Dr. Eric Li's Blog

A Survey of Female HRT

 

Consecutive to our article on male hormone replacement therapy, in this article, we'd like to give you an overview information to arm you with knowledge when you are considering HRT. 

 

First, let's talk about the main female hormones (also present and important in male bodies).  Estrogen consists of mainly 3 forms, estradiol, estrone and estriol, in a ratio roughly 10-20%, 10-20%, 60-80%, respectively.  Like any other hormones, both the magnitude and the ratios among them are critically important to health and longevity.  Estradiol is the most potent,  estrone a little bit less potent, and estriol being the weakest.  In general, the most biologically active estrogens are the unconjugated ones.

 

Metabolism of estrogens occurs mainly in liver and gastrointestinal tissues.  Most of the metabolism and conjugation of estrogens takes place in the liver.  A major pathway of estrogen metabolism is from estradiol to estrone.  In turn, estrone can be metabolized further to2-hydroxyestrone or 16alfa-hydroxyestrone.  Then finally 2-hydroxyestrone or 16alfa-hydroxyestrone convert into estriol, which are then conjugated primarily as glucuronides, sulfates and thioether to readily excrete via bile, feces and urine.

Progesterone is another vitally important female hormone, which plays a critical role in a woman's body such as pregnancy, bone regeneration.

Female hormones change in magnitude and ratio during the day, the month, age, and during pregnancy. 

i) In a normal adult woman, estrogen rises from the lowest at the start of the 28 day menstruation cycle (initial heavy flow of menstruation) to its highest peak at ovulation on day 14, reach second peak on day 21, then continue drop until day 28 (period).  Progesterone is produced immediately after ovulation (day 14) to prepare the uterus for reception and development of the fertilized egg.  The level peaks at day 21.  If no fertilization takes place, it gradually falls back to very low level towards day 28.

ii) If pregnancy occurs, both estrogen and progesterone increases and maintain at high level to promote the development of the fetus.  

iii) Prior to puberty, starting from Tanner stage II towards IV, estradiol gradually increase to about 20-40% of that of a mature woman (Tanner stage V), while progesterone increases to 37-50% of that of a mature woman. 

iv) During perimenopause, menopause, and post-menopause, estradiol and progesterone continue to fall to as low as 5% and 3%, respectively of that of a young adult level. 

 

What's Important?

As a woman ages, her main sex hormones (estrogen and progesterone) decline progressively and fall off the cliff at menopause.  At the same time, her hormone balance could be out of whack, e..g, estrogen dominance which means the ratio of estradiol/progesterone has increased from normal level).  She may also go through a lot volatility of hormones during perimenopause.  The magnitude as well as the balance (ratio) are significant biomarkers of aging.  To maintain health and youthfulness, HRT has its important place in a woman's life.  However, it is very easy to administrate HRT wrong, resulting in serious diseases such as cancer, for the following reasons: 

i) The lab "normal range" is huge.  For example, estradiol at mid cycle peak normal range is 150-750 pg/mL.  You can be in severe decline and imbalance and still fall into the "normal range".  Therefore, benchmark your hormones when you're still young and vibrant to know exactly what's best for yourself, as prescribed in YBM Test.

ii) There's other complexity.  For example, which hormones, estradiol, estrone, estriol, progesterone do you take, at what mix and volume?

iii) When during a day or a month do you take it?

 

Types of HRT

There're many ways for HRT.  However, if you look around the doctors and clinics who do HRT, you may see a few main methods:

i) Synthetic hormone replacement using drugs such as Premarin and Progestin.  These are hormones which are different  in chemical structure from the hormones in our body.  Study has demonstrated that this method is unsafe.  Therefore, despite how they use it, we should avoid such a method.

ii) Natural (or bioidentical) hormone replacement minicing the menstruation cycle.  Some doctors administer hormones based on how they rise and fall during a menstruation cycle.  In this case, they could make a woman continue to have period even if she has already entered menopause.

iii)  Natural (or bioidentical) hormone replacement using estrodiol and progesterone at a level not causing the return of menstruation.  The quantity is based on sympotoms of estrogen excess and deficiency, and timing is uniform.

iv) Natural (or bioidentical) hormone replacement mimicing pregnancy.  There have been studies showing that pregnancy has beneficial effect to women, such as reduced cancer rate, longer life.  This has mainly credited to the beneficial effect of progesterone which is high during pregnancy.  Thus the method would take a balanced preparation of 25% estradiol, 25% estrone, and 50% estriol, plus progesterone.  The quantity and timing is based on a qualitative test of estrogen dominance or defficiency during the day or month.  This method usually administes less hormones than method in ii), and does not cause menstruation after menupause.

v)  YBM Horrnone.  Our method is to i) try to baseline your hormone level and balance when you're still young and vibrant, ii) try to restore your hormone level and balance as long as we can using sex chi-gong methods and herbal methods, iii) using bio-identical hormone replacement as the last resort.  Our approach of using bio-identical hormones for females is to restore estradiol, estrone, estriol, and progesterone levels and mix back to pre-puberty level (around Tanner stage III).  This breakthrough method was invented by YBM, and is still pretty new, never published and discussed anywhere else.  However, it is consistent to the Taoist Alchemy.  In Taoist sex chi-gong, a woman, who is sitll way before menopause, could stop menstruation through chi-gong, and settle at pre-puberty.  This is because Taoist believes, verified by modern science, that a woman has finite vital essence (blood and eggs).  Monthly menstruation through life consumes that finite vital essence, and ultimately leads the woman to menopause (a sign of vitality decline).  By staying at pre-puberty, it maximally preserves the limited vital essence, and thus extend younger life, as well as lifespan.

In summary, we have given you an, as concise as possible, overview of  female hormone replacement therapy, its background, land mines, and variety.  Hope this is helpful in guiding you through your choices.