Estrogen Treatment for Women
Estrogens are a group of steroid compounds produced mainly by follicles in the ovaries during a woman’s reproductive years. Estrogen is responsible for the “feminine” features of women and has action in 300 tissues of the body. Some of these include:
- feminine body shape
- vaginal lubrication
- memory and mental calculation
- skin tone
- maintenance of healthy bones
- muscle tone of the bladder and vaginal walls
Estrogen production in women is usually well maintained until menopause, it is at this time that the symptoms of estrogen deficiency typically develop.
Signs/Symptoms of Estrogen Deficiency
- Menstrual irregularities
- Pain with intercourse
- Muscle/joint aching
- Pale skin/loss in tone
- Low libido
- Shrinking or sagging breasts
- Poor memory
- Frequent bladder infections
- Hot flashes
- Vaginal dryness
There are three main naturally occurring estrogens in the body that are worth mentioning in greater detail.
At True Balance for Estrogen Replacement Therapy we use, BIEST, a combination cream with two forms of estrogen. It includes a small proportion of Estradiol (E2) the strongest form of estrogen, produced mainly in women of reproductive age. It is used to provide relief from menopausal symptoms. Also included in BIEST is Estriol(E3) which is naturally produced during pregnancy. Although, Estriol is the weakest of the three, research shows higher levels of estriol are associated with decreased risk of breast cancer.
While there are many pharmaceutical estrogen products with estradiol, there are none with estriol. It is the relief from menopausal symptoms combined with the breast protective properties of BIEST that encouraged us to use this specific combination. BIEST is not available at conventional pharmacies and must be formulated with a compounding pharmacy at a dosage that is right for you!
Estrone (E1) is produced mainly after menopause. It is the most harmful estrogen and elevations of it are linked to increased risk of breast and uterine cancer. It comes from the liver, adrenal glands, fat tissue and breasts. It has the potential to convert to Estradiol giving relief from menopausal symptoms. Although, if suffering from either adrenal fatigue and/or liver stress, symptoms can worsen as your body is not producing adequate levels. This estrogen is not used in True Balance preparations.
Directions for Use
BIEST Cream comes in simple to use dispensers for easy application of your daily hormone dose. Many women will be prescribed a cream with BIEST and Testosterone combined for convenience.
- Apply according to specific instructions (typically per vulva application for more reliable blood levels)
- Apply to area where there is little or no hair growth
- Apply cream in the morning AFTER showering
- Apply cream after using the toilet to allow maximal absorption
- Wait approx. 1 hr after application before using the toilet again
- Keep the cream in a visible location to ensure consistent daily applications (ex. bathroom)
- Take Progesterone while on Estrogen therapy to provide protection against uterine cancer
- Apply to stomach as it can be converted into other hormones and may increase abdominal obesity
- Apply to regions with too much body hair as it does NOT absorb well
- Store in direct sunlight
General Reminder of when to take Estrogen Cream:
Because estrogen is impacted by so many different things, our need for estrogen can change as anything else. In fact, if a woman is unfortunate and gains significant weight, even without supplementation her estrogen production will rise above normal levels. This is why it is important to be aware of the signs and symptoms of too much estrogen
Signs/Symptoms of Estrogen Dominance
- Fluid retention in the hands and feet
- Irritability with outbursts of anger
- Breast tenderness
- Heavy, painful periods
- Weight gain/abdominal bloating (especially just before periods)
- Migraines before periods
If these symptoms occur while using BIEST, move application site to transdermal site (ex. inner forearm), until symptoms subside. This effectively reduces the amount of estrogen absorbed, as the skin does not allow estrogen uptake to the degree that the vulva does. If already applying cream transdermal stop taking cream until symptoms subside and resume taking cream every other day.
- Women taking Estrogen and who have a uterus should also be on some form of Progesterone therapy as unopposed estrogen has limited safety.
- We advise against oral estrogen as it can increase the risk of blood clotting and stroke.
- Post-menopausal Women – Apply the daily dose of cream continuously or skip one application per week. It is not necessary in menopause to take estrogen to mimic the natural cycle as many women do better with daily use. And after all, isn’t one of the main benefits of menopause throwing away the pads and tampons!?Talk to your practitioner to decide which method is best for you.
- Peri-menopausal Women – This life-stage is characterized by missing the occasional period and fluctuating Estrogen levels. This can mean that the symptoms of menopause also fluctuate over the course of just one month. Refer to the following table to know what symptoms to look for, when to start and stop BIEST cream if prescribed Estrogen on an as needed basis. Quite often at this stage of life, we will separate the BIEST and Testosterone prescriptions to allow titration of estrogen without altering testosterone levels.
START taking BIEST SUSPEND taking BIEST
- hot flashes
- night sweats
- vaginal dryness
- tender breasts
- PMS (can vary)
- Cycling Women – In general, BIEST cream is NOT used for women who still have a regular menstrual cycle.
If your physician has recommended that you do, apply the cream once daily in the morning on days 1 to 25, and taking a break on days 26 to 31. Skipping the BIEST while menstruating prevents the body from down regulating the estrogen receptors that allow the BIEST to work.