September 2, 2002
To Take Or Not To Take Estrogen
By Ruth Winter, MS
Women live longer than their great-grandmothers. At the turn of the century, women died before or shortly after their ovaries shut down so they never had to face heart attacks, hip fractures or high cholesterol. Before the bad news on hormone replacement therapy that shut down the use of supplemental estrogen in the Women’s Health Initiative (WHI) study funded by the National Institutes of health, one fourth of all postmenopausal women in the United States were taking some form of estrogen replacement therapy (ERT) to relieve hot flashes, mood swings, vaginal dryness, and other effects of menopause. The use of oral estrogen, often taken in combination with progestin (a natural or synthetic progesterone), were reported to provide other benefits – including control of thinning bones and heart and blood vessel disease (CVD). There were also reports that said it prevented tooth loss and acted as a barrier against Alzheimer’s Disease.Much of the research promoting the use of estrogens was supported by pharmaceutical companies, which, of course, wanted good results that could help sell their products. Countering this "good news," however, were studies that challenged the use of hormone replacement therapy (HRT) for its preventive properties. Estrogen, delivered through HRT or oral contraceptives, had been implicated in breast cancer, overgrowth of the lining of the womb and blood clots. For a number of years. Certain forms of progestin, were reported to be a factor in contributing to heart disease. As physicians and researchers debated about giving healthy fertile and postmenopausal women hormones, an effort was made to try and identify patients who would benefit or be harmed by the therapy. Patient history, genetics, and even alcohol intake were considered as well as timing in initiating therapy, dosing and type of estrogen. One thing is clear---in her entire lifetime, a women produces less than two teaspoonful of estrogen and progesterone. Swallowing supplemental estrogen and progesterone could certainly affect the exquisite balance of hormones in her body. What choice should you or your loved one make about whether or not to take supplemental estrogen either in a birth control pill or as a hormone replacement therapy? Even before the stoppage of the estrogen administration in the Women’s Health Initiative, experts advised, in general, that hormone not be used if: You have an immediate family member---mother, sister, or daughter---who has had breast cancer If you have had a stroke If you have high blood pressure that is poorly controlled by medication If you suffer from migraine headaches If you have had circulatory problems such as a deep-vein blood clot If you have a family history of heart disease If you take other prescription or over-the-counter medicine, estrogens may alter the effect of some other drugs, including those to prevent blood clots, diabetes drugs, calcium supplements, and the breast-cancer drug, tamoxifen. Eventually, the decision as to whether or not to take estrogen rests with each woman and her physician. *** WHAT ABOUT SOY AND OTHER PLANT ESTROGENS? A host of estrogens, including genistein and daidzein have been identified in plants. Although they are considerably less active than those in animals, they have been reported to protect against a number of cancers including prostate, breast, colon, melanoma, and others.. Increased blood levels of phytoestrogens-- plant estrogens found in such foods as soybeans, chickpeas and other beans – were linked to beneficial cholesterol levels and better arterial function in women, according to results of a nationwide study presented by Cedars-Sinai Medical Center cardiologist C. Noel Bairey Merz at the American Heart Association's annual meeting in November 2000 Kenneth Setvchell, PhD, professor of pediatrics at Children’s Hospital and Medical Center in Cincinnati, demonstrated that regular soy foods contain enough plant estrogens to have a marked hormonal influence. He and his colleagues fed a group of young women sixty grams of textured soy protein daily and observed what happened to their menstrual cycles. After four weeks, the time between their cycles increased two to five days. Longer menstrual cycles mean a lower lifelong exposure to estrogen, which in turn is believed to lower cancer risk. Scientists at Wake Forest University School of Medicine began a five-year study in 1999 to determine which ingredients in soybeans are the active ones in protecting against heart disease, stroke, cancer and osteoporosis under a $2.4 million grant from the National Heart, Lung and Blood Institute. The research team, headed by Thomas B. Clarkson, D.V.M., are focusing on two phytoestrogens in soy: genistein and daidzein. Clarkson said, "We have obtained preliminary evidence suggesting that daidzein rather than genistein may be of greater cardiovascular benefit." Genistein is the predominant phytoestrogen in the outer portion of soybeans. Daidzein predominates in the germ of the soybean, he said. How plant estrogens in soy and other foods work in the body may depend upon a woman’s age, according to Johanna Dwyer and her Colleagues at New England Medical Center and Tufts University. In an article in The Journal of The American Dietetic Association as far back as 1994, they theorized that in premenopausal women, who have high levels of circulating estrogen, the estrogen receptors (docking stations on the cell) are occupied and plant estrogens must compete for these sites. Because the plant estrogens have lower “docking power” than human-made estrogens, the net effect may be only weakly effective. In postmenopausal women, however, The New England researchers say, self-produced estrogen concentration declines about 60 percent, leaving the “docking stations” more receptive to plant estrogens. The story is not finished about either pharmaceutical hormone replacers or plant estrogens. There are epidemiological studies, however, that show that Japanese men have a far lower incidence of prostate cancer than American men and that Japanese women have a much lower incidence of breast cancer. A number of researchers have attributed this to the Japanese diet high in soy. For more information about soy estrogens and for soy recipes check: Super Soy: The Miracle Bean (Crown and Replica editions). *** MEDICATIONS ARE GETTING NOSEY Diabetics are eagerly awaiting insulin that can be sniffed through the nose instead of injected and researchers are working on a flu vaccine that can be administered the same way—without an injection. In the meantime the Mayo Clinic Health Letter this month says that nasal forms of medications can provide a safe, effective alternative when pills or Injected drugs are impractical or ineffective. Conditions being treated nasally, right now, include osteoporosis (fragile bones), migraines and a water-retention-and- elimination disorder (diabetes insipidus). Nasal sprays also are used to help in smoking cessation. When given nasally, medications are absorbed through mucous membranes. In some cases, this allows delivery directly to the brain. Nasal delivery makes it possible for the drugs to take effect more quickly than pills. If you are interested in the Mayo Clinic Health Letter, you can call for information, 800-333-9037, extension 9PR1. *** NEW LIGHT ON LASER LIGHTS Dermatologist Arielle N.B. Kauvar, MD, Clinical Associate Professor of Dermatology, New York University School of Medicine, New York, reported at the recent meeting of the American Academy of Dermatology that the new lasers can treat the signs of aging, such as wrinkles, brown spots, and loss of elasticity with less destruction of the skin and less downtime. "In the past, techniques for improving aging skin required invasive laser or surgical procedures which produce open wounds and require long recovery times," said Dr. Kauvar. "Today, men and women can choose from a variety of non-ablative laser procedures designed to reverse, improve or erase the early signs of aging, take very little time to perform and have a minimal, if any, recovery period." Non-ablative lasers heat a layer of tissue under the skin's surface without damaging the top layer of the skin, therefore producing no visible wound. By emitting a beam of light that is absorbed by the water in skin cells, these high-energy lasers can improve superficial and moderately deep wrinkles, such as those on the upper lip, the crow's feet around the eyes, as well as the shallow wrinkles on the cheeks and forehead. These treatments result in a microscopic wound healing response, which promotes new collagen formation. The production of a new layer of collagen leads to improved skin tone and texture, and a decrease in wrinkles and scars. This procedure is known as laser toning. Using computer analysis of skin texture and devices to measure skin elasticity, Dr. Kauvar studied the use of non-ablative lasers to treat aging skin. In Dr. Kauvar's study, YAG lasers were used to treat fine lines, acne scars and overall skin tone. Dr. Kauvar's research found that three to six treatments, at two to four week intervals, produced overall improvement in the skin's appearance. Non-ablative laser rejuvenation generally takes 10 to 15 minutes, and may be proceeded by a 30-minute application of a topical anesthetic cream. Following laser toning procedures, the skin may appear red and blotchy for a period of several hours. Since there are no visible wounds to the skin, make- up may be applied immediately after treatment. The results from these laser treatments generally last six months. A series of treatments may be safely performed from time to time to maintain the outcome of the procedure. "In addition to treating fine lines and wrinkles and overall skin toning effects, some of these non-ablative lasers are also being utilized to improve skin discoloration from dilated blood vessels or irregular pigmentation," said Dr. Kauvar. "The pulsed dye lasers, which deposit heat energy selectively in the superficial capillaries of the skin, have been shown to be effective in improving skin tone and texture, as well as redness from dilated blood vessels and rosacea." Additionally, a combined technique utilizing pulsed and YAG lasers has shown improvement in skin discoloration from pigment and blood vessels as well as overall tone and texture. The light from the pulsed laser is absorbed by blood vessels, which are then destroyed by the laser's energy and cleared away by the body. The light from the YAG laser is absorbed by pigment in the skin as well as by water. By targeting the pigment, brown blotches can improve, new collagen production is stimulated and an improved appearance of the skin's texture results. The advantage these laser rejuvenation treatments have over other skin rejuvenation procedures is that these enable the improvement of a variety of changes in skin texture and color in just a few visits with little to no downtime. Further, these laser techniques do not damage the skin's natural pigmentation and almost any skin type or ethnic skin type can be safely treated with non-ablative laser therapy. For more information, contact the AAD at 1-888-462-DERM or www.aad.org . copyright Ruth Winter 2002
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