Women's hormones part 3 Flashcards
functional medicine approach for cognitive decline
Hormone replacement therapy improves mood and depression.
Cognitive functioncan be improved by hormone replacement only in case of an early start (critical window hypothesis, healthy cell bias hypothesis).
On the contrary, at the age over 65, it increases the risk of dementia. The same dependence applies to Alzheimer’s disease.
Guidelines say NO
Biological plausibility and literature support the use of both E2 and bio identical P early in menopause.
Remember this even in patients without a uterus that have cognitive decline as their priority.
functional medicine approach for bone loss
Estrogen is not the only hormone involved in bone health:
Progesterone
Testosterone
Cortisol
Medications have side effects but are probably better than hormones in the TREATMENT of severe osteoporosis.
Hormones are probably better than medications for the
PREVENTION of osteoporosis and TREATMENT of osteopenia
women who may benefit from hormone replacement
Those in whom there is a high risk of CVD but low risk of breast cancer
How Estrogen Benefits Bones
1)
Lowers the sensitivity of bone mass to PTH
(parathyroid hormone), thus reducing bone
resorption
2)
Increases the production of calcitonin, thus
inhibiting bone resorption
3)
Accelerates calcium resorption by the intestine
4)
Reduces the calcium excretion from the kidney
5)
Direct binding to estrogen receptors
red light
• Abnormal genital bleeding • Known, suspected, or history of cancer of the breast • Known or suspected estrogen dependent neoplasia • Active DVT, pulmonary embolism, or history of these conditions • Active arterial thromboembolic disease • Known anaphylactic reaction or angioedema in response to any ingredient in the medication • Known liver impairment or disease • Known protein C, protein S, or antithrombin deficiency • other known thrombophilia • Known or suspected pregnancy
modern cow milk
high e in preg in fat
dense breasts tx
• Check E2 levels and normalize them as previously stated. • Improve E2 and other detoxification pathways • Borage Oil and EPO • Iodine (as per Dan’s Talk)
leptin in breast Cancer
inc risk
•
SNPs that can increase BC Risk:
CYP 450 1A1, 1B1, 3A 4/5
COMT
MTHFR
yellow light
Women with increased risk of breast cancer: • FM and Lifestyle (Wendy’s Talk) • BMI, Dysglycemia, Abn E Metabolism or Methylation • Elevated baseline estradiol • Dense breasts on mammography • Elevated leptin • Genetics: • Strong family history of breast cancer • Genetics of estrogen metabolism and detoxification • Genetics of breast cancer risk • WE ALL HAVE TO ASSESS RISK!
Labs to check before initiating HRT
• Serum E2 • DHEAS • Insulin • Glucose • Cardio CRP • Leptin • Estrogen Metabolites and Methylation
ER Receptor Facts
Estradiol (E2) equally activates ER α and ER ß.
Estrone (E1) preferentially activates ER α at a ratio of 5:1.
Estriol (E3) selectively binds ER ß at a ratio of 3:1.
Synthetic progestins synergistically downregulate ER ß
receptors.
P and breast CA
•
Progesterone inhibits estrogen stimulated breast
epithelial cells 1,2,3
•
P also downregulates estrogen receptor 1 (ER 1) in
the breast. 4,5,6
•
P induces breast cancer cell apoptosis. 7,8
progestins
Synthetic progestins may increase the conversion of
weaker endogenous estrogens into more potent
estrogens, potentially contributing to their carcinogenic
effects, which are not apparent with progesterone
Synthetic progestins promote the formation of the
genotoxic estrogen metabolite 16 hydroxyestrone
Progestins added to estrogen therapy seem to
increase inflammatory markers
Can you give T. and E together?
no
