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Want to Learn More About Your Body’s System of Communication?


Announcing a New Series:

How Your Body Talks:

Estrogen and Progesterone

Stan Gardner, M.D., CNS

Women are different than men (believe it or not!). Some of that difference is related to different levels of messengers called hormones. Two of the hormones–estrogen and progesterone–communicate different things to the same organ. To make matters more complicated, their levels change, depending on the time of month or stage of life.

The Reproductive Years (About age 11 to 45 to 50)

During the reproductive years, most women have regular periods. Part of the purpose of menstruation is to prepare the uterus and body for pregnancy. Of the two hormones I mentioned in the previous paragraph, estrogen levels only change a little during the month. Your body’s hormones are always talking to various tissues. Progesterone levels are quite low from the start of the period until the egg is released from the ovary (ovulation). The scar tissue (corpus luteum) generated where the egg leaves the ovary produces high levels of progesterone until a day or two before the next period starts.

In the uterus, estrogen tells the inside of the uterus (the lining) to produce more cells. When progesterone is produced, it tells the newly produced cells to develop or mature to get ready for a fertilized egg. The fertilized egg loves the newly developed cells, burrows in and starts to divide and divide, becoming a new human being 9 months later.

If the egg is not fertilized, the corpus luteum stops producing progesterone. It tells the uterine cells to remove themselves from the uterus (through the menstrual cycle) and starts the whole process over again.

Estrogen and progesterone talk to nine other organs, and for the most part they confuse the organs by giving them opposing directions.

In the ovary, estrogen stimulates the maturation of the egg. Estrogen tells the egg to move toward the outside of the ovary as it matures. Meanwhile, progesterone suppresses further egg release. If these two hormones were not giving conflicting information, twins and triplets would be much more common.

Balance and Counterbalance

Here are some other fascinating ways that estrogen and progesterone balance and counterbalance in the body:

  • In the breasts, estrogen stimulates tissue growth, occasionally so much that it causes discomfort. Progesterone provides protection from cancer. Because of high progesterone levels during pregnancy, women with multiple pregnancies have a reduced rate of breast cancer.
  • In the bones, estrogen slows bone loss. When estrogen levels drop at menopause, bone loss (osteoporosis) accelerates as the FSH level (follicular stimulating hormone, another hormone messenger that talks to the ovary) rises. Progesterone stimulates new bone growth.
  • In the thyroid, estrogen interferes with the thyroid hormones, while progesterone talks to the thyroid gland and improves its function.
  • In the brain, estrogen stimulates function and improves mental sharpness. Progesterone helps to calm the brain and acts almost like an anti-depressant.
  • Estrogen increases deposition of fat, especially on the hips and thighs. (Testosterone tends to put fat in the abdomen.) Progesterone tells the fat to break down.
  • Estrogen tells the cells to make more progesterone receptors, while progesterone up-regulates estrogen receptors.
  • Estrogen increases retention of water, including helping to hydrate the skin. Progesterone acts as a natural diuretic.
  • Estrogen decreases libido, while progesterone increases it.

Estrogen speaks exclusively to two organs, without counter-talk from progesterone:

First, it talks to support the lining in the blood vessels.

Second, estrogen increases collagen production. Collagen is the connective tissue in the body. Faster healing and softer, more elastic skin take place when estrogen speaks to the connective tissue.

What happens when Estrogen levels are too high, compared to Progesterone levels?

When estrogen talks too loudly, and progesterone influence is minimized, it is called estrogen dominance. This condition causes some classic symptoms:

  • Water retention
  • Breast tenderness, lumps, cysts
  • Moodiness, emotionally labile, anxiety, depression
  • Decreased libido
  • Heavy bleeding, clotting, and/or cramping
  • Fibroids, endometriosis
  • Polycystic ovarian syndrome

What Happens When Estrogen (and Progesterone) Levels Drop?

When neither estrogen nor progesterone talks to the body, some women have no problems, while others are incapacitated. This time of life is called menopause, and may happen naturally or after surgical removal of the ovaries.

The following difficulties may arise with onset of menopause:

  • Mental fog, forgetfulness
  • Anxious, depressed, mood change
  • Hot flashes, night sweats
  • Dry eyes, skin, vagina
  • Insomnia
  • Fatigue
  • Pain and stiffness
  • Palpitations, (racing heart)
  • Headaches
  • Feeling bloated

Is There Any Help?

Yes, there is help, if it is needed.

First, however, let me state that I am opposed to synthetic, chemically changed forms of estrogen. These forms of treatment include a chemical group(s) that has been added to the chemical structure of estrogen the body makes, so it can be patented and sold as a pharmaceutical.

Unfortunately, that extra chemical has caused unwanted side effects. This causes a number of problems, which come from communicating to the wrong organ in the wrong way:

  • Blood vessel clots, causing heart attack, stroke
  • Endometrial and breast cancer
  • Double the risk of dementia
  • Double the chance of surgery to remove the gall bladder

If there is a reason to treat hormonal issues, my first choice is to choose herbs and natural products that function as phytoestrogens and support, or speak to the ovaries.

Some of these include:

  • Angelica sinensis
  • Blessed thistle
  • Licorice root
  • Wild yam
  • Motherwort herb
  • Black cohosh
  • Cramp bark
  • Dong quai

Although these natural products may not be as strong as bio-identical estrogen and progesterone, they may talk to your organs well enough to solve the problem.

Bone Density

Bone loss around the time of menopause is a reason to be aggressive with reducing the FSH level. In treating patients with bone loss, I typically start with progesterone, to see if stimulating the estrogen receptors is enough to solve the problem. If not, then bio-identical estrogen is usually needed.

If, on the other hand, estrogen is talking too loudly in your body (dominating), then bio-identical progesterone is usually needed. I generally prefer that a local compounding pharmacist formulate the progesterone, rather than a pharmaceutical firm, which tends to use unnecessary fillers. Unfortunately, insurance companies tend to pay for pharmaceuticals, rather than healthier, more natural products.

When neither estrogen nor progesterone is communicating with your body, and you need help (sometimes desperately!), I always start with a natural product. If that is insufficient, the next step is progesterone. Everyone likes progesterone—just look at what it does to the body. If more is still needed, I pay attention to symptoms and response to what has been added, and then add bio-identical estrogen until the symptoms resolve.

To your dynamic health and energy,

Dr. Stan Gardner

If you would like more information about Dr. Gardner and his philosophies, please feel free to explore this site. Dr. Gardner’s office is in Sandy, UT. Phone number 801-302-5397. 

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Fibroid Tumors

Uterine Fibroid tumors. Thank you for your post on menopause today. That is exactly my issue these days. I finally went to see a doctor because my symptoms were interfering with my life and he found a fairly large uterine fibroid tumor. He put me on prometrium, which has helped me feel so much better, and has suggested some traditional treatments for the fibroid including hysterectomy as a last resort. Do you have any suggestions on the best way to shrink a uterine fibroid tumor?? Thanks for your time.

Fibroid tumors in the uterus are caused by estrogen dominance; that is, excessive estrogen compared to progesterone in the body. It is easier to add progesterone to change the ratio than to reduce the estrogen.

Prometrium is bio-identical progesterone, so it is safe and is my recommended treatment for fibroids.  If the symptoms continue after months of treatment with progesterone, you may need surgical fibroid removal or hysterectomy.  If the symptoms improve enough, then you can take progesterone indefinitely.

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What is normal Menopause? When is it not normal that I would have to seek medical attention from a doctor who is not traditional but holistic alternative.

Menopause, by definition, is going without a period for 12 months.  The period stops because the hormones that cycle in order to have periods have diminished, and all of this is normal.

Some women have annoying or devastating symptoms associated with these changes, and others have no symptoms.  When the symptoms interfere with the quality of your life, it is time to try some things or see a physician who uses bio-identical hormones.

Conventional medicine continues to use ‘fake’ estrogen and ‘fake’ progesterone to treat these symptoms, even in the face of significant side effects shown in their studies.  Over-the-counter products like Vitex, Dong Quai and Black Cohosh have helped many people, and others have found low-dose progesterone from yam sources helpful.  If these are insufficient to get your life back, it is time to see someone with experience with bio-identical hormones in the alternative/holistic medicine field.

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Just wondering about your thoughts about a product called Zymessence for shrinking fibroids?

Zymessence is a concoction of a number of enzymes, all of which the body makes or are used commonly in pancreatic enzyme mixes, so it is safe.

One ingredient, amla, is an ayurvedic herb which is also safe. This product is marketed for a number of female problems, and it makes scientific sense that it could work. My position is that fibroids are part of estrogen dominance, so prevalent is many women, and could be corrected by adding progesterone if the fibroid is not too large.  Just another thing to consider. Remember to work with your physician in carefully deciding what to do for optimal health.

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Iodine, Rheumatoid Arthritis, and Your Thyroid

Is there a link between polycystic ovarian disease, thyroid issues and rheumatoid arthritis, and if so how to balance all this in one body?

Iodine is the common link between ovarian problems and thyroid.

Women use iodine in 3 organs:

  • thyroid,
  • ovaries,
  • breast.

Men only use the iodine in the thyroid gland.  This is probably why women are 10 times more likely to have thyroid deficiency than men.

Since rheumatoid arthritis is an autoimmune disease (the immune system has identified joint tissue as the enemy and attacks it), it is possible to have a second autoimmune disease, Hashimoto’s thyroiditis.  In this disorder the immune system has identified thyroid tissue as the enemy, and attacks it.

There could be a genetic propensity in a person with more than one autoimmune disease present, which could link them in that way.  That said, each of the diseases needs to be treated.  This is best done by looking at the body as a whole, and not as separate parts.

The beauty of alternative medicine is that the goal is treatment of the cause, and not just treatment of the end organ symptoms.

You need to be on an excellent diet and supplements so the body has the nutrients to repair and heal itself.  Iodine, and probably thyroid hormone, will need to be administered to fix the thyroid symptoms.

PCOD may be made worse by estrogen dominance, so the addition of progesterone may prove helpful.

If you have rheumatoid arthritis, you will need a physician or practitioner in the alternative medicine field to set up a comprehensive program for treatment.

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Pregnancy and Progesterone

I was taking topical progesterone for what I assume is endometriosis. My doctor said this will thicken the cervix and inhibit pregnancy, (eradicating endometriosis for pregnancy was my goal for taking it in the first place). I took it for 5 months, felt 100% better but have not conceived 5 months after that. Do I need to take it for a certain amount of time and then stop to get pregnant?

Endometriosis is one of the many female challenges which is probably related to estrogen dominance.  Estrogen dominance means there is a mismatch in the ratio of the amount of estrogen to progesterone. The taking of progesterone helps the ratio and reduces or eliminates the estrogen dominance. This is why you felt better on the progesterone.

While you are on high doses of progesterone, it could inhibit ovulation. This is what the high levels of progesterone do in the second half of the cycle so you don’t ovulate a second or third egg, and have more than one baby during pregnancy.

As soon as you stop taking progesterone ovulation will return. If progesterone were a sure-fire way to stop pregnancy, it would be used more often, but many women get pregnant while on progesterone, so it is not as effective as birth control pills, but it is a lot safer.

You may need to stop progesterone for a few months to see if you can get pregnant, and hope the endometriosis does not return. If you still cannot get pregnant, it may be there is some residual scarring or inflammation from the endometriosis that is still present, or any number of other things that would need to be evaluated by a qualified obstetrician/gynecologist.

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Irritable Bowel Syndrome, Endometriosis

My daughter has recently found out that her stomach problems are due to irritable bowel syndrome. She also may have endometriosis. She is only 17 years old. What can I do to help her get well and be rid of the daily stomach aches and horrible menstrual cramps she experiences. The OB/GYN put her on birth control pills that she takes daily. They don’t seem to be helping. She also may have gastritis. Please send me suggestions on how to help her get well so that she can experience days, weeks, months and years without this chronic stomach pain and cramping.  Thank you for your quick response.

Two problems, each with pain. Seventeen-year-olds should not be this sick (and frankly, neither should anyone else).

Treatment starts with cleaning up the diet–no sugar or processed foods. Why?  Because many of the ingredients in processed food are pro-inflammatory, and both of these conditions are inflammatory conditions, so they will only make it worse.  If that diet is not cleaned up, nothing else is going to work.

  1. Endometriosis is uterine tissue outside the uterus, that bleeds monthly like the uterine lining. This causes pelvic pain. Often there is what we call estrogen dominance in this setting, which means that the estrogen to progesterone ratio is in favor of estrogen, which causes an imbalance.  Obviously I am not your doctor, and you’ll need to consult your doctor about these options: Try progesterone in the last half of the cycle, days 16 to 27, and see if it helps. The birth control pills increase her risk of vascular disease (strokes and heart attacks long term), so I am against them, especially if they do not seem to be helping.
  2. Irritable bowel syndrome is a ‘leftover’ term that folks often use to describe any gastrointestinal upset that can’t be diagnosed as anything else. Try the following–
  • drink plenty of water,
  • increase fiber,
  • add probiotics,
  • try L-glutamine,
  • address stress reduction and emotional issues.

All of these will help, particularly the last one.

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Breast Cancer Decline: Where Credit is Due

Study Credits 2002 Warning on Hormone Replacement Drugs

Breast cancer rates prior to 2002 were 210,000 per year, reports the Wall Street Journal, with a drop to 190,000 per year after 2002. In the year 2002, the Women’s Health Initiative sponsored by NIH halted the study of Wyeth’s drug Prempro because it caused an increase Continue reading Breast Cancer Decline: Where Credit is Due

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Hormone Replacement Therapy: Risks and Reliable Information

The 7 Things You Should Know About Hormones

The Health Journal section of the Wall Street Journal describes mainstream thinking on hormones and concerns with the recent “Oprah Winfrey Show” with Suzanne Somers. Melinda Beck, author of the article, recites the following mainstream thinking:

1) ‘Bio-identical’ hormones are Continue reading Hormone Replacement Therapy: Risks and Reliable Information