It’s All About Balancing

By Yew-Por Ng, M.D.

Our hormones are the most delicately balanced system of our bodies. The same hormones that keep us healthy and happy can cause emotional and physical distress if they are not in equilibrium. Women with a healthy hormone balance tend to enjoy long, healthy and productive lives. However, long-term hormonal imbalance can make life pretty miserable for women and their loved ones.

The common problems that are associated with hormonal imbalance are premenstrual syndrome (PMS), infertility, breast cancer, tender or lumpy breasts, osteoporosis, heart disease, fibroids, endometriosis, mood disorders, fatigue, irritability and depression, foggy thinking, memory loss, bleeding between periods, ovarian cysts and hot flashes.

Hormonal treatment of all kinds is growing steadily more popular. The most common hormonal replacement treatment (HRT) is the use of Premarin,Provera, or Prempro. Premarin is an animal-derived form of estrogen. It contains equilin, or a conjugated estrogen derived from the urine of horses and is not human bio-identical. Provera is a synthetic progesterone called progestin or medroxyprogesterone. A large Women’s Health Initiative which studied the risks and benefits of the use of Prempro was closed recently because of the increased risk of breast cancer, heart disease, strokes and blood clots.

Why does it matter whether replacement hormones are an identical match (bio-identical) or just similar to your body’s hormones? It matters most when a hormone binds with its receptor.

Hormones are meant to fit perfectly with their receptors just like a “ lock and key.” When a molecule of bio-identical progesterone travels through your bloodstream and binds with a progesterone receptor, the fit is same as if the progesterone had been created in your own body.

On the contrary, a molecule of synthetic progestin such as Provera, which has a chemical structure only slightly different from that of progesterone, is in actuality a completely different molecule. The receptor can be fooled by it, but it does not fit quite right resulting in many side effects such as weight gain, swollen, tender breast, bloating, increased blood pressure, and feelings of anger and irritability, or depression.

After the hormone has completed its job at the receptor, it will be metabolized (broken down). The enzymes that metabolized hormones are very specific and discerning. This can create problems and manifest many adverse effects because the synthetic hormone sits on the receptor site longer than it should. The enzymes bypass the hormone without “recognizing” it .

Similar problems can occur with conjugated estrogen and Premarin. Because the hormones are not bio-identical to human hormones, they will exert an influence on the receptors and eventually on you.

For most women suffering from hormone imbalances, bio-identical progesterone and estrogen are far better choice than synthetic estrogens or progestins to establish the right biochemical communication between various organs.

The only way we can know for sure whether we need replacement hormones or not is to test our hormone levels.

Physicians who do hormone testing have traditionally used blood tests to determine hormone levels. But blood tests measure the total hormone content of our blood. That means they measure both the protein bound and bioavailable, or free, hormones. Bound hormones are ones that are a kind of circulating reservoir, being held in reserve. They are not biologically active. So a blood test that cannot differentiate between bound and free hormones gives us information that is not that useful.

Fortunately, there is a new method of hormone testing by measuring the free hormone levels in saliva. This is because bioavailable hormone molecules easily enter the saliva through the cells of the salivary glands, whereas the bound hormones do not. When we test for hormones in saliva, we get a precise level of the free hormones that are circulating through our bodies and interacting with the hormone receptors.

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