Estrogen: Which Type is Best?

This topic has been visited many times in The Happy Apple but there is a lot happening in the field of female hormonal therapy. There are two common question asked and I will try to address them here. First is, which type of estrogen should I take? The type I am on makes me bloat and my breasts swell. The second question is, Which is better for me and my bones, estrogen or progesterone?

With the answer as to the type of estrogen, I will introduce you to a new version of an old concept, the compounding pharmacist. The most common commercial estrogens are from mare's urine, but I do not usually treat horses so why do we give these conjugated estrogens that are mainly estradiol?

At this point, we need to inject a bit of chemistry into our discussion. There are three estrogens produced by the 20-40 year old female: Estriol (80 percent), Estradiol (10 percent), and Estrone (10 percent). The percentages after each hormone represents approximate amount of hormone produced in the human (not horse) female. Yet most of our supplements contain either estradiol or estrone. None contain the good estrogen, Estriol. The estradiol and estrone are the type of estrogens that are implicated in uterine cancer, cause the breast swelling and fluid retention. That is so commonly associated with estrogen replacement therapy. Estriol has none of the dangers associated with other types of estrogens. It is the estrogen most commonly used in Europe and is the dominant estrogen produced by the pregnant female, and may actually protect the uterus and breast by blocking the actions of estrone and estradiol. The problem is one makes it in this country.

Now we can get off of the chemistry and back to the story. Since no one makes it, we have reverted to the use of compounding pharmacies to make these prescriptions. The one that we most commonly have compounded is a formulation called Tri-est, which is short for Triple Estrogen. In contains 80 percent Estriol, 10 percent Estradiol, and 10 percent Estrone, the same ratio produced by the female when she produced estrogen. The way we prescribe it is to call in a prescription to a compounding pharmacy (there are many located around the country) and the patient calls with a credit card and the prescription is mailed to heir home. If interested, contact us about this novel approach to Estrogen replacement therapy.

We have compared the merits of progesterone vs estrogen in previous issues and will elaborate more on it in a subsequent issue.

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