Not unlike Eve White, Eve Black, and Jane, played by Joanne Woodward in the 1957 film, The Three Faces of Eve, estrogen has three personalities. Who knew, right? Most of us say estrogen and think one hormone. It is one hormone, but there are three kinds, estradiol, estrione and estrone. Why this is important is that each of these estrogens play a different role in the body of men and women at different stages of life. As we age, the kinder gentler forms grow weaker while the dominant crazy one with the knife grows stronger. This shape-shifting affects every aspect of our health and quality of life. Some people feel the effects, and others breeze through life with nary a cramp or hot flash. (Don’t you want to hate those people?)
Lest you think of estrogen as purely a sex hormone, read on. It is a sex hormone, and it also affects all systems in the body — all hormones do. Your bones, cardiovascular system, and brain all rely on healthy levels of estrogen. Men, you are not a testosterone-only kind of being. You have much less estrogen than we women do, unless you are obese, middle aged, or have other estrogen producing situations like a chemical overload — but it does figure into your whole hormone picture.
When estrogen levels are good, things are all in balance, we feel really good. People who have too much, called estrogen dominance, can feel anxious and irritable. Too little can feel like the same, but is more a depressed kind of feeling; crying for no reason or getting angry at the drop of a hat are symptoms. As we approach perimenopause and then menopause, our sex hormones begin to do a manic sort of dance. This erratic supply leads to the all too common hot flashes, moodiness, sadness, weight gain, forgetfulness and more.
Of the three estrogens, estrone holds its own and becomes the dominant kind at and after menopause, while estradiol and estrione wane. Estrone can make you more prone to cancers of the breast and uterus, according to Dr. James LaValle, author of The Metabolic Code. As progesterone, estradiol, and estriol decline at menopause, so do their health-protective effects. This explains in part why we see so many cases of breast cancer after menopause.
Other things that increase estrone production are alcohol use (enhanced for women who take hormones as pills vs creams or gels), and sugar consumption. Dr. Daniel Amen adds, writing on page 94 of his book Unleash the Power of the Female Brain, “the antacid cimetidine (sold under the name Tagamet), birth control pills, hypothyroidism, smoking and pesticide exposure” also increase production.
Estradiol is the strongest of the three estrogens, but not in a bad way. It helps us think clearly, helps maintain bone density, keeps the blood from getting sticky, helps with mood, and in maintaining a healthy lipid profile. While too much can be associated with estrogen-related cancers, according to Dr. Amen again, “deficiencies can lead to osteoporosis, heart disease, dementia, and other diseases of aging.”
When you keep your levels optimized after menopause, your skin has help against wrinkling and dryness, and Yale University found that it “suppresses appetite using the same pathways in the brain as leptin, one of the hormones that regulates appetite.” The key to staying disease-free is managing levels with a doctor who understands hormone restoration.
Our last estrogen, estriol, plays a protective role in breast and uterine tissue. This is the one that will help with hot flashes and in prevention of urinary tract infections, which are more common as we age. Bone density also gets a boost from this “good” estrogen.
An expert in bio-identical hormone restoration is a great team member for those of us entering perimenopause ,or past that point into our later years — and the only way to safely use hormones for the protective effects they can provide. Not all doctors are expert in this arena. Dr.John Lee, author of five books on natural hormone programs adds, “Conventional hormone replacement therapy (HRT) composed of either estrone or estradiol, with or without progestins (excluding progesterone) carries an unacceptable risk of breast cancer, heart attacks and strokes.”
If your doctor has prescribed or wants to prescribe estrogen only, whether or not you still have a uterus, I’d find another doctor. Testing is critical to your continued safety once you are using BHRT (Bio-dentical hormone restoration therapy). Since everything is connected, all female hormones + thyroid and testosterone should be tested every 6 – 9 months to be sure that levels are in safe ranges.
If your doctor wants to start you off without blood work using the height + weight + symptoms list as a diagnostic tool, it’s perfectly safe for a healthy person. He or she should ask you to get blood drawn at about six weeks into this new protocol to see where the levels are with the meds on board. If your doctor says once per year is fine after establishing that the levels are safe and you got the relief you need AND no health issues come up or other medications are added then I’d say yeah, maybe. I prefer every 6 to 9 month blood draws. I really prefer saliva testing, but New York does not allow those tests for some crazy reason.
Now that you know the three faces of estrogen, you are armed and ready to talk to a doctor if and when the time feels right. If your quality of life has gone down due to symptoms like lack of sleep or moodiness, consider bio-identicals as a safe option. Hormonal fluctuations alone don’t create multiple personalities, but it sure can feel like it when in the throes of it. Why suffer when there are doctors you can trust help you feel whole and do so safely?