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HEALTH CONCERN? BioHealth Health Concerns

Estrogen and Progesterone: Two Key Female Hormones

Contributing Author: Kalish, Daniel D.C.

Daniel KalishFor two decades Daniel Kalish, D.C. has successfully treated patients with hormone imbalances, food cravings, fatigue, depression, digestive distress, and many other health complaints. Dr. Kalish founded The Natural Path Clinic California, where he led a staff of physicians, nutritionists, chiropractors, psychotherapists, physical therapists, personal trainers, massage therapists and acupuncturists for more than ten years. He currently maintains an active international phone consultation practice with patients and trains physicians in natural medicine. He has designed health programs for countless professional athletes including the world’s top skateboarders, hockey players, elite runners, tri-athletes, golfers, tennis players and world-class weight lifters. Download his ebook Your Guide to Healthy Hormones.

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Few people had much awareness of estrogen and progesterone until recent studies revealed the dangers of female hormone replacement therapy. Millions of women had been taking synthetic hormones for years, yet the role these hormones play is still largely misunderstood. The goal of this article is to clear up some of the confusion.

The Role of Estrogen
While the dangers of hormone replacement therapy may have given estrogen a bad name, this vital hormone contributes greatly to a woman’s health when maintained in a natural balance. Estrogen is responsible for female sexual development at puberty. As a foundation to fertility, estrogen promotes accumulation of fat in the hips, thighs, and breasts. It causes the lining of the uterus to grow and thicken every month in preparation for a fertilized egg. At the end of the menstrual cycle, this lining is shed as estrogen levels drop. Another essential role this hormone plays is to promote the movement of salt and minerals into cells.

For decades, drug companies and doctors pointed to estrogen deficiency as the main problem behind the common symptoms of menopause. For those of us who practice natural medicine, however, these same symptoms signal an imbalance in both the ovarian hormones and those that generate the stress response. We believe that the solution lies in re-establishing the natural balance of multiple hormones, rather than simply increasing the amount of estrogen in a woman’s system.

Estrogen, Diet, and Exercise
Dr. Peter Ellison of Harvard University, who pioneered the use of salivary testing that I incorporate in my practice, found that women in industrialized nations have abnormally high levels of estrogen, which he links to our high levels of breast and uterine cancer. As documented in Dr. John Lee’s book, Natural Progesterone, the results of Dr. Ellison’s studies demonstrate a relationship between hormone levels, diet, and exercise worldwide. Inactive women who consume more calories than they burn have elevated levels of estrogen, which may help explain high estrogen levels among American women, a majority of whom are overweight and obese. The natural drop in estrogen levels with the approach of menopause will be steeper in these women, leading to a corresponding rise in cortisol production. This intensifies any symptoms related to stress, and gives rise to a host of problems related to cortisol, including insomnia, hot flashes, night sweats, and mood swings. This may help explain why women in technologically advanced Western countries with higher estrogen levels report more pronounced menopausal symptoms than women in less-developed nations.

A 1998 study of 625 female runners in the United States supports Dr. Ellison’s theory. The runners had higher levels of physical activity and far less obesity than average women, and reported being able to reduce the discomforts of menopause with increased exercise. Indeed, for some women, changes in diet and exercise alone can eliminate many menopausal symptoms.

Estrogen and Environmental Factors
High estrogen levels are also promoted by environmental factors. Exposure to xenoestrogens (chemical compounds widely found in our environment) exert a powerful estrogen-like effect on the female body. These toxic compounds are most commonly encountered as by-products of the petrochemical industry, and we are exposed to them during the course of many daily activities, such as when plastic or Styrofoam containers are heated in a microwave, or when we eat food wrapped in plastic or drink water from plastic bottles. The hormones added to our food supply are another source of increased estrogen levels. Many of the conveniences of modern life are contributing to hormonal imbalances in American women.

How Estrogen Affects the Body
While estrogen is needed for healthy functioning, too much of it has a negative impact on a woman’s cardiovascular system. It promotes blood clots in the lungs, increases the risk of heart attack, contributes to blood vessel spasms, elevates blood pressure, and lowers the blood’s oxygen-carrying capacity. It is therefore not surprising that estrogen replacement therapy, in which women are given high levels of synthetic estrogen, has been linked to an increased risk of cardiovascular disease.

Another role of estrogen is to stimulate cell growth. Therefore, when taken in excess, estrogen causes excessive cell growth and increases the risk of certain types of cancer.

Excess estrogen is also associated with other health problems that, while less dangerous, are uncomfortable and potentially debilitating, such as the water retention that many women experience as bloating and weight gain, and an increase in gall bladder problems. It also causes a loss of zinc, a mineral vital to the repair of soft tissue. Low zinc levels make it more difficult to recover from injury and affect immune function, making people more susceptible to colds and flu.

The Role of Progesterone
Chronic stress reduces progesterone levels, and affects the levels of two other important hormones, cortisol and DHEA, which are central to many body functions. Our modern diet is also responsible for lowering progesterone levels. Our increasing reliance on grains and decreased consumption of fruits and vegetables contribute to this trend.

The Estrogen-Progesterone Balance
In most of my patients I have tested, low progesterone levels are exacerbating the effects of estrogen imbalances. It is the correct balance between these two hormones that maintains healthy functioning, while an imbalance can lead to a range of problems. In some women, low estrogen triggers the imbalance. Estrogen levels normally decline with age, but if stress hormones remain balanced few symptoms occur. However, women as young as 30 can experience prematurely low estrogen levels, leading to low sex drive, infertility, dry or wrinkled skin, excess fat deposition (especially around the waist and back of the thighs), inability to lose weight despite dieting and exercise, and migraine headaches. Depending on each individual patient’s estrogen levels, treatment options must be configured differently.

Also, many women have more than one factor contributing to hormone imbalance, such as low estrogen combined with low progesterone and high stress hormone levels. It is hardly surprising that they exhibit symptoms ranging from mood swings to insomnia. Estrogen-progesterone imbalances are not exclusive to menopausal women.

In menstruating women, estrogen peaks at ovulation, around two weeks into the typical 28-day cycle. This is followed by a surge of progesterone in the second half of the cycle as the egg is released. This natural cycle can be disrupted, however, by disturbances in the circadian rhythm, or 24-hour cycle, of production of the essential hormone cortisol. The daily rhythm is the driving force behind regulating the monthly cycle, and when cortisol levels are disturbed by irregular sleep patterns, skipped meals, emotional stress, or other factors, the result is hormonal symptoms. And in effect, the entire system becomes imbalanced.

Correcting Hormonal Imbalance
In the majority of my patients sex hormone symptoms can be eliminated by making certain lifestyle changes and by balancing adrenal hormones. High levels of adrenal or stress hormones often cause or worsen many menopausal symptoms. Women with imbalances of the stress hormones cortisol and DHEA often develop problems at menopause, when the ovaries rely more heavily on estrogen produced by the adrenal glands. Under chronic stress, demand rises for cortisol and DHEA at the expense of producing progesterone. This effect is intensified by the rise in cortisol triggered by the normal drop in estrogen at midlife. At this stage of life many women will require the support of natural, or bioidentical, progesterone.

Progesterone creams have become popular because they can be bought without a prescription. They are fast acting because they are absorbed directly and rapidly into the bloodstream. However, it is difficult to get exact dosages each day, and some women build up high progesterone levels with extended use of creams. High progesterone levels can lead to many symptoms such as fatigue, insomnia and depression. Furthermore, some women have an enzyme that converts progesterone from the creams into other hormone compounds, and this can interfere with successful treatment.

Bioidentical progesterone tablets taken under the tongue or in liquid form tend to be the best options for most women. It’s easiest to get precise daily doses, and like creams these forms deliver hormones directly to the bloodstream.

Likewise, many women who are low in estrogen require the use of bioidentical estrogen to achieve hormone balance. Natural estrogen can be prescribed in pills, gels, patches, or troches (sublingual lozenges). When a patient chooses one of these forms of prescription estrogen, I work with her medical doctor to coordinate this treatment with the rest of her program. Patients also can use phytoestrogen compounds — natural, plant-based formulas — that can be obtained without a prescription. I have found that most of my patients are willing to improve their diet and exercise patterns will have complete symptom relief by using an adrenal hormone program plus plant-based natural progesterone and estrogen.

Insulin is yet another hormone we produce that coordinates with our sex and stress hormones. Patients with a condition known variously as Metabolic Syndrome, Syndrome X, or insulin resistance will not fully benefit from the typical female hormone programs until their metabolism is healed. Dr. Diana Schwarzbein, an endocrinologist in Santa Barbara, California who has used bioidentical hormone programs with thousands of patients, has pioneered the use of bioidentical female hormone therapy in conjunction with lifestyle changes. Her books are a must read for anyone who wants to learn more about this subject.


Dr. Kalish: One of my patients provides a prime example of estrogen-progesterone imbalance. Helen is a 58-year-old athlete with a long history of hormonal problems that led her to undergo a hysterectomy followed by hormone replacement.

Helen: When I went to Dr. Kalish I was desperate, and — to be honest — quite pessimistic. An athlete friend of mine who is a long-standing patient of his suggested I go when I complained to her about my inability to lose weight even though I was eating healthy and exercising several times a week. She said that he did natural hormone replacement therapy, and this intrigued me because I’ve always been interested in natural health alternatives and I wasn’t feeling any better with the hormone replacement therapy I was prescribed after my hysterectomy.

 Dr. Kalish: When I first saw Helen, she was frustrated by her inability to lose weight despite a restricted diet and a heavy training schedule. She was experiencing back and lower-extremity joint pain after running. She also reluctantly admitted to feeling moody and depressed after starting an estrogen regimen, and her symptoms were getting worse.

Helen: I had a good feeling about Dr. Kalish right off the bat. The first thing he did was reassure me that my problems were normal and that he had successfully treated thousands of women just like me! This was hopeful news, and I was excited to find out the results of the lab tests that he ordered for me.

 Dr. Kalish: Lab testing showed that Helen’s estrogen levels while using HRT were alarmingly high. Since she wasn’t taking any progesterone, her ratio of progesterone to estrogen was greatly disturbed. She needed to lower her estrogen dosage and increase her progesterone levels.

Helen: When Dr. Kalish explained my lab results to me in my follow-up consultation, I was shocked and somewhat angry that I had been prescribed such an excessive dosage of estrogen. I was very curious to see the results of Dr. Kalish’s treatment.

 Dr. Kalish: After only a few weeks of treatment with bioidentical progesterone, and a shift to a bioidentical estrogen at the appropriate dosage, Helen’s mood swings were gone and her depression had greatly diminished. Without the excess water weight and body fat promoted by the estrogen, she returned to her normal weight. The progesterone also had an anti-inflammatory effect, helping her to resume her running program without the constant joint pain.

Helen: It’s been six months, and I am feeling much more like myself these days. I am able to maintain my weight, and the occasional migraines I was having have vanished. I have been given my vitality back, and I am living the kind of active life I love.

Unfortunately, Helen’s situation is far from unusual. In addition to placing themselves at heightened risk of life-threatening illnesses, many women on HRT are only further disturbing further their estrogen-progesterone ratio. My technique of carefully testing hormone levels, combined with a more healthful diet, adequate exercise, and stress reduction, can put their lives back on track.