Estrogen Part 2

Last time, in part 1, we briefly talked about estrogen during the different phases of life.  But now, let’s focus on the post-menopausal period.  That stage of life when the ovaries no longer produce adequate amounts of estrogen, OR an individual has entered menopause surgically after total hysterectomy with oophorectomy (removal of the uterus and ovaries).  Symptoms during this time are due to low levels of estrogen.  These include hot flashes, increased abdominal fat, mood swings, decreasing bone density or bone fractures, foggy brain, wrinkles, and thinning of skin.  Sounds uncomfortable, right?  So, what do we do about it?  Replace it!  But wait, you say, aren’t there studies indicating that hormone replacement is dangerous?  The answer to that is, yes and no.  Yes, there are studies of replacement with SYNTHETIC estrogens (and progestins) that show increased risk of cardiovascular disease, stroke, and breast cancer.  On the other side, BIO-IDENTICAL hormones actually show protection and risk reduction of these same things. 

The bottom line is that there are multiple avenues to go about replacing estrogen.  So, let’s get into the details below!


What if prescriptive options don’t appeal to you, are there herbal options?  Yes!  Some individuals either prefer herbal options or are too sensitive/reactive to hormone replacement that prescriptive options are not viable.  There are many herbs used in the post-menopausal period that are very beneficial for estrogen balance and helping alleviate symptoms of estrogen deficiency.  These are primarily Dong Quai, Maca, Black Cohosh, Borage Oil, and Evening Primrose Oil.  Often these herbs are accompanied by herbs that also help promote progesterone balance.  It is important to remember that we never want to replace estrogen without also replacing progesterone, as they balance each other out, like Yin and Yang or two sides of the same coin. 


Bio-identical estrogen, while synthetically made in a lab, is as natural as you can get in a prescription form.  Bio-identical estrogen is, well, IDENTICAL to the estrogen you naturally produce in your body.  There are three ways that this hormone can be replaced in your body; orally, topically, and via pellet insertion.  Let’s go through each one.

                Oral: Oral is the most common form of replacement and is a tablet to be taken daily.  Typically, very well tolerated, and absorbed easily, this form rarely carries side effects if dosed at low levels and gradually increased over time. 

                Topical:  Topical preparations come in two forms, cream or patch, and are great options for those that may not be the ideal candidate for oral estrogen replacement.  Topical or transdermal applications also have the advantage of not having to go through gastrointestinal processing, which may reduce absorption rate in the liver.

                Cream: Estrogen creams are a great option for individuals who don’t mind daily application, or who may have an allergy to medical adhesive.  Creams are also wonderful for individuals who are sensitive to oral replacement, as there is a lower absorption rate with creams. 

                Patch: Patches are commercially available and are switched out twice a week.  They are great for those who may not remember to apply the cream daily and are administered in a lower dosage due to wearing the patch constantly.

                Pellet: Estrogen pellets is a therapy in which the hormone is surgically implanted just under the skin for constant delivery.  While this offers even more convenience than the patch, once implanted, it cannot be removed.  Many women prefer this option to daily medications, or weekly patches, but it would not be advised for those with a medication history that included sensitivity to hormones or other medicines.


Synthetic estrogens have been used in both oral and topical applications and carry a higher side effect risk and profile.  They are commonly used in birth controls and are also given later in life during menopause.  The Nurses’ Health Study is commonly cited for its observation of increased risk associated with cardiovascular events with use of synthetic estrogens.  Of additional note, the duration of use for synthetic estrogens (and progestins) is included on many risk assessments in oncology.  While easily available, synthetic preparations are not the ideal or healthiest options for women seeking hormonal balance and support.


In summary, there is a multitude of options for women seeking to optimize their hormonal health. A conversation between the patient and the practitioner is the best way to choose which method would be best, and how to best individualize care. Optimizing this incredibly important hormone leads to improved quality of life and increased vitality. Now that’s something we all want!

Dr. Elysia Harrsch Dr. Harrsch became a board-certified primary care Naturopathic Physician after completing a four-year medical degree program at the National College of Natural Medicine in Portland, OR. During this time, she developed a passion for physical medicine, thyroid disorders, nutrition, bio-identical hormone replacement therapy for men and women, complimentary cancer care, and preventative medicine.

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