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Do I need estrogen? Answers, by Dr. Joseph Collins Question: Dr. Collins, I chose to quit taking an estradiol patch. I am using a progesterone cream that supplies 20 mg per dose. I ma taking it twice a day. I've not had any hot flashes, night sweats or vaginal dryness. I have solved my problem of getting to sleep with 3mg of sublingual Melatonin. My doctor is not in agreement with me. She says if I don't take estrogen that my vagina, labia, breasts, bladder will all suffer atrophy. She also claimed it would help with bone loss and my heart, but I know that there are never been found osteoblast receptors for estrogen and that estrogen actually causes clotting. If I feel good, do I need estrogen? Answer: The only way to determine if you need estrogen is to have your levels tested. You want to be sure that you have enough to protect your tissues. Even though progesterone can decrease some of the symptoms of menopause, it cannot protect vagina, labia, breast, bladder, bone, heart and brain from estrogen and testosterone deficiency. So your doctor is doing well by drawing your attention to the actions of estrogen. But talk some more with your physician and ask her to explain to you the different choices you have available. Since progesterone is a precursor (building block) for estrogens and testosterone there is a "chance" that you are making estrogens and testosterone. So testing is a good idea. However, there is also a chance that you may develop deficiencies of both estradiol and testosterone. There actually are estrogen receptors on osteoblasts, a fact first published in 1992. See page 65 and reference numbers 22-25 on page 146. There are also testosterone, DHEA, and androstenedione receptors on osteoblasts. Each of these hormones is required to prevent osteoporosis. Of interest is the fact that estradiol deficiency in men (yes, males) causes osteoporosis - all men normally have some estradiol. Though a high dosage of synthetic estrogens, as was once used for birth control, does increase risk of blood clots, normal estrogen levels do not increase this risk. The most important point to remember when evaluating hormone replacement therapies is the fact that the three hormones - estradiol, progesterone and testosterone - are all required for healthy function. Even if a woman "feels good" she can still be developing osteoporosis, heart disease, dementia and other hormone deficiency conditions. Remember - osteoporosis, heart disease and dementia may not have symptoms until the damage is done. As always, do not expect hormones to do all the work. Exercise, rest, good nutrition, herbs and hormone precursors should also be considered. Also, use caution when using topical progesterone twice a day. Progesterone levels peak once a day in the morning, and upsetting this rhythm may cause sleep, mood or fatigue disorders. Dr. Joseph Collins
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