So there you are…
Nauseated, the room is spinning. You are wondering if you will ever make it off of this “I’m-going-to-hell-in-a-hand-basket roller coaster.” You bend over, hands on your knees, and watch a few more beads of sweat drip into a huge puddle pooling on the floor. Your hair is soaked, your skin is red, and your entire body feels like it’s on fire. The bottom of your feet are soaking wet and even your sweat is beginning to sweat. Are you gearing up to finish the most brutal workout in the history of properly periodized weight lifting? No, you are not…because you are having the mother of all hot flashes!
This is a very common scenario. If I had a nickel for every time someone contacted me asking about the use of various types of hormone creams for hot flashes and other symptoms of hormonal imbalance, I would be composing this post from a hammock in a tropical paradise while sipping bone broth and eating lots of tropical fruit (instead I am composing it from my home office, which is not in a tropical paradise – yet- but I am sipping bone broth and eating tropical fruit).
It is very common to hear in popular medical culture that, “Hormone creams are a great way to balance hormones and help alleviate the symptoms of menopause.”
My question to you is – Is that really true?
My take on this topic may surprise you; and that is…hormone creams may in fact cause more problems than they solve long-term.
Hormonal Hell, Fire, and Other Stuff
It has been my experience that in a great majority of cases, women find them themselves suffering more symptoms and creating other more problematic hormone imbalances as a result of the hormone creams they are using. One of the reasons, among many, for this is that many of these women have never had their hormonal system accurately assessed to any real degree. On top of that, even fewer of them have taken a serious look at their nutrition and in what ways what, how, and when they are eating may be contributing to the creation of their hormonal hell.
By far the most common scenario that I see is that many females are placed on progesterone creams, particularly when they are “pre-menopausal” or going through “menopause.” Personally, I find the term “pre-menopause” to be very peculiar. Isn’t every female, from the time she is born, technically in a “pre-menopausal” state?
Oh, a quick side note – the body doesn’t magically start with these symptoms at some predetermined, arbitrary age. The body doesn’t wake up one day and say, “Welp, today we are 40, or 45 years of age…let’s start screwing a bunch of stuff up today!” That’s not how the body works.
While progesterone is a critically important hormone and has protective and youth-associated properties to it, often the recommendation to use a topical cream has little to no long-term benefit.
- Most of those creams, even when well compounded, contain several or more types of solvents. These solvents actually block some of the absorption of progesterone and also make it very difficult to regulate the dosage that one receives when rubbing on 1 pump or ¼ teaspoon, or whatever the recommendation may be.
- Progesterone cycles in terms of its ratio to other hormones in the body as do other hormones. Slapping on a random amount without an accurate assessment of what is really going on with your hormonal chemistry throughout a given 28-35 day duration can only lead to further imbalance in the long run. Oh, and by the way, this is true whether you are cycling or not.
- What if one is not deficient in progesterone? It is possible to have hormonal issues and be going through a personal hormonal hell without being deficient in progesterone. One could simply be dealing with excess estrogen, which does not always include progesterone deficiency. Taking progesterone when it is not needed will lead to further disruption of the monthly cycle.
- If one does not regulate the nutritional factors necessary to optimize thyroid function and estrogen:progesterone balance, one will inevitably super saturate with these creams. I have seen this in more cases than I care to count.
Estrogen Accumulation and Dominance
Typically, it is thought that estrogen dominance is strictly a female issue. This is definitely not the case. While it is true that many females are challenged with estrogen dominance for a variety of reasons, it is equally as challenging for males. Estrogen can be allowed to accumulate, which often leads to estrogen dominance, for a variety of reasons. Please note, there is also a physiological scenario that presents as estrogen dominance when estrogen levels are low, and not normal or elevated (this, in my opinion, does not mean that you need estrogen therapy or creams however).
MANY things can contribute to excess estrogen. SOME of those things are…
- Chronic Stress Response: Any time the energy demand on the body exceeds the supply, the stress response is initiated. Excess estrogen has been shown by Hans Selye, M.D. to mimic the shock phase of the stress reaction. As well, as part of the stress reaction/response, the amount and biological effects of estrogen are likely to increase through a number of physiological mechanisms that are beyond the scope of this post.
- Dysglycemia (Poor blood sugar control): Having poorly regulated blood sugar levels throughout the day and night will basically exacerbate Number 1. On a side note, excess estrogen is a glucose waster and will contribute to blood sugar issues if left unchecked.
- Decreased thyroid function: Excess estrogen effects the binding sites for thyroid hormone. Basically, the more estrogen one has running around in the system, the less effective their thyroid output becomes. The key point is that adequate thyroid hormone (T3) is required for the effective detoxification of estrogen. Without it, estrogen is allowed to further accumulate and further decrease thyroid output and this series of physiological events literally perpetuates themselves.
- Environmental exposure: Estrogenic chemicals and endocrine disruptors are quite literally everywhere in our environment. From hygiene products to cosmetics to air fresheners and household cleaners – our exposure to estrogenic substances is incredibly high and frequent.
- PUFAs (poly-unsaturated fatty acids): The detrimental effect of PUFAs on human physiology is well beyond the scope of this post. That said, one of the largest issues with PUFAs is that they will prevent the binding of estrogen to sex hormone-binding globulin (SHBG), which much estrogen is typically bound to in order to render it “inactive.” By breaking and/or preventing this binding, PUFAs directly and indirectly increase the biological activity of estrogen.
- Radiation exposure: Aside from being estrogenic, radiation exposure structurally damages and decreases the function and efficiency of the mitochondria of your cells. This down-regulates energy production at the cell level which is exactly the opposite of what anyone wants and needs in order to create a healthier, better functioning physiology.
- Endotoxin: Clinically known as LPS – lipopolysaccharide – endotoxin can actually down-regulate certain detoxification pathways that are utilized in the detoxification of estrogen. It has been shown that endotoxin can increase estrogen levels by up to 500% in both males and females. It is easy to overproduce and absorb endotoxin when one has a diet that is high in indigestible foods, such as cellulose and pectin containing foods.
- Heavy metals: These, particularly mercury, can affect the binding sites for thyroid hormone. The same can be said for halogens such as fluoride, etc.
- Overproduction of aromatase: Too much aromatase in the body will convert testosterone into estrogenic hormones and leave both men and women with low testosterone and high estrogen levels. Blood sugar control and reduction of PUFA in the nutritional regimen are critical here because when blood sugar is not regulated tightly, or if one’s physiology is under the influence of a chronic stress response, this will eventually lead to elevated blood sugar and insulin levels. Remember, PUFAs hyper-stimulate the beta-cells of the pancreas and can create hyperinsulinemia (elevated insulin in the blood). In the end, the high insulin will lead to an increase in aromatase, thus increasing the conversion of testosterone into estrogen.
A key point to be made is that estrogen is not the downfall of the western world (that’s soccer…just kidding, sort of). It is needed. It is the ratio of estrogen to progesterone and other hormones that really matters. Just like all other things in life, it is a matter of balance.
So – what do we do about all of this?
Just because a female has identified herself (accurately) as being estrogen dominant does not necessarily mean that she should start replacing her bathwater with progesterone cream. The body manufactures progesterone from cholesterol (and LDL actually). To make a long physiological story very short, cholesterol is converted to pregnenolone and then to progesterone in the mitochondria and cytoplasm of the cells of the body.
The trick is that the body must have the nutrition on board to support the conversion. If it does not, cholesterol is allowed to accumulate and much of the body’s protective and youth associated hormones are not synthesized in proportionate amounts to maintain hormonal balance. Vitamin A (animal source), magnesium, thyroid (T3), zinc, manganese, copper, and other nutrients are necessary for this conversion to take place. Does that mean that one should look to supplement with these nutrients? No, not necessarily…
Nutrition is Key
For me, the first steps in overcoming or avoiding estrogen dominance/progesterone deficiency are to decrease the intake or exposure to the items on the list mentioned above. Tight regulation of blood sugar is a critical first step. Without it, one will be on the proverbial hormonal roller coaster both short and long term. This leads to further hormonal imbalance in the long run.
Think of the effective regulation of blood sugar as a three-legged stool. The three legs of the stool are: (1) Eating the proper foods to support energy production at the cell level (2) eating those foods in the proper macronutrient ratio – carbohydrates:proteins:fats and (3) eating meals at the appropriate frequency for your physiology at this stage in the process of creating health.
If any one of the three legs of the stool is unstable or missing, the stool is likely to collapse. This collapse comes in the form of fatigue, weight gain, sleep issues, energy highs and lows, hormonal imbalance, sluggish liver and thyroid function, headaches, irritability, cravings, skin issues, GI upset and dysfunction, inability to lose/gain weight, fertility issues, and on and on the list goes.
To be honest, it is best to not focus on “end result” hormones such as estrogen hormones, progesterone, and/or testosterone. Using these hormones as a body spray or skin moisturizer may in fact create more hormonal havoc long-term. Instead, it is more advantageous to focus one’s efforts on the core of the hormonal challenges/imbalances as they are represented in your thyroid function. There is actually research that demonstrates that correcting and optimizing thyroid function is more effective at reversing gynecological issues than all other efforts combined! The focus is on the proper nutrition and lifestyle/behavioral modification to assist you body in enhancing its auto-regulation capacity and recreating its balance.
If one puts in the necessary effort to fully customize their nutritional regimen based on that three-legged stool for say 6 months to a year (and neither of these is a long period of time in the grand scheme of things) and s/he is still dealing with symptoms of hormonal imbalance, then consideration of the proper replacement of the hormone in question could potentially be warranted…but not before that is done. In my experience, the use of hormone creams is unnecessary in the vast majority of cases.
- From PMS to Menopause: Female Hormones in Context by Ray Peat, PhD.
- Nutrition for Women by Ray Peat, PhD.
- What Your Doctor May NOT Tell You About Menopause by John R. Lee, M.D.
- John Lee’s Hormone Balance Made Simple by John R. Lee, M.D.
- What Your Doctor May NOT Tell You About Premenopause: Balance Your Hormones and Your Life from Thirty to Fifty by John R. Lee, M.D.
- Hypothyroidism: The Unsuspected Illness by Broda O. Barnes, M.D.