How Hormone Fears Started

When it comes to hormone fears... they actually make sense - IF you understand where they came from... so let's take a lil' stroll at the timeline of hormone replacement therapies to see where these fears came from.

Back in the 1940's, estrogen therapies started to be used to help women manage their menopause symptoms. In the mid 90’s the decision was made to actually study the impact of HRT on women’s health outcomes and the Women’s Health Initiative began. In 2002 the study was abruptly stopped when some early analysis of data suggested there were increased health risks for some women, including potential increases in the risk for developing breast cancer. The media got hold of this message and went wild. Women were yanked off HRT without any back up support, doctors were advised only to use HRT for a minimum amount of time to handle the worst symptoms. You can read more about all this in our blog on Hormone History.

However, something crucial was left out of much of this story, namely, the type of estrogen being used... Conjugated Equine Estrogens (CEEs).

Understanding Estrogen Differences

See, the female human body makes three kinds of estrogens - estrone, estradiol, and estriol. You can read more about each one here. But, synthetic hormone like (but not bioidentical) CEE's also contain equilin. Equilin is the primary form of estrogen found in... horses, and unsurprisingly, horse estrogen doesn't play well with our bodies and has significant 'growth effects', hence the rise in risk factors for cancer. You can read more about equine estrogen, here.

The bottom line is that we do not make equilin in our bodies so the body has to work out what to do with it to get rid of it. Equilin is metabolized to estrone. Estrone is the form of estrogen that can be further broken down into additional metabolites; and some of these metabolites have significant risks for changing our DNA and increasing the risk of cancer cell growth. The more estrone we make, the more we risk making harmful metabolites.

But, that wasn't the only reason that the WHI study caused so much fear...

So what else was going on? Well:

• The early analysis of the results conflated statistics about cancer risk for women, meaning instead of looking at different sorts of risk independently, the risks were all added together and so the risks looked significantly higher for women of all ages. The message stuck “women have a 1:8 chance of getting breast cancer”.
• The media loves a scandal, or, if there isn’t a scandal, the whiff of a scandal, if there isn’t a whiff of a scandal - well, we know where this story goes. The statement “estrogen causes cancer” took hold. When you think about it, it’s utter nonsense: if estrogen caused cancer then every young woman going through puberty would immediately be at risk for developing breast cancer. Sure - synthetic estrogens CAN be a risk factor for developing cancer, but bioidentical estrogens are not.

20-Year-Old Research versus 2020+ Research

Ok, but if we know all this... then why aren't we being told this?

Well, the North American Research Society (NAMS) DID actually publish a new report (typically known as a research review - that you can read here), all about these things...

Key Summary Points For 2022:

In July of 2022, the NAMS updated its position statement on the use of hormone replacement. The following items were called out and we want to share some key areas with you:

1. The WHI only looks at oral synthetic estrogen (from pregnant mare’s urine CEE) and one progestin – medroxyprogesterone acetate (MPA). It did not look at bioidentical hormones or topical, pellets, or sublingual hormones.
2. Estrogen alone without being balanced by progesterone increases the risk for abnormal uterine bleeding and uterine cancer.
3. Non oral use of hormones (e.g. vaginal, transdermal) may offer more advantages because the hormones are not first broken down by the liver.
4. After 20 years of following the women who took part in the study, those who had the synthetic progestogen MPA (not bioidentical progesterone) showed an increased incidence of breast cancer.
5. Low dose vaginal estrogen is very well indicated for women with vaginal dryness, atrophy, and incontinence.
6. Estrogen and progesterone therapy is approved for severe hot flashes, osteoporosis, very low estrogen levels, and vulvovaginal symptoms.
7. There is the belief that studies do not support use of bioidentical hormone replacement. While studies may be smaller in size, there are still significant studies that support its use. This whole topic is still a very political hot potato. While NAMS doesn’t outright say “don’t use bioidenticals” it states, “patient preference alone should not be used to justify use of compounded bioidentical hormones therapy” Essentially, we cannot choose for ourselves, which is another can of worms when it comes to female healthcare.
8. Low dose vaginal estriol is safe to use for vaginal atrophy. For women with breast cancer or post breast cancer the decision to use estriol can be made in consultation with the oncologist. The benefits of resolving painful vaginas may well outweigh any slight risk of increased estrogen levels, especially if balanced by progesterone.
9. Conjugated estrogens (CEE) and MPA use is linked to increased stress incontinence whereas vaginal estrogen use is linked to reduced stress incontinence and reduced UTI’s.
10. Vaginal estrogen is better than oral estrogens for libido and arousal, because oral estrogens will increase sex hormone binding globulin which reduces the amounts of hormones available to be used a different receptor sites in the body.
11. Micronized progesterone is really good for reducing hot flashes and night sweats and improves sleep.
12. Hormone therapy prevents bone loss in healthy postmenopausal women. Given that we always want our bones to be healthy – this statement suggests that long term use of hormones is actually a good idea.
13. Hormone replacement – especially progesterone, helps with glycemic control so someone with type 2 diabetes could benefit from hormone replacement.
14. Micronized progesterone is more protective of the cardiovascular system than synthetic progestins.
15. Oral CEEs are associated with increased risk of gallstones, whereas transdermal hormone therapy has a lower risk of gallstones.
16. Oral CEE’s with MPA are associated with increased risk of all-cause dementia, there is no mention of bioidentical hormones protective effect on the brain.
17. Risk of breast cancer with use of CEE plus MPA is slightly greater than drinking 1 glass of wine a day, less than 2 glasses of wine a day, and similar to the risk of obesity and low physical activity. The greatest risk for developing breast cancer comes from a combination of factors – low activity, high inflammation, two or more alcoholic drinks a day, carrying too much extra weight, and smoking. Lifestyle factors are the biggest influences on breast cancer risk.
18. The effect of hormone therapy on breast cancer risk may depend on the type of hormone therapy [use topical rather than oral, and bioidentical rather than synthetic], duration of use, and individual characteristics.

As you can see, there has been significant developments in research since the WHI, but many doctors are slow on the update (blame a lack of training and some questionable practices around drugs being prescribed).

Bioidentical - Just a Marketing Ploy?

We hear the word “bioidentical”, often along with the word “natural” and we also hear the term “synthetic”, how do all of these terms fit together?

What does the word bioidentical actually mean?
Let's break the word into its two parts “bio” and “identical”. In this contect, bio means “ body” so bio-identical means “exactly like the body”. Each hormone has a distinct chemical structure and cell receptors are waiting for that specific molecule structure to arrive so it can get the correct chemical message.

A lab can make all sorts of molecules from base ingredients. Pharmaceutical labs will take pregnant mares urine, extract the estrogen hormones and then alter them to make estrogen-like compounds. These hormones are not bio-identical, they don’t have the same structure as hormones made by the body and so give a partially correct chemical message.

A different lab can take a compound called diosgenin found in soy and wild yam plants and use this as the basis for making hormones which DO have the same chemical structure as those made by the body. These hormones are therefore “bio-identical”.

All estrogen used in creams, pills or patches can be described as 'synthetic'. Essentially, all this means is that it is artificially manufactured (i.e., in a lab). However, bioidentical means that the molecular structure is identical to the hormone made by your body.

Parlor Games’ estriol (as well as our DHEA and our progesterone) is derived from diosgenin found in plants like soy and yams, and then it is chemically altered so it has the exact same number of molecules (in the same quantity and layout) as the hormones in your body. (Unlike equilin, which will NOT be found in your body). You can read more about this process, here.

What about Environmental Xenoestrogens?

Xenoestrogens are molecules which are not estrogens but act like estrogens. Xenoestrogens are found in our environment - in food, plastics, beauty products, clothing, gasoline, fertilizers, and in equipment like non-stick pans. Because xenoestrogens mimic estrogens they disrupt our hormone receptors and our hormonal balance. Because the body doesn’t recognize these molecules it doesn’t have a way to easily metabolize them and clear them from the body so they can hang around for a long time causing damage to cells.

Phytoestrogens are natural plant compounds that can mimic the effects of estrogen in the body. They’re found in foods like soy, flaxseeds, lentils, and chickpeas. While they’re much weaker than your body’s own estrogen, they can still bind to estrogen receptors and have mild hormone-like effects. This can be helpful during perimenopause or menopause when estrogen levels drop — phytoestrogens may help reduce symptoms like hot flashes, support bone health, and even offer some protection for the heart and brain.

Xenoestrogens are NOT phytoestrogens.

Again, there are sweeping misconceptions around these as phytoestrogens (plant estrogens) and xenoestrogens are confused, i.e., soy is bad - actually soy is good and thought to be one of the reasons why women with diets high in soy have less cancers AND less menopause issues. In reality, things like parabens are much more of a problem and more hormonally disruptive. This is something we go into more depth in our xenoestrogen blog here.

So, Explain Estriol...

Silky Peach Cream contains 1mg of bioidentical estriol (at 0.02% - a low dose), designed to be applied topically (i.e., to the skin) to your vulva. Estriol is the most gentle of the estrogens. Estriol circulates in low levels in menstruating females. It levels are significantly higher during pregnancy. Estriol is especially helpful for skin integrity and mucous membranes. It is helpful in hormone replacement to balance estradiol side effects. Estriol can also be used in BHRT for women that cannot tolerate the strong potency of estradiol.

But, it doesn't stop there - estriol also plays a crucial role in your EQ - your estrogen quotient. You can read in depth about hormone ratios, here. In regards to your EQ, the Estrogen Quotient (EQ) shows how your three estrogens (estrone, estradiol, and estriol) are balanced. A healthy EQ leans more toward estriol (the gentler, protective estrogen) and away from estrone (the more aggressive estrogen linked to increased cancer risk).