Estrogen and Perimenopause
Ooooh, estrogen is so much to unpack during perimenopause!
First off - let's start with the idea that “estrogen dominance” is not really a thing, it’s more of a term to describe low progesterone.
Why is this important? Well let’s talk about period poop, PMS and clots!
These don't happen because you have too much estrogen. They are probably due to not having enough progesterone. While there is one pro-gest-erone (a steroid to keep you gestating with a baby friend) there are 4 different types of estrogen!
Estrogen makes people soft in a strong way. Soft powerful belly, luscious bouncy hips, lustrous soft skin, and juicy vajayjays. All people have estrogen in them, as well as testosterone and progesterone, all of which happen to be steroids.
Perimenopause can bring on its form of “roid rage”.
Estrogen Receptors
There are estrogen receptors all over the body, from top to tail and beyond. That includes skin, heart, brain, bladder, pelvic floor, genitals, uterus, prostate, lungs, bones, kidneys, and of course most famously the breasts, boobs, tits, and milkshakes, one reason there is caution around supplementation.
So estrogen is not as simple as “one and done."
The 4 Types of Estrogen
There are four different types of estrogen: E1, E2, E3, and E4. They differ in function, origin, and strength.
Instead of going from E1 to E4, let's talk about the most impactful first.
E2 - Estradiol is the estrogen that all people possess until they don't. It is sometimes referred to as E2. It is made in the ovaries and the testicles. When we think of hormone supplementation this is the type of estrogen that is usually prescribed. Estradiol is known for helping mood, bone strength, hot flashes, and feeling moist where moisture is desired.
E1 - Estrone, synthesized from cholesterol, liver, and fat cells, takes over when E2 is no longer able to do its job. E1 can make us fluffy and increase our cholesterol levels to give the body some estrogen before it transforms to E2. Once menopause sets in (no period for one year +), E1 takes over. This is the reason that we love an elastic band.
E3 - Estriol, well this one may bring the luster to the skin, luscious locks on the head, and is virtually nonexistent without a placenta pumping it out. Meaning that pregnancy makes this abundant and E3 is synthesized in the placenta. It has been recreated in a lab, the E3 is not a placenta, and many compound pharmacies add it in combination with E2. Some companies use E3 in skin care products. But who knows if they help.
E4 - Estetrol is the newest estrogen to hit the estrogen marketplace. In the lab, the formulation is synthesized from soy but IRL, meaning the body's factory, is the result of pregnancy. More specifically it is the estrogen that is produced by the fetal liver. No livers are in the actual pharmaceutical so calm down. This newest formulation does not connect to the estrogen receptors in the breast. There is a ton to be discovered with this new medication however it looks promising for all bodies dealing with the change in hormones.
Estrogen + Hormone Therapy
Finally, when we talk about hormone treatment/therapy. Lots of compounders may talk about Bi-est or Tri-est treatments, which combine 2 or more of the estrogens into a pellet or cream.
Some people swear by them, but the North American Menopause Society, as well as international organizations, do not endorse any compounding.
I have my thoughts, I go more with evidence-based medicine however if you like it, I love it as long as you know the risks. Mainly, unregulated and also less estradiol and more of the other types.
"What Estrogen Treatments are covered by insurance?"
Estradiol Patch
What it does: places the formulation that was most abundant in your body back into the body.
Bi-Est Cream
Used in hormone replacement therapy (HRT) to alleviate menopausal symptoms such as hot flashes and vaginal dryness.
I have tried the bi-est cream as an adjunct to my E2 patch and it was a MEH for me.
E4 Pill
Estetrol, or E4, is the first and only human estrogen that is sourced from a plant for birth control pills.
I have tried the E4 formulation in a pill, and while it may be great for nubile bodies, this old heffa (me) went right back to the E2 patch before any of her loved ones were harmed.
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Here’s the thing: the more you know, the more you can make the best choice for yourself. The idea is to take the pressure off.
Want to learn more about estrogen and perimenopause? I'm here to help! Contact me by clicking the button below for a free 15-minute discovery call.
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