Healthcast 689 - Menopausal Women on Estradiol: Were you told your Estradiol is too high?

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

If you are female who is menopausal and you have experienced your OBGYN or internist drawing your blood to check your hormone levels, (Estradiol, and LH and FSH) to see if you are menopausal or to see what your estradiol level is while on HRT, you may have heard your doctor tell you that your estradiol level is too high. That is what I would like to talk about today….. This often occurs when my patients take the blood work I order to another doctor who doesn’t know anything about estrogen and just looks at the reference range on the lab sheet.

Most of you have heard me talk about the fact that lab reports must be interpreted by the treating physician, because what is written on the lab sheet isn’t tailored to your situation.

The lab reference ranges for menopausal women are based on women who don’t take any hormones, very low estradiol and high LH and FSH, which is not healthy and is the level that causes women overwhelming hot flashes and painful periods. Estradiol blood tests have a list of numbers that don’t reflect the healthy estradiol level, but a level that makes women miserable. After I replace a woman’s estradiol, their tests show blood levels of a young healthy woman who is pre-menopausal, and that brings them back to feeling like themselves. “I have my life back!  Estradiol and Testosterone Pellets have cured all my symptoms (low libido, hot flashes, poor interrupted sleep, bladder spasms, depression, and I feel like myself again!”

No other hormone replacement brings estradiol blood levels to (60-250ng/ml), patches, creams and gels just stop one symptom, hot flashes. 

There is a reason that your doctor doesn’t know about hormones. The education that OBGYNs get in residency effects what they recommend to their patients for life, and they have very little training about hormones which means that no one is taking care of the hormones for women, and bioidentical estradiol is never discussed because it is not approved by the FDA which is why I DO! 

I have made it my business to know everything about women’s hormones and have prescribed them to women for over 45 years.  Therefore, when I am told that the primary care or internal medicine doctor told one of my patients that their estradiol and estrone are “too high”, I am dismayed.    Women must think about the fact that when they feel normal after menopause treatment, then that is the best treatment for them.  My patients become better, healthier, and their relationships are more fulfilling with Estradiol replacement, and I know the range the Estradiol should be within (60-250), the same as when we were fertile and young.

Estradiol taken non-orally (patch, cream or pellet) is safe and does not cause breast cancer or liver cancer or cause blood clots.

What Should I Tell My Doctor about my estrogen replacement?

Therefore, If your doctor tells you to stop estradiol, you can tell him that estradiol replacement decreases all causes of death in Menopausal women, it decreases heart disease, bladder disease, bladder infections, osteoporosis, and dementia/Alazheimer’s Disease! Tell him or her that, they can stop worrying about your Estrogen because you are being prescribed it by a doctor who knows how to manage hormones.

Breast Cancer Patients

There is another type of patient who I often see in my office. Breast Cancer patients with estradiol receptors are taken off their estrogen, and they are given an estrogen blocker like Tamoxifen® (oral) or Anastrazole (Arimidex®) to get rid of the estrogen in their body which is to “starve” breast cancer cell that may have seeded other tissues in the body.

These patients are miserable. I treat them with Testosterone pellets only and monitor their Estrogens. That works until their doctor sees an Estradiol level that is in the premenopausal range in a patient who hasn’t had an estradiol pellet in a year.  E2 pellets are tiny and friable, and they can’t last longer than 6 months. What happens when the oncologist freaks them out saying it is the Estradiol pellet causing the E2, E1 levels. They are upset but this is estradiol from other sources (not the ovaries).

Here are the facts:

• Estradiol pellets are 2-3 mm in size. They dissolve by blood flowing around the pellet located in the fat.
• Estradiol pellets dissolve completely over 3-4 months in most women. We cannot see them by ultrasound at 4 months. Therefore, a year later a woman who has estradiol over 60
• The oncologist is not a hormone specialist and doesn’t know the other sources of estradiol and estrone in the body.
• a prescribed amount of Estradiol (E2) is given every 4 months. The medium dose of E2 is 25mg and it lasts 120 – 180 days The size of an estradiol pellet = 2×2 mm

Causes Of Continuing High Estrogen In a Woman Long After She Stops E2 Pellets:

• Tamoxifen given for Breast Cancer is an Estrogen and also an Estrogen Receptor modulator, but is really an Estrogen, which turns off the receiving end for E2 (the cellular receptors) so the breast cancer cannot be stimulated by circulating estrogens, but the rest of the body is. When on Tamoxifen it is not the pellets that are raising the blood level of E2, E1, it is the Medication. When someone is on Tomoxifen all their other organs are stimulated by estrogens from Tamoxifen, but the Breasts are not. That means that the estrogen in the blood is from the medication Tamoxifen and not the previous pellets.
• Obesity increases body fat and E2 is made in the fat and the less fat the lower the Estrone and estradiol.
• Other Medications and supplements can increase the E2 and E1 in the circulation but rarely help with menopausal symptoms. Your doctor should know what medications you can’t take if you are trying to get rid of estradiol and estrone usually prior to Breast Cancer therapy.
• Drinking alcohol can prevent the liver from processing the estrogen that is meant to be removed normally so it builds up in the circulation. Liver disease causes an increase in E1 as well.
• Some medications increase estrogens in the body, but do not relieve symptoms of menopause, so have you doctor review your other medications you take.
• High intake of soy, edamame, soy nuts, soy in nut milk, Tofu, and other vegan (fake meat) is made of soy and soy is a phytoestrogen which can cause uterine bleeding but doesn’t help the symptoms of menopause. Soy is in everything so read the labels.
• Genetic Diseases can cause high estrogen in menopausal women who are not taking estradiol for their symptoms.

 

• Some women have an aromatase defect, which is genetic and can’t be cured but can be treated with anastrazole or Arimidex, the same medication. This means that they convert Testosterone into estradiol and estrone. Even before menopause women have very low testosterone, so this is not obvious when they come to my office. The test for the gene defect is very expensive and this is not a common occurrence.  We diagnose this when a woman’s estrogen is too high for the dose she is taking, AND her testosterone ran out too fast!

We treat that condition with a testosterone + anastrazole pellet in the normal dose of T, and it corrects the conversion of T into E2, E1. Oral anastrazole also called Arimidex blocks that conversion too and is tolerated better by men but women get arthritis symptoms.

DIM can treat this genetic conversion by blocking the enzyme at a different place than Arimidex.

• Fat Loss through dieting releases the estradiol stored in the body fat

 

Obesity and weight loss can cause estradiol and estrone to be high in the blood.

Estrogen is made and stored in fat tissue.  The more you have, the more E1 and E2 you have in your fat.  Obesity can store the hormone and slowly release it which fools us and makes us think we are seeing pellet E2 nd E1. The more fat you have the more estrogens you make!

When people lose fat under the supervision of a doctor, they usually have somewhat rapid weight loss.  This floods the blood with both estradiol, estrone, and triglycerides.  It takes longer to clear the estrogens because the liver is also processing fat.

PubMed

https://pubmed.ncbi.nlm.nih.gov

Does reducing body fat reduce estrogen?

Making some lifestyle changes may help lower your estrogen levels. Your provider may recommend that you: Decrease your percentage of body fat. Decreasing your body fat can reduce the amount of estrogen that your fat cells secrete. Feb 9, 2022

Above is what your doctor should think about when diagnosing you for high estradiol long after a pellet is gone.  There are some ovarian and adrenal specific problems that are also possible to be the reason E2, E1 are increased. I hope this gives you ammunition to discuss with the doctors who don’t know anything about hormones, estradiol and menopausal women.  Tell them what you know to be true and stop blaming a 2mmx2mm pellet that can’t physically last more than 120 day.