... for your health, your children's health and the health of the environment.
Overview
Pre-menopausal women produce three main oestrogen hormones ... Oestrone (E1) 5 to 10%, Oestradiol (E2) 5 to 10% and Oestriol (E3) 80 to 90%. Triest, is a mixture of E1, E2 & E3 made in the above proportions by Compounding Pharmacies. Until recently it had been generally accepted that oestrogen levels dropped to almost zero at menopause.
Not so ...
In most women, Oestrogen levels drop to 40 to 60% only, while Progesterone levels can drop to nearly zero.Consequently, when BHRT is begun, it is essential that Progesterone is replaced first. Only after oestrogen eficiency is clearly established (hot flushes, vaginal dryness, night sweats, Pathology Lab. tests) should oestrogen replacement be considered.
The Important Next Step in BHRT
Having decided that oestrogen replacement should occur, which of the three oestrogens and how much should be taken. There is a large body of evidence from many studies which suggest that the safest oestrogen to use is Oestriol (E3) as it has a protective effect against breast and uterine cancers, prevents vaginal atrophy and urinary tract infections, prevents bone loss, doesn't cause blood clots and protects the skin from ageing . E1 & E2, while they are absorbed more quickly, are now considered to over stimulate oestrogen receptors in the breast tissue and over a period of time may contribute to breast cancer if used in doses which are excessive. Many doctors, however, prefer to use Triest, which replicates pre-menopausal oestrogen concentrations, allows the quicker, low dose uptake of E1 & E2 to relieve menopausal symptoms while still giving some protection from E3.
Breast Cancer Survivors
For more than 30 years, Professor Henry Lemon, now retired, but best known for his extensive clinical and basic research on the protective actions of Oestriol, has advocated its use in hormone replacement. As far back as 1966 in the prestigious Journal of The American Medical Association, he stated that "Oestriol offers a non toxic, physiologic antagonist for ovarian oestrogens, inducing little or no endometrial proliferation in post-menopausal women, which together with Progesterone, might simulate the protective effect of pregnancy upon on subsequent cancer risk."
Breast Cancer survivors who wish to use HRT should always be aware of the potential for over stimulation of breast cells by E1, E2 and other synthetic oestrogens and therefore ask their doctor to prescribe a preparation containing Oestriol or Triest.
Dosage Forms
Oestriol and Triest swallowed orally are quickly broken down by the gut and liver and therefore require a higher dose to be effective. If administered sub-lingually (allowed to dissolve slowly under the tongue or between the gum and cheek) in troche form, or as a cream applied to a thin skin area (e.g. sternum), delivery can be up to 20 times more efficient. Initial doses in both troche and cream form are often 1 to 2 milligrams per gram per day.
Please Note:
To avoid Oestrogen Dominance, a phrase coined by well-known BHRT proponent, Dr. John Lee, it is unwise to use oestrogen replacement without including Progesterone supplementation as well.
A typical, initial BHRT prescription in troche form, would be Progesterone 100 to 200mg per gram per day with Oestriol or Triest as above. In cream form, because of more efficient transdermal absorption of Progesterone it is normally reduced to 20 to 40mg per gram per day.
A Word about the W.H.I. Study
The comprehensive Women's Health Initiative study in the U.S.A., reported in July 2000, indicates an increased risk of breast cancer for women undergoing long term Hormone Replacement Therapy using a synthetic Progestin (Provera®) and synthetic Oestrogen (Premarin®). Neither of these drugs is Bio-identical.
Disclaimer
The decision to embark upon BHRT is one which must be made in conjunction with your medical adviser. The author of this paper accepts that risks may exist in any form of HRT.
References and Suggested Further Reading
What Your Doctor May Not Tell You About Breast Cancer (Drs. John Lee and David Zava)*
What Your Doctor May Not Tell You About Menopause (Dr. John Lee)*
Life Extension Foundation Web-site ... www.lef.org
*Contains comprehensive scientific references
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