KEVIN M' LOGAN, MD

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KEVIN M. LOGAN, MD
Advancing the Treatment of Womens Health Through
Integrative and Complementary Medicine April 27,
2005 Conseco Conference Center Carmel, IN
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Womens Health and Integrative Medicine

• Breast cancer has increased from 1 in 10 to 1 in
  8 women over the last 50 years
• Womens health initiative study and hormone
  therapy showed increased risk of breast cancer
  with Premarin (horse urine) and increased risk of
  stroke/heart attack with synthetic Progestin
  (Provera)
• Osteoporosis continues to increase at a rapid
  rate
• Women have surpassed men in occurrence rates of
  cardiovascular disease
• Hormonal disorders such as fibroid tumors,
  severe PMS, infertility, endometriosis,
  fibrocystic breast disease, and others afflict
  more women every year
• Why the increase? Does stress have a role?
• Prevention is the key

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Lets Talk Hormones!

• Essential for quality of life and well-being
• Regulate energy production and cognitive
  function
• Stimulate metabolism and promote healthy weight
• Maintain healthy bone structure and muscle mass
• Important for sex Libido and sexual function
• Promote youthful appearance Skin integrity,
  hair and nail growth
• Support healthy mood and restful sleep

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Pituitary
Hypothalamus
TSH
LH/FSH
ACTH
Thyroid
T3
T4
Adrenal
DHEA
Cortisol
Glucose (Sugar)
Insulin
Aldosterone
Mineral/Water metabolism
Estradiol
Estrone
Estriol
Ovaries
Progesterone
Testosterone
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Adrenal Fatigue is the Most Common Hormone
Imbalance in the 21st Century

• Causes
• Poor diet, lifestyle, excessive work, chronic low
  grade infections, toxicity and stress
• Symptoms
• Fatigue, hypotension, sugar craving, weight gain,
  poor immune function
• Diagnosis
• Low cortisol, DHEA, Pregnenolone, and stress
  intolerance, low blood pressure
• Treatment
• B Complex (especially B5/B6) vitamins,Zinc,Magnesi
  um
• Licorice root, Ashwaganda, Rhodiola
• DHEA, Pregnenolone

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Low Thyroid

• Causes
• Iodine deficiency
• Heavy metal toxicity- especially mercury from
  silver fillings
• Low progesterone, infection, high
  carbohydrate/caffeine intake
• Symptoms
• Weight gain
• Low basal body temperature (BBT)
• Fatigue
• Hair loss
• Dry skin
• Brittle nails
• Depression, bipolar, inability to sweat, and
  constipation
• Diagnosis
• Low BBT
• TSH gt 2
• Low NL T3/T4
• High RT3
• Treatment

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Menopause

• Causes
• Decrease in of ovarian function
• Severe symptoms may be due to dietary
  indiscretion
• Lack of adrenal hormones
• Toxicity
• Symptoms
• Insomnia
• Dry/wrinkled skin, vaginal dryness, hair loss
• Hot flashes, night sweats
• Frequent urinary infections
• Decreased libido
• Emotional lability, mood swings, fatigue
• Cognitive dysfunction-decreased focus, memory and
  concentration
• Facial hair growth
• Osteoporosis
• Diagnosis
• High FSH
• High or low estrogens
• High or low progesterone

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Womens Hormonal Health Assessment

• Contemplation of hormone therapy
• Beforebaseline levels and metabolism
• Afterto monitor therapy make adjustments
• Evaluation of hormone-related disorders (e.g.,
  PMS, fibrocystic breast disease, PCOS,
  osteoporosis)
• Assessment of breast CA risk (positive family
  history, previous breast CA, HRT considerations)

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Steroidgenic Pathway
Pregnenolone
Cholesterol
Progesterone
Precursors
Androgens
Androstenedione
DHEA-S
Testosterone
Binds
Aromatase
SHBG
Aromatase
Estradiol (E2)
Estrogens
Binds
Estrone (E1)
Estriol (E3)
Legend
Estrogen Metabolites
Promoter
2-Hydroxyestrone
16-alpha-hydroxyestrone
Inhibitor
Methylation Products
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Estradiol (E2)

• Most potent estrogen (12 Xs more potent than
  estrone, 80 Xs more potent than estriol
• Predominant estrogen in pre-menopausal years but
  the one most off prescribes to treat menopausal
  symptoms
• Produced primarily in ovary
• High levels of E2 associated with PMS, ovarian
  cysts, uterine fibroids, endometrial hyperplasia,
  and increased risk of breast CA in both pre-
  post-menopausal women
• Increased incidence of the above conditions when
  excessive xenoestrogens are present ie toxins
  such as plastic, pesticide, perfumes, paint, soy,
  etc.
• Low E2 may be associated with infertility/absent
  menses, bone resorption, and depression-type PMS

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Estrone (E1)

• Predominant estrogen in post-menopausal women
  (despite lesser amount of total estrogen)
• Primarily produced by conversion of adrenal
  androstenedione in the peripheral tissues
• May correlate with high insulin and body mass
  index
• Similar clinical correlations for E1 and E2

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Estriol (E3)

• Least potent and smallest fraction of estrogen
• Metabolized primarily from estrone
• MAY be cancer protective when more potent
  estrogens are high
• Limited research on non-pregnant women

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Progesterone

• Balances estrogen and counters proliferative
  effects of estrogen on endometrium and precursor
  to other steroid hormones
• Downregulates estrogen receptors
• Produced primarily by corpus luteum (egg
  remnant) in pre-menopause, and the adrenal glands
  in post-menopause
• Low progesterone common with luteal defects,
  infertility, or chronic stress
• Critical to have even if the uterus has been
  removed

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Testosterone

• High levels related to facial hair growth, PCOS,
  Syndrome X, acne, increased CV risk in women
• Low levels associated with reduced bone density,
  libido, lean muscle mass
• Derived from both ovarian and adrenal activity
• Increasingly included in HRT regimens
• -Oral ERT increases SHBG reduced
  levels of bioavailable testosterone (98 of T is
  bound to SHBG)
• -Important to monitor in HRT, along with free
  androgen index and SHBG

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DHEA-S

• Stable form of the hormone, less time-of-day
  dependant than salivary DHEA
• Precursor to androgens and estrogens/Plays role
  in immune regulation, libido, lean muscle mass,
  insulin sensitivity, the bodys stress response
• May stimulate certain types of breast CA in post
  menopausal women
• Low levels associated with osteoporosis risk in
  post- menopausal women
• Aromatized to estrone with bone

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Hydroxylated Estrogens
Miscellaneous Considerations

• Low 216 ratio associated with increased risk of
  breast cancer however, 2-OHE1 is protective only
  when methylated
• Ratio as marker of breast cancer survival (ratio
  gt2.0 gt10 yr survival ratio lt2.0
  mean survival lt 5 years
• Ratio may be surrogate marker for redox balance
• 16- ?OHE1 is an indirect marker for 4-OHE1
  activity
• Oral contraceptives tend to lower the ratio
• Evaluate ratio in light of total estrogen levels
  (aim for balance)
• HRT may be contraindicated if it causes ratio to
  drop

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Modification of 216 OHE1 Ratio

• 2 OH-estrone (protective) increased by
• Flaxseed
• Omega-3 fatty acids
• Soy isoflavones
• Indole 3-carbinol (I3C), diindolylmethane
  (DIM)-found in Brussel sprouts, broccoli,
  cauliflower
• Rosemary, turmeric, kudzu
• Smoking
• Strenuous exercise
• Weight loss
• Estrogen (most potent inducer of 2-hydroxylation)

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Treatment of Menopause with Bio-Identical Hormones

• Semi-synthetic compounds derived from wild yam
  that are the exact molecule native to women
• Most common is Triple Estrogen (Triest) made up
  of 80 Estriol, 10 Estrone, 10 Estradiol
• Natural progesterone cream
• Other options include Testosterone, DHEA, and
  Pregnenolone
• Therapy is individualized to a womans need and
  follow-up testing is recommended to evaluate for
  metabolism of hormones and ratio of 216 Estrone
• Safe and effective at much lower doses than
  synthetically derived hormones

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Conclusions

• Identify root cause of illness
• Commit to diet and exercise FIRST
• Detoxify the body and maintain adequate
  elimination
• Test for hormone imbalances
• Work with a practitioner who understands the
  interplay of all the hormones