Is Estrogen Really Necessary for Perimenopause?
As a woman enters perimenopause and begins to experience initial symptoms, the common assumption by healthcare professionals is the need for supplemental estrogen.
In reality, a woman’s estrogen levels do not begin to decline until the final 6-12 months of perimenopause. Hot flashes that occur at the early outset are often a result of rising estradiol levels and a lack of progesterone, not a lack of estrogen. High levels of cortisol, low thyroid function, and resistance to insulin can also present symptoms common to perimenopause, including weight gain, irritability, hot flashes, irregular cycle, and more.
At certain stages, even the most precise measurements of estrogen levels may not dictate need for supplemental hormone therapy. Therefore, approaching these symptoms with a proactive, preventative treatment should be a higher priority than estrogen treatment. Correcting issues with progesterone, cortisol, thyroid, and insulin resistance as well as shortcomings in nutrition and lifestyle are recommended before taking a hard look at estrogen levels and addressing them accordingly.
Even when the need for estrogen replacement therapy is verified, patients are routinely given too much, which can cause similar problems as having too little estrogen. This provides respite from symptoms such as hot flashes for a month or two, but with time, symptoms return. Excessive estrogen also increases the number of estrogen receptors, causing the body to downregulate the number of receptors, nullifying the efficacy of the treatment regardless of the amount present.
There are several best practices when it comes to considering estrogen replacement therapy:
– Correlate symptoms with measurement of estrogen levels
– Don’t assume estrogen replacement therapy is the answer to symptoms
– Restore progesterone prior to considering estrogen treatment
– Test cortisol four times daily to help determine adrenal influence on estrogen levels
– Check insulin resistance prior to prescribing any estrogen treatments
– Gradually and slightly increase estrogen dosages over time
– If hypothyroid symptoms are present, test the TT4, TT3, fT4, fT3, TPO antibodies, and TSH
– Help ensure safe estrogen metabolism by optimizing living conjugation, bowel elimination, reducing lipid peroxidase activity, and methylation and glutathione conjugation
If you or a loved one are beginning to experience symptoms of perimenopause and are considering estrogen replacement therapy to ease those symptoms, it’s important to consider all of your options. Dr. Samuel Madeira at Apollo Health Clinic can help guide your treatment strategies and provide expert medical insight as your body begins to transition to menopause. Contact us today to schedule an appointment and to learn more about our services.
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