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As many of you know, I am a believer in getting your estrogen therapy across the skin (transdermal - i.e., the estrogen patch); or across the vagina (transvaginal - i.e., the estrogen ring) -- as opposed to taking it in pill form. To me, getting estrogen across the skin or vagina is almost exactly like you get it from your ovary . . . a very steady dose 24/7 . . . what could be more "natural?"
On the other hand, when you get your hormones by swallowing a pill every 24 hours, there are two unnatural effects. First, when you swallow the pill, the hormone goes directly to your liver at an unnaturally high concentration. And second, the blood hormone level cycles up and down every 24 hours.
It has been theorized that the unnaturally elevated "first pass through the liver" might cause the liver to produce more blood clotting factors and might be the reason that the infamous WHI study, last July, found an increased risk of heart attacks, strokes and blood clots in their patients. It's also well known that this "first pass through the liver" increases blood triglyceride levels which also may increase heart disease.
This is only theoretical and a lot of research is on-going to prove whether trans-dermal / trans-vaginal estrogen is safer than oral estrogen. Much more will be known in the next few years.
Below is a very new article which found that oral estrogen increased CRP (C-reactive protein) as well as suppressed a molecule called IGF-1 . . . possibly two more reasons for the increased safety of transdermal / transvaginal estrogens.
Study: Estrogen Patch May Be Easier on Heart
By Kathleen Doheny
HealthScoutNews Reporter
WEDNESDAY, April 16, 2003 (HealthScoutNews) -- Estrogen delivered to postmenopausal women in patch rather than pill form doesn't raise blood levels of a protein associated with higher heart disease risk, a research team has found in a small study.
The study included only 21 women and looked simply at a marker of heart disease. In the new study, Vongpatanasin and her colleagues took baseline levels of the participants' C-reactive protein, a marker of inflammation that predicts heart attack and heart disease. Then, the women were rotated among three treatments -- the patch, oral estrogen and placebo, taking each for eight weeks and having their C-reactive protein measured before and after.
"The pills raised the C-reactive protein by more than twofold, whereas when the women were on the patch or on placebo, there was no change," Vongpatanasin says. But the blood levels of estrogen were similar with pill and patch.
In a recent study evaluating more than 27,000 women, reported in The New England Journal of Medicine, high levels of C-reactive protein were found to be a more accurate predictor of heart disease than high levels of so-called "bad" cholesterol, LDL. Exactly why oral estrogen drives up C-reactive protein is not known, Vongpatanasin says. While oral estrogen is processed through the liver before circulating to other areas in the body, estrogen delivered by patch enters the bloodstream directly.
When delivered by patch, the amount of estrogen is less than in pill form, Vongpatanasin says. In the study, the patch delivered a maximum of 100 micrograms of estrogen a day, while the pill delivered 625 micrograms.
In her study, Vongpatanasin also found that oral estrogen, but not the patch form or the placebo treatment, suppressed the women's blood levels of insulin-like growth factor, IGF-1, a substance that fights inflammation.
Another expert, Dr. Ravi Dave, a cardiologist at the Santa Monica-UCLA Medical Center in California, says that while the study is small, "the concept and hypothesis they used are very sound." He adds more study is needed, but that "estrogen might not be as bad as it was thought to be in terms of cardiovascular risk."
Earlier research by the same doctor concluded that transdermal / transvaginal estrogen lowered blood pressure a small amount as compared to the estrogen pill.
Two points: I am not saying that no one should take estrogens by mouth. The increased risks are very slight. However, if you have a personal history or a strong family history of heart disease, high triglycerides or excessive intravascular clotting (blood clots in legs or lung), then you might want to consider the transdermal / transvaginal route.
The second point I want to make is that birth control pills parallel menopausal hormone therapy. Birth control is now available in a patch and in a vaginal ring. If you are on birth control pills and have a bad personal or family medical history as described above, it might be theoretically a little safer if you switch to these newer birth control methods. Stay tuned -- more research to follow.
The above is not meant to be medical advice. Please read the attached Disclaimer, Etc.
Best wishes. Dr. Rehert
Best wishes. Dr. Rehert
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