Lilly’s Question: 

Dear Dr. Davidson, I’m writing to say how illuminating your article on Estriol was for me. Especially your metaphorical descriptions of the actions of the 3 types of estrogens. I have a question, if I may. I am 49-years-old, I just entered menopause and started taking Botanical Phytoestrogens to help with the once a day hot flash. It helped for a month and then the flashes increased to several times a day. I then took Estriol, 5 milligrams and it helped. But since then that flashes have again increased and I’m using even more Estriol, 2 pumps morning and night. It’s made me feel very, very good, calm and a great sense of well being. My question is, is this too much Estriol to be using? What is the safe upper limit for Estriol in cream form? If I take progesterone and cream form as well, with this dull the good effects of the Estriol? Thank you for the possibility of asking these questions. Very best wishes, Lily.

Short Answer: 

Dosing for bioidentical hormones is dependent on the woman. It also depends on if she has her uterus or not. One of the rules of BHRT that we follow is that you never give a woman “unopposed” estrogen. This is especially true if she still has her uterus because estradiol and estriol will cause the uterine lining to grow. This is why progesterone is important because it helps to inhibit the growth of the uterine lining. For women that still have their uterus, we prefer to use bioidentical progesterone capsules, as opposed to progesterone cream.

PYHP 087 Full Transcript: 

Download PYHP 087 Transcript

Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast, I’m Dr. Maki. 

Dr. Davidson: And I’m Dr. Davidson. 

Dr. Maki: So, I’m just getting ready to start talking and my mic and my headphones practically fell off my head. How you doing this morning? 

Dr. Davidson: I’m doing great. Maybe you shouldn’t wear your Golden Knights hat. 

Dr. Maki: Yes, shoutout to everybody in Vegas. 

Dr. Davidson: We’d love The Golden Knights.

Dr. Maki: Yes, it’s really ironic. We live there for so long never had any professional sports. And right when they got that team, the season was going to start. And we left pretty much like, right as the season started and they had like one of the, I don’t know if anybody out there is a hockey fan or not I’m from Minnesota. So of course, I’ve liked hockey since I was a little kid. But they had like this crazy season that no one’s ever had before, for an expansion team. 

Dr. Davidson: It was definitely inspirational. 

Dr. Maki: And it’s funny too, well have granted it’s kind of started off in tragedy with that whole shooting they had there in October. But there are people there, we have patients there. And none of them really care for sports all that much now. Everybody is into the Golden Knights, which is kind of an interest, in which kind of a cool thing. It’s a very much created a very community-friendly environment. 

Dr. Davidson: And we wear our Golden Knights gear here in Washington like you’re wearing your hat right now. Which is why your headphones are slipping off but some people recognize it, it even appears in Washington, they recognize the team. 

Dr. Maki: Yes. Well, Seattle’s supposed to be, they already been awarded the team but now they’re going to be announcing the mascot here fairly soon or the logo or whatever. I’m not really sure what it’s going to be there’s rumors it was going to be the Kraken, and everyone thought was going to be the Sockeyes. Who knows? We’ll see. So we have another listener question to talk about. Why don’t you go ahead and read the question? 

Dr. Davidson: I think actually, this one was a reader. So this is one of the articles or blogs that we had written about Estriol and the different types of Estrogen. So this is a reader, this is a great shoutout to Lily. She wrote, “Dear Dr. Davidson, I’m writing to say how illuminating your article on Estriol was for me. Especially your metaphorical descriptions of the actions of the 3 types of estrogens.” Lily, you’re already my new favorite person. Illuminating metaphorical descriptions of, she’s awesome, anyway. So, Lily goes on to say “I have a question, if I may. I am 49-years-old, I just entered menopause and started taking Botanical Phytoestrogens to help with the once a day hot flash. It helped for a month and then the flashes increased to several times a day. I then took Estriol, 5 milligrams and it helped. But since then that flashes have again increased and I’m using even more Estriol, 2 pumps morning and night. It’s made me feel very, very good, calm and a great sense of well being. My question is, is this too much Estriol to be using? What is the safe upper limit for Estriol in cream form? If I take progesterone and cream form as well, with this dull the good effects of the Estriol? Thank you for the possibility of asking these questions. Very best wishes, Lily.

Dr. Maki: So, there’s a few things there. First off, she says she started off with Botanical Phytoestrogens. So that is herbs like black cohosh, red clover. 

Dr. Davidson: Dong Quai. 

Dr. Maki: Yes, those are herbs that have, they don’t have hormones in them. 

Dr. Davidson: Vitex too. That’s another real popular phyto es- well, that’s more for the progesterone.

Dr. Maki: Yes. that’s more on the progesterone side. But still, definitely, herbs that have somewhat of a, they don’t have hormones in them, right. They don’t provide the body with hormones, but they have a hormone-like effect. The phytoestrogens especially black cohosh it works by affecting the estrogen receptors so you get a similar response. Now granted, when a woman’s going from perimenopause into menopause, the severity of their symptoms will dictate just like in this case, whether those phytoestrogens will be effective or not. 

Dr. Davidson: Exactly. So you think, phytoestrogens are actually great to use in both lower hormones like from perimenopause to menopause. And it’s actually great to use also in people that have high estrogen. Because like you said as a phytoestrogen, what it’ll do is that black cohosh or as a phytoestrogen will kind of basically stimulate the receptor weakly like very weak stimulation of the estrogen receptor. So if you don’t have any estrogen in your system, and you have a weak stimulation of that receptor, you’re going to have a little estrogen activity in the body. Hence, with Lily, going into menopause, the phytoestrogens probably helped for a little bit. But let’s say you’re a younger female with you’re making too much estrogen so if you put that phytoestrogen, if they take phytoestrogens, it’ll actually block that receptor and dampen down the big reaction that they’re having from that estrogen dominance if that makes sense. 

Dr. Maki: Yes, right. So hormones in the body are produced by certain glands. They go into the bloodstream and then they attach to a receptor that is on basically all of our cells, our brain cells, our muscle cells, our liver cells, our kidney cells, every cell has receptors for these particular hormones. So when a woman’s in menopause or transitioning into menopause in her own hormone production. Progesterone and estrogen are declining, then taking a phytoestrogen in some respects makes some sense because now you’re still going to be stimulating those receptors in a way, but you’re not taking any hormone. But like this question says, or what she’s alluding to is which is what we see. You and I are naturopaths, we love our herbs but sometimes the herbs are just not enough to provide the relief that a woman needs. 

Dr. Davidson: Yes, so I like how she’s using basically, the therapeutic working at the very least intervention, at the very lowest therapeutic range. So, you never want to jump up to the top which would be harsher medications or surgery is you always want to start lower with lifestyle, or supplementation, or botanicals so she started at that lower intervention. Notice that it helped a little bit and then it didn’t. And that could be because really, truly if Lily’s 49 and she’s transitioning, she’s probably not necessarily 49, not exactly in menopause she’s between perimenopause just gently gliding into menopause, and the phytoestrogens to help spur a little bit and as her body is transitioning more into the full phase of menopause, she needed to go a little higher on that ther