels and therefore lower cardiovascular risk factors. In addition, since elevated homocysteine is associated with menopause, supplementing with vitamin B-6, B-12, folic acid, and betaine may be indicated to prevent cardiovascular disease.

Botanical Medicines

There are a number of botanical medicines that have shown to be beneficial in treating menopausal symptoms.

Black Cohosh (Cimicifuga racemosa): Traditionally, black cohosh was used by native Americans to assist in child birth, for dysmenorrhea, and for menopausal symptoms. Black cohosh improved hot flashes, heart palpitations, anxiety, insomnia, and depression associated with menopause in a number of studies. The mechanism of action appears to be similar to other phytoestrogens, as pharmacological studies have shown a weak estrogen binding activity in vitro. Black cohosh extracts have been shown to suppress LH levels and cause peripheral vasodilation in human. Black cohosh is also known to be anti-inflammatory, hypotensive, mildly sedating and spasmolytic.

Estrogenic and Progesterogenic Herbs: Many other botanicals have estrogenic or progesterogenic effects. For this reason combination products are commonly seen containing a mix of estrogenic and progesterogenic herbs. Estrogenic herbs include red Ccover (Trifolium pratense), dong quai (Angelica sinensis), licorice (Glycyrrhiza glabra), and Chamaelirium luteum. Progesterogenic botanicals include chaste berry (Vitex agnus castus), wild yam (Dioscorea villosa), and cramp bark (Viburnum opulus). Of these, chaste berry is the most studied and considered to be one of the most effective. It acts directly on the pituitary to stimulate LH and inhibit FSH, thereby decreasing the ratios of estrogens to progesterone. It also promotes progesterone synthesis at the corpus luteum by inhibiting prolactin synthesis at the pituitary.

Sympton Specific Herbs: Other botanicals may be prescribed in menopause depending on symptoms. For instance, Chimaphila umbellata can be used to treat cystitis. St John’s wort (Hypericum perforatum) can be prescribed if depression, insomnia, or sciatica are present. Anxiolytic herbs, such as kava kava (Piper methysicum) can be employed if insomnia or anxiety is present.

Bio-identical Hormones

Bio-indentical Progesterone: Replacing progesterone alone, by application of bio-indentical progesterone cream, can be used as a first line treatment of vasomotor symptoms. Although progesterone by itself is not as effective as estrogen , it can be useful when estrogens are contraindicated. Bio-indentical progesterone cream can also be combined with oral phytoestrogens.

Bio-identical Estrogen: If symptoms persist, or if risk modification is paramount, bio-identical estrogen cream treatment can be implemented. This is typically done using a “biest” (estradiol and estriol) or a “triest” (estrone, estradiol, estriol) product, always combined with progesterone treatment. Typical “triest” formulas from compounding pharmacies contain 80% estriol, 10% estrone, and 10% estradiol, thus promoting a healthy estrogen quotient. Dosages should be titrated by starting low and increasing until a sufficient amount is absorbed to relieve symptoms without cyclic bleeding. The estrogen and progesterone doses should also be cycled to mimic the premenopausal hormone cycle.

Testosterone: If testosterone is replaced, it should be cycled so as to be given on the same days as estrogen.

DHEA: DHEA, which has also been shown to benefit menopausal symptoms, would be given daily to mimic adrenal production, if supplementation is necessary.

Three Basic Rules of Bio-identical Hormone Replacement Therapy (BHRT)

(Reprinted by permission of Dr John Lee, www.johnleemd.com)

The Lancet publication of the Million Women Study (MWS) removes any lingering doubt that there’s something wrong with conventional HRT … Why would supplemental estrogen and a progestin (e.g., not real progesterone) increase a woman’s risk of breast cancer by 30% or more? Other studies found that these same synthetic HRT hormones increase one’s risk of heart disease and blood clots (strokes), and do nothing to prevent Alzheimer’s disease. When you pass through puberty and your sex hormones surge, they don’t make you sick — they cause your body to mature into adulthood and be healthy. But, the hormones used in conventional HRT are somehow not right — they are killing women by the tens of thousands.
The question is — where do we go from here? My answer is — we go back to the basics and find out where our mistake is. I have some ideas on that.
Over the years I have adopted a simple set of three rules covering hormone supplementation. When these rules are followed, women have a decreased risk of breast cancer, heart attacks, or strokes. They are much less likely to get fat, or have poor sleep, or short-term memory loss, fibrocystic breasts, mood disorders, or libido problems. And the rules are not complicated.

Rule 1. Give hormones only to those who are truly deficient in them.

The first rule is common sense. We don’t give insulin to someone unless we have good evidence that they need it. The same is true of thyroid, cortisol, and all our hormones. Yet conventional physicians routinely prescribe estrogen or other sex hormones without ever testing for hormone deficiency.
Conventional medicine assumes that women after menopause are estrogen-deficient. This assumption is false. Twenty-five years ago I reviewed the literature on hormone levels before and after menopause, and all authorities agreed that over two-thirds (66%) of women up to age 80 continue to make all the estrogen they need. Since then, the evidence has become stronger. Even with ovaries removed, women make estrogen, primarily by an aromatase enzyme in body fat and breasts that converts an adrenal hormone, androstenedione, into estrone. Women with plenty of body fat may make more estrogen after menopause than skinny women make before menopause.
Breast cancer specialists are so concerned about all the estrogen women make after menopause that they now use drugs to block the aromatase enzyme. Consider the irony: some conventional physicians are prescribing estrogens to treat a presumed hormone deficiency in postmenopausal women, while others are prescribing drugs that block estrogen production in postmenopausal women.
How does one determine if estrogen deficiency exists? Any woman still having monthly periods has plenty of estrogen. Vaginal dryness and vaginal mucosal atrophy, on the other hand, are clear signs of estrogen deficiency. Lacking these signs, the best test is the saliva hormone assay. With new and better technology, saliva hormone testing has become accurate and reliable. As might be expected, we have learned that hormone levels differ between individuals; what is normal for one person is not necessarily normal for another. Further, one must be aware that hormones work within a complex network of other hormones and metabolic mediators, something like different musicians in an orchestra. To interpret a hormone’s level, one must consider not only its absolute level but also its relative ratios with other hormones that include not only estradiol, progesterone, and testosterone, but cortisol and thyroid as well.
For example, in healthy women without breast cancer, we find that the saliva progesterone level routinely is 200 to 300 times greater than the saliva estradiol level. In women with breast cancer, the saliva progesterone/estradiol ratio is considerably less than 200 to 1. As more investigators become more familiar with saliva hormone tests, I believe these various ratios will become more and more useful in monitoring hormone supplements.
Serum or plasma blood tests for steroid hormones should be abandoned — the results so obtained are essentially irrelevant. Steroid hormones are extremely lipophilic (fat-loving) and are not soluble in serum. Steroid hormones carry their message to cells by leaving the blood flow at capillaries to enter cells where they bond with specific hormone receptors in order to convey their message to the cells. These are called “free” hormones. When eventually they circulate through the liver, they become protein-bound (enveloped by specific globulins or albumin), a process that not only seriously impedes their bioavailability but also makes them water soluble, thus facilitating their excretion in urine. Measuring the concentration of these non-bioavailable forms in urine or serum is irrelevant since it provides no clue as to the concentration of the more clinically significant “free“ (bioavailable) hormone in the blood stream.
When circulating through saliva glands, the “free” non–protein-bound steroid hormone diffuses easily from blood capillaries into the saliva gland and then into saliva. Protein-bound, non-bioavailable hormones do not pass into or through the saliva gland. Thus, saliva testing is far superior to serum or urine testing in measuring bioavailable hormone levels.
Serum testing is fine for glucose and proteins but not for measuring “free” steroid hormones. Fifty years of “blood” tests have led to the great confusion that now befuddles conventional medicine in regard to steroid hormone supplementation.

Rule 2. Use bio-identical hormones rather than synthetic hormones.

The second rule is also just common sense. The message of steroid hormones to target tissue cells requires bonding of the hormone with specific unique receptors in the cells. The bonding of a hormone to its receptor is determined by its molecular configuration, like a key is for a lock. Synthetic hormone molecules and molecules from different species (e.g., Premarin, which is from horses) differ in molecular configuration from endogenous (made in the body) hormones.
From studies of petrochemical xenohormones, we learn that substitute synthetic hormones differ in their activity at the receptor level. In some cases, they will activate the receptor in a manner similar to the natural hormone, but in other cases the synthetic hormone will have no effect or will block the receptor completely. Thus, hormones that are not bioidentical do not provide the same total physiologic activity as the hormones they are intended to replace, and all will provoke undesirable side effects not found with the human hormone. Human insulin, for example, is preferable to pig insulin. Sex hormones identical to human (bio-identical) hormones have been available for over 50 years.
Pharmaceutical companies, however, prefer synthetic hormones. Synthetic hormones (not found in nature) can be patented, whereas real (natural, bio-identical) hormones cannot. Patented drugs are more profitable than non-patented drugs. Sex hormone prescription sales have made billions of dollars for pharmaceutical companies. Thus is women’s health sacrificed for commercial profit.

Rule 3. Use only in dosages that provide normal physiologic tissue levels.

The third rule is a bit more complicated. Everyone would agree, I think, that dosages of hormone supplements should restore normal physiologic levels. The question is — how do you define normal physiologic levels? Hormones do not work by just floating around in circulating blood; they work by slipping out of blood capillaries to enter cells that have the proper receptors in them.
As explained above, protein-bound hormones are unable to leave blood vessels and bond with intracellular receptors. They are non-bioavailable. But they are water-soluble, and thus found in serum, whereas the “free” bioavailable hormone is lipophilic and not water soluble, thus not likely to be found in serum. Serum tests do not help you measure the “free,” bioavailable form of the hormone. The answer is saliva testing.
It is quite simple to measure the change in saliva hormone levels when hormone supplementation is given. If more physicians did that, they would find that their usual estrogen dosages create estrogen levels 8 to 10 times greater than found in normal healthy people, and that progesterone levels are not raised by giving supplements of synthetic progestin, such as medroxyprogesterone acetate (MPA).
Further, saliva levels (and not serum levels) of progesterone will clearly demonstrate excellent absorption of progesterone from transdermal creams. Transdermal progesterone enters the bloodstream fully bioavailable (i.e., without being protein-bound). The progesterone increase is readily apparent in saliva testing, whereas serum will show little or no change. In fact, any rise of serum progesterone after transdermal progesterone dosing is most often a sign of excessive progesterone dosage. Saliva testing helps determine optimal dosages of supplemented steroid hormones, something that serum testing cannot do.
It is important to note that conventional HRT violates all three of these rules for rational use of supplemental steroid hormones.
A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes, or heart attacks. Hormone replacement therapy is a laudable goal, but it must be done correctly. HRT based on correcting hormone deficiency and restoring proper physiologic balanced tissue levels, is proposed as a more sane, successful and safe technique.

Other Factors

Hormone imbalance is not the only cause of breast cancer, strokes, and heart attacks. Other risk factors of importance include the following:

• Poor diet. (Excess sugar and refined starches, trans fatty acids, lack of needed nutrients such as omega-3 fats, full range of essential amino acids, vitamins, minerals, etc.)
• Environmental xenoestrogens and hormones not removed by water treatment. (Be sure that your home water filter will remove hormones.).
• Insulin resistance.
• Stress.
• Lifestyle problems, such as excess light at night (poor sleep, melatonin deficiency), alcohol, cadmium (cigarette smoking), and birth control pills during early teens.

Men share these risks equally with women. Hormone imbalance and exposure to these risk factors in men leads to earlier heart attacks, lower sperm counts, and higher prostate cancer risk.

Conclusion

Conventional hormone replacement therapy (HRT) composed of either estrone or estradiol, with or without progestins (excluding progesterone), carries an unacceptable risk of breast cancer, heart attacks, and strokes. I propose a more rational HRT using bio-identical hormones in dosages based on true needs as determined by saliva testing. In addition to proper hormone balancing, other important risk factors are described, all of which are potentially correctable. Combining hormone balancing with correction of other environmental and lifestyle factors is our best hope for reducing the present risks of breast cancer, strokes, and heart attacks.