| Estrogen Dominance in Post-menopausal Women |
01.25.12 11:36:22 |
Video Transcript:
Hi. I’m Dr. Christopher Mote, and today’s another ARK Clinical Pearl.
I want to talk to you about a concept called estrogen dominance. Maybe more appropriately, progesterone deficiency, but specific to a postmenopausal woman. You know, one of the common symptoms or the common symptoms that seem to happen or occur in these patients are the hot flash, of course, which drives them into the office; anxiety; insomnia`; fatigue; depression.
And typically what you get back on their test result is an estrogen that oftentimes is normal but a progesterone that’s low. And if you compare those two and you use the ratio of progesterone to estradiol – some experts will say that should be 30 to 1, maybe 100 to 1 – but in either case, if that’s a low progesterone and you have these symptoms, I want to give you an understanding of the hot flash using an analogy of a ballerina on a stage. And estrogen is the ballerina. The stage is your progesterone.
As a ballerina leaps into the air and lands, everything is great unless the ballerina happens to leap ten feet in the air. She’s gonna crash, and there’s gonna be a hot flash. Or the progesterone, as she leaps into the air, could bottom out and that stage drops ten feet. In either case, if the ballerina falls to the stage, you have a hot flash. And hour by hour, the estrogen levels and the progesterone levels in a postmenopausal woman can fluctuate. So how do we approach that?
Well, the traditional approach to HRT has been to put that ballerina on a guide wire and keep the estrogen levels up high, and we know that that’s not the safest approach. The more recent approach has been to use progesterone creams and keep that stage up really high, so again you don’t have a crash. But we feel like the safest approach is to work with the adrenal axis first, because the progesterone and estrogen levels that a postmenopausal woman requires, 50 percent of that need can be met by a functioning HPA axis. But chronic stress robs a woman of the estrogen and progesterone level.
So our plea is to work on the HPA axis first, regain all the endogenous estrogen and progesterone that a woman can get, and then use sparing, small, icing-on-the-cake doses of estrogen and progesterone.