Though many still ascribe to the use of oral estrogens, which were the estrogens studied in most of the research showing questionable cardiovascular effects, I prefer to use patches, creams, gels, or pellets for their safety profile.

A ten year review of literature found that topical use of estrogen avoids much of the liver metabolism required with oral estrogen, causing less inflammatory and clotting markers and less binding proteins so that testosterone levels (and libido) aren’t compromised. Oral hormone therapy has more blood clotting effects and causes higher C-reactive protein levels.

Though both topical and oral estrogen have positive effects on LDL cholesterol, transdermal estrogen has a lowering effect on triglycerides and a lower incidence of weight gain and metabolic syndrome compared to the oral route of delivery. Both Premarin and oral Estradiol stimulate higher levels of estrone, though Premarin contains at least 50% estrone. Estrone has been found to stimulate receptor sites that are more cancer-promoting. Though estrone does have some benefits to the brain for women, I prefer to keep it at a lower level than I see in oral estrogen use.

Progesterone has the potential to slow the growth of or even shrink many breast tumors, according to a study published in the July 2015 issue of Nature. The researchers took breast cancer cells that were both estrogen and progesterone positive and exposed them to both hormones. When the progesterone receptors were activated by progesterone, they attached to and turned OFF the estrogen receptor. Then the estrogen receptors stopped turning on cancer promoting genes and turned on the genes that kill cancer cells and also those that promote healthy cells! The tumors that received only estrogen grew and those that received both hormones shrunk.

Another tool I use when prescribing estrogen, especially stronger estrogens in pellets, is diindolylmethane (DIM), a chemical found in cruciferous vegetables. Many studies have documented that DIM increases metabolism of existing estrogens through the 2-hydroxy estrone pathway and less through the 16 and 4-hydroxy estrone pathways. This is a very good thing since the the 2 hydroxy metabolite is the anti-cancer pathway.

I became sold on DIM for helping my patients with damaging estrogen activities. Mood swings, tender breast, weight gain, and painful periods can all improve greatly with DIM so it is one of my good friends! We can also test urine through a 24-hour collection to see how estrogens metabolize naturally. Mine were metabolizing more in the 4 and 16-OH pathways than I’m happy with so I began to use DIM, and I also support my liver detoxification function frequently. Herbs for the liver that I’ve written about previously and alpha-lipoic acid, along with adequate vitamins and minerals, help the liver do its work.

Many women optimize their detoxification pathways, eat an organic, whole foods diet, balance their adrenals and don’t need any estrogen at all.