The Delivery System Makes All the Difference When it Comes to Hormones
One of the issues up on the radar screen in natural hormone replacement therapy is whether taking estrogen in the oral (pill form) or transdermal (skin cream or patches) works best. (It's already very clear that progesterone cream works better than progesterone pills.) A few studies
have been published showing that oral estrogen increases levels of C-reactive protein
(CRP), a marker of inflammation that is associated with heart disease.
The Voices of Experience
Jane Murray M.D., who specializes in natural hormone replacement therapy in
her
medical
practice in Kansas City, decided to test this for herself after she noticed that
her
patients who used estradiol patches seemed to be doing better than those taking
pills. She
first tested an elderly patient who had been on a small dose of Premarin for
many years.
When her blood tests showed high CRP levels, Dr. Murray suggested she switch
to a patch.
After three months on the patch, the patient was tested again, and her CRP levels
were
normal. According to Dr. Murray, “That was my index case that woke me up to the fact that
this is a real and clinically relevant phenomenon. Since then I’ve had other patients with
the same result, so I now routinely recommend patches or cream over pills. I have noticed
that my overweight patients who are insulin resistant are more sensitive to the
CRP-elevating effects of oral estrogen. This may be why we’ve gotten such conflicting
reports over the years about estrogen’s effects on heart disease.”
Oral Estrogens Associated with Low Sex Drive
Dr. Murray continues, “I also found that patients on oral hormones tended to
have more
problems with low libido or sex drive. When I researched this I found that oral
hormones
stimulate the liver to make proteins, including SBHG [serum binding hormone globulin],
which binds to hormones and makes them inactive. When I tested hormone levels
in my
patients I found that when they were put on oral hormones their SBHG went way
up and their
free testosterone went way down, which accounts for the low libido. I found this
to be true
with oral hormone replacement hormones and with birth control pills. When I switched
these
women to the birth control patches their libido came back.”
Dr. Randolph Weighs In on Oral Estrogens
C.W. (Randy) Randolph, M.D. of Jacksonville Beach, Florida has had similar
results in
his busy natural hormone therapy practice, and adds that compared to transdermal
estrogens,
oral estrogens increase the risk of thromboembolic events [strokes and blood
clots]. He
points out that the liver proteins created by oral estrogens also raise blood
pressure,
raise triglyceride levels, and suppress thyroid function. Because he is a pharmacist
as
well as a physician, Dr. Randolph makes his own transdermal hormone gels. He
usually
recommends that women begin with a combination of 0.75 mg of estradiol and 1.5
mg of
estriol daily, and then adjust according to salivary hormone level tests and
symptoms.
References
Ylikorkala O, Evio S, Effects of hormone therapy and alendronate on C-reactive protein,
E-selectin, and sex hormone-binding globulin in osteoporotic women, Fertil Steril.
2003
Sep;80(3):541-5.
Kawano H, Yasue H, Effects of transdermal and oral estrogen supplementation on endothelial
function, inflammation and cellular redox state, Int J Clin Pharmacol Ther. 2003
Aug;41(8):346-53.
Frohlich M, Muhlberger N, Markers of inflammation in women on different hormone
replacement therapies, Ann Med. 2003;35(5):353-61.