HOPKINS HEALTH WATCH Q&A

Bioidentical Hormones in Normal Doses Can Bring Relief

Q: Thanks for keeping me in the loop with the Health Watch, which I always find most interesting. Can you please advise me about vaginal skin atrophy?

It doesn't matter whether I use natural progesterone or estradiol cream, both of which help in the short term with this problem. However, I find that my breasts and stomach swell up for several days after using either of these creams, and by the time they have gone back to normal it’s time to use the cream again.
Any solution or advice would be appreciated (maybe you know of something more effective that doesn't create the swelling), as I am wondering if the creams just do not suit my body. It also concerns me that from just inserting a little in the vagina, it creates this swelling effect elsewhere in my body so quickly. 

A:  Some women are very sensitive to hormones, so the first question would be, what dose are you using?

Many doctors mistakenly believe that if a hormone is applied in the vagina, it only affects that area, but in truth it can travel through the blood to the rest of the body, especially if you’re using high doses. Vaginal creams will also come into contact with the labia, which will certainly transport hormones quickly into the blood and from there to other tissues.

The breast swelling may be caused because the progesterone is helping switch on your estrogen receptors, thus increasing your estrogen levels. In this case you would probably have breast swelling and tenderness. Or, it may be caused by extremely excessive progesterone doses, which can—in some women—cause breast swelling and stomach swelling.

Progesterone Cream as a Lubricant
Some natural progesterone creams can be nice vaginal lubricants, but it only takes a pea-sized dab to be effective. This would amount to 10 to 20 mg of progesterone in a cream that contains 450 to 500 mg per ounce of cream. If you need to use more cream for effective lubrication, get one that contains less progesterone, or mix it with another moisturizing cream to dilute it. Just be sure to use “clean” creams that are as free as possible of chemicals.

Here’s a neat piece of inside info: I have heard from a number of reliable sources over the years that when a woman uses natural progesterone cream as a vaginal lubricant during intercourse, it can increase the intensity of her (male) partner’s orgasm.

Estriol and Vaginal Dryness
The three human estrogens are estradiol, estrone and estriol. You could also call these natural or bioidentical estrogens. One of the most common symptoms of estrogen deficiency is vaginal dryness or atrophy, which can make intercourse painful.

Estriol is used in vaginal cream, especially in Europe where it’s available under the brand name Ovestin. In the U.S. you can only get it from a compounding pharmacy. Research has shown that estriol doesn’t stimulate cell proliferation as much as the other estrogens, and thus should have a reduced risk for causing hormone-related cancers such as uterine and breast cancer. Estriol has been shown in numerous studies to be very effective in treating vaginal dryness when applied vaginally. Dr. Lee recommended just 0.5 mg of estriol twice weekly, and noted that many women find just half that amount usually works fine.

Tired Adrenals can Cause Hormone Imbalance
Supplemental hormones can also cause breast swelling when the adrenals are tired and your body’s regulation of adrenal hormones is disrupted. This in turn disrupts how your body processes the steroid hormones, which are estrogen, progesterone and testosterone. If stress is a big issue in your life, this might be the underlying cause of your hormone imbalance.

You might want to consider a blood spot or saliva hormone level test that includes estradiol, progesterone, testosterone and cortisol. This will give you more information about whether your symptoms are caused by a hormone imbalance. If you suspect that chronic stress might be involved, it may be worth testing both morning and evening cortisol levels.

Resources

Dr. John Lee’s Hormone Balance Made Simple
A basic guide to natural hormones and how to assess symptoms.

What Your Doctor May Not Tell You about Stress – article
by John R. Lee, M.D. and Virginia Hopkins

Hormone Test – Profiles for Women
Hormone Profile II or III is recommended for assessing hormones plus adrenal function.

Test for Adrenal Function
These tests assess adrenal function only.