Estrogen replacement therapy natural, herbal alternative and herbal and dietary supplements
February 27 2014, by
Ray Sahelian, M.D.

Estrogen is a hormone "messenger" molecule that has receptor sites in many locations of the body: uterus, vagina, breasts, bones and brain are the major sites. It stimulates the growth of the uterine lining each month to prepare it for implantation of a fertilized egg. Estrogen is produced by the ovaries, by egg follicles, by the adrenal glands and in fat cells. More than 30 different forms have been identified; the most common forms tested are estrone [E1], estradiol [estradiol-17 beta, E2], and estriol [E3].

This female hormone, actually men have it also, is quite controversial when it comes to hormone therapy or replacement in menopause. Estrogen is used primarily to prevent or reduce the risk of osteoporosis and to reduce symptoms of hot flashes. Excess can lead to blood clots and increased risk of breast cancer. Reduction of its use (such as Premarin)  by post menopausal women could potentially reduce the risk of breast cancer.

Low estrogen levels can cause several symptoms including raised LDL, the bad cholesterol, and lowered HDL, the good cholesterol. These women also tend to have low blood pressure. They can have depression, thin hair, poor memory and other deficiency symptoms. Women with low estrogen levels are also at risk of bone loss that leads to osteoporosis.

Types of natural estrogen
These include: estrone (E1), estradiol (E2), estriol (E3) and estetrol (E4). Estradiol is mostly secreted by the ovaries, and estriol is mostly secreted by the placenta).

I would like to know how natural estrogens often found in herbs, for instance pfaffia and fo-ti or soy, effect men. Evidently the very same components helps women in menopause. Do natural estrogens have any effect on men?
   This issue is very complicated. Much depends on one's diet, body metabolism, liver function, age, other supplements taken, dosage of the herbs, how often they are used, etc. No clear answers can be given. Natural estrogens, or phytoestrogens, have a variety of functions. Plus, there are many types of natural estrogen like compounds in the diet and herbs, and each may work in different ways.

Anti Estrogen supplements and herbs
Losing weight can reduce overall estrogen levels in the body since the hormone is stored in fat cells.

Q. Are there any herbal remedies that block or reduce estrogen which have no or limited side effects?
    A. There is very limited research in this area. There are many compounds in soy and other plants that act as estrogen blockers. Some of these compounds are called phytoestrogens. It is thought that by blocking these estrogen receptors with milder forms of phytoestrogens could reduce the risk of certain cancers that are stimulated by estrogen dominance or high estrogen levels.

Q. I have breast cancer and I'm seeking the holistic path. I have an estrogen dominant cancer meaning I produce too much estrogen in my body. Will Pycnogenol elevate the estrogen.
   A. We have not seen specific research regarding the influence of Pycnogenol.

Q. Are there any herbs or supplements that will act to reduce estrogen levels in men? I have a problem with high-ish estrogen, and I'm loathe to keep taking prescription drugs like Nolvadex on and off.
   A. Nolvadex is a SERM (Selective Estrogen Receptor Modulator). Selective estrogen receptor modulators (SERMs) act as either estrogen receptor agonists or antagonists in a tissue-selective manner. Rather than focusing on lowering a particular hormone in the body, one should rather treat the whole person and the actual medical condition. Having said this, it is possible that phytosterols could be helpful. Weight loss can also help since fat cells produce estrogen. Diet Rx is an excellent appetite suppressant.

Q. I read that eating a small amount of soy is healthy and when you eat soy foods the body does not have to manufacture estrogen itself.
   A. Eating a small amount of soy is healthy. There are many ways that compounds in soy interact in the human body, and it is quite complicated. I have seen no evidence that soy ingestion in small amounts influences estrogen manufacture by the body.

Q. I am taking testosterone by injection because of diagnosed hypogonadism. I heard that there can be an increased level of estrogen because of the injections. Is this true, and are there any natural supplements that would control the increase, i.e., anti estrogen supplements? Thanks for your amazing products and support.
   A. Estrogens are generated mainly by the activity of aromatase enzyme, which converts testosterone to estradiol and androstenedione to estrone. However, in addition to estradiol and estrone, a variety of other steroids, whose synthesis is not dependent on aromatase, can stimulate the estrogen receptor. I am not aware of any formal studies that have clinically evaluated the role and influence of supplements as anti estrogens but some laboratory studies show certain natural compounds to have anti estrogenic activity. However, rather than focusing on influencing a particular hormone level in the body, one has to look at the overall physiology and health of the body and whether it is desirable or necessary to take such supplements. Perhaps one could even consider taking a lower dosage of te testosterone injection and only enough to be effective rather than having an excess. Although chrysin flavonoid has been mentioned as a potential anti estrogen supplement, I have not seen actual human studies that showed the use of chrysin supplements have an anti estrogenic effect or lower estrogen levels. Green tea extract has also been mentioned.

Herbs, foods and supplements that influence levels
Q. Could you please be so kind and tell me if any of these items raise estrogen levels in the body. I have been reading for months and I can not find out direct answers: Olive leaf extract, Milk thistle, peppermint, wormwood, oil of oregano, bcaa, chyrsin, cayenne, peppergreen tea, black tea, oolong tea, Psyllium husks, black walnut hulls.
   A. Little research has been done to determine their influence but most of the time these herbs would have little effect.

Can you tell me some natural ways middle-aged men can avoid estrogen dominance? What foods cause this? What supplements balance or block bad estrogens?
   Excess weight on the body from fat cells can make more of this hormone, so weight loss could be of help.

Estrogen and breast cancer
High levels of estrogen in the body increases the risk of breast cancer recurrence. Women who have had breast cancer should take extra steps -- such as regular exercise and weight management -- to reduce their estrogen levels and minimize the risk that the breast cancer will return. Estrogen is strongly linked with the initial development of many breast cancers.

Doctors are now much more cautious in giving women high doses of estrogen after menopause due to more awareness about estrogen replacement therapy and the increased risk of breast cancer. Some doctors who practice alternative medicine think that the use of bioidentical estrogens would not have the safe effect on breast cancer stimulation as the equine estrogens used in the past. I am not so sure I would agree. I think excess estrogen from any source, whether equine, synthetic or bioidentical, can raise breast cancer risk. In an interesting study that adds to our knowledge on this topic, 4,000 women genetically at high risk for breast cancer found that a daily hormone-blocking pill, called anastrozole, reduced the risk of developing breast cancer by more than half after five years of use. Anastrozole, sold as Arimidex, works by inhibiting the synthesis of estrogen in the body. Some of the adverse effects include hot flashes and joint pain. I am pointing out this information is not to necessarily suggest the use of this drug in women genetically prone to breast cancer -- I still have not fully evaluated its full benefit/risk profile -- but just to point out that high amounts of estrogen is a factor in breast cancer incidence. Synthetic estrogens are more likely to cause blood clots. If your doctor believes you need estrogen replacement, use the least dosage that helps to alleviate your symptoms.

Cardiovascular system
Mol Cell Endocrinol. 2014 Jan 22. Estrogen and the female heart. Estrogen has a plethora of effects in the cardiovascular system. Studies of estrogen and the heart span human clinical trials and basic cell and molecular investigations. Greater understanding of cell and molecular responses to estrogens can provide further insights into the findings of clinical studies. Differences in expression and cellular/intracellular distribution of the two main receptors, estrogen receptor (ER) α and β, are thought to account for the specificity and differences in responses to estrogen. Much remains to be learned in this area, but cellular distribution within the cardiovascular system is becoming clearer. Identification of GPER as a third ER has introduced further complexity to the system. 17β-estradiol (E2), the most potent human estrogen, clearly has protective properties activating a signaling cascade leading to cellular protection and also influencing expression of the protective heat shock proteins (HSP). E2 protects the heart from ischemic injury in basic studies, but the picture is more involved in the whole organism and clinical studies. Here the complexity of E2's widespread effects comes into play and makes interpretation of findings more challenging. Estrogen loss occurs primarily with aging, but few studies have used aged models despite clear evidence of differences between the response to estrogen deficiency in adult and aged animals. Thus more work is needed focusing on the effects of aging vs. estrogen loss on the cardiovascular system.

Estrogen and Skin
Estrogen loss at menopause has a profound influence on skin. Treatment in postmenopausal women has been repeatedly shown to increase collagen content, dermal thickness and elasticity, and data on the effect of estrogen on skin water content are also promising. Further, physiologic studies on wound healing suggest that hormone replacement therapy (HRT) may play a beneficial role in cutaneous injury repair. Results on the effect of HRT on other physiologic characteristics of skin, such as elastin content, sebaceous secretions, wrinkling and blood flow, are discordant.

Dermatoendocrinol. 2013. Estrogens and aging skin. Estrogen deficiency following menopause results in atrophic skin changes and acceleration of skin aging. Estrogens significantly modulate skin physiology, targeting keratinocytes, fibroblasts, melanocytes, hair follicles and sebaceous glands, and improve angiogenesis, wound healing and immune responses. Estrogen insufficiency decreases defense against oxidative stress; skin becomes thinner with less collagen, decreased elasticity, increased wrinkling, increased dryness and reduced vascularity. Its protective function becomes compromised and aging is associated with impaired wound healing, hair loss, pigmentary changes and skin cancer. Skin aging can be significantly delayed by the administration of estrogen. This paper reviews estrogen effects on human skin and the mechanisms by which estrogens can alleviate the changes due to aging. The relevance of estrogen replacement, selective estrogen receptor modulators (SERMs) and phytoestrogens as therapies for diminishing skin aging is highlighted. Understanding estrogen signaling in skin will provide a basis for interventions in aging pathologies.

Estrogen and Hair
Estrogens (1 beta-estradiol, E2) are mainly involved in skin physiology and operate as potent hair growth modulators. Knowledge about the estrogen target cells in skin and exact signaling pathways is still very limited but it is known to affect hair follicle cycling.

Estrogen and vaginal dryness
Tablets containing low-dose estrogen reduce vaginal discomfort that often comes with menopause. After women go through menopause, declining estrogen levels cause a gradual thinning in the tissue of the vagina which can lead to atrophic vaginitis. This causes symptoms such as dryness, irritation and pain during sex. Estrogen replacement is one therapy for the condition, but because of the health risks of oral hormone replacement, many women want an alternative. One alternative is estrogen-containing tablets that are inserted directly into the vagina, which limits the risk of side effects. Vaginal tablets containing low-dose estrogen such as 10 micrograms of a form of the hormone called estradiol can be helpful. Side effects related to the estrogen treatment include headache, back pain and abdominal pain.

Estrogen cream
Topical - estrogen cream or patch - and oral pills are beneficial in maintaining skin firmness and elasticity in postmenopausal women. Obstetrics & Gynecology, January 2008.

Estrogen side effects, danger, safety, risk
Estrogen side effects include changes in vaginal bleeding pattern and abnormal withdrawal bleeding or flow. Breakthrough bleeding, spotting. Increase in size of uterine fibromyoma. Breast tenderness or enlargement. Nausea, vomiting, abdominal cramps, bloating; headache, migraine, dizziness; mental depression; increase or decrease in weight; reduced carbohydrate tolerance; aggravation of porphyria; edema; changes in libido.

Estrogen levels
In normal reproductive age women, during the menstrual cycle, estradiol levels range from 50-170 pg/ml, and as high as 400 during the periovulatory stage. PG/ml stands for picogram per milliliter. The level of estrogen changes during different parts of the menstrual cycle. Estrogen levels below 50 to 80 pg/ml may be associated with hot flashes, and may signal perimenopause. After menopause, estrogen levels are usually less than 35 pg/ml.
    In men, the normal estrogen level range is between 12-34 picograms per ml of blood.

Breast Cancer - research is contradictory
Exposure to high estrogen may promote breast cancer. The mechanisms of cancer formation in the breast caused by estrogen include its metabolism to genotoxic, mutagenic metabolites and the stimulation of tissue growth. Together, these processes cause initiation, promotion, and progression of carcinogenesis. Estrogen metabolism is affected by both BMI and hormone therapy potentially explaining the interaction between BMI and hormone therapy in relation to breast cancer risk. Source: International Journal of Cancer, 2006.

Q. The January 2009 newsletter Supplement Research Update discusses the disastrous effects of conjugated equine estrogens and synthetic progestins uncovered by the Womenís Health Initiative, but you seem to paint bio-identical hormones with the same brush. My understanding is that the WHI did not study the use of bio-identical human estrogens and progesterone at all. Everything Iíve read indicates that they have a completely different effect on womenís bodies, and in fact progesterone (the real thing, not progestin) may be protective against breast cancer. I think you should distinguish between the two.
   A. Until long term studies are done testing bio-identical hormones in terms of their effect on breast cancer and how they compare to synthetic progestins and conjugated equine estrogens, it is premature to claim that one form has less risk than the other. I did mention that if you were to use hormones as a symptomatic relief for menopausal symptoms, it would be preferable to use natural hormones.

Q. In your Jan. 2009 newsletter, you site an MSNBC news article that reports taking menopause hormones for five years doubles one's risk of breast cancer. The article clearly stated that the hormones studied were estrogen and (synthetic) progestin ingested by mouth. This is quite different than applying a cream of bio-identical hormones. It may be that these creams increase the risk, as well, but that is not part of the referenced study, and many contemporary studies indicate otherwise. To equate Prempro pills with bio-identical cream in my opinion is illogical thinking.
   A.  Until long term studies are done testing bio-identical hormones in terms of their effect on breast cancer and how they compare to synthetic progestins and conjugated equine estrogens, it is premature to claim that one form has less risk than the other. What if bio-identical hormones end up being even more potent in stimulating certain cancers than synthetic progestins or equine estrogens? It took decades for the medical community to find out the full risks of hormone replacement and it may take a long time for women who are currently taking bio-identical hormones, under false safety assurances by many natural hormone marketers and promoters, to find out that these medications have risks that we are not currently aware of. I did mention that if you were to use hormones as symptomatic relief for menopausal symptoms, my impression is that it would be preferable to use natural hormones. If you are aware of long term studies regarding the safety of natural hormone use, please let us know. Until then, people using them in high dosages for prolonged periods are gambling with their health and potentially increasing their risk for cancer. It is up to you if you wish to take this risk. As with the use of any supplement, hormone, or medication, the benefits have to be balanced with the risks. Keep in mind that there is a physiological reason why hormone levels drop with age. The human body was not meant to be exposed to high levels of certain hormones with aging. Therefore, any form of replacement through pills, creams, or shots, and whether synthetic or bio-identical, is not something the human body is genetically adapted to. If, a decade from now, research shows bio-identical hormone use to be safe, then I will change my opinion.

Q. I received Dr. Sahelianís January 2009 newsletter article with his comments on using estrogens and progestins to help with menopause symptoms. I feel it is very important to point out that the HRT used in the WHI study contained horse estrogen which is not the same as human estradiol now available in products such as Estrace and the Vivelle patch. While the horse estrogen does bind to human estrogen receptors, it does not have the same action as the human estradiol, ie. It fits in the lock but you canít turn the key. Also, since the human body doesnít have the enzymes necessary to break down the horse estrogen, it can stay in the body attached to the receptors for several months. Human estradiol is essentially out of the body in 1-2 days after you stop treatment. I have not been able to find any studies linking Human estradiol products to an increased cancer risk but would be interested for references if there are some. In fact, I have read several books and studies indicating that replacing a womenís estradiol with the so called bio identical estradiol is very beneficial. I personally have found this to be the case.
   A. See the answer above. It is fine to look at how some effects occur on a receptor level, but until actual human studies are done for several years the safety of natural estrogens will not be known to their full extent.

Estrogen replacement therapy
Concerns about estrogen replacement therapy stem from the results of both the combined estrogen-progestin and the estrogen-alone arms of the Women's Health Initiative (WHI) clinical trial. The study population consisted of older postmenopausal women ó the average age was 63 at the start of the trial. For women taking the combination estrogen-progestin used in the study (Prempro), researchers found an increased risk of heart disease, breast cancer, stroke, blood clots, and dementia. In addition, not only did hormone therapy increase the women's risk of breast cancer, it also made tumors harder to detect, leading to potentially dangerous delays in diagnosis. For women taking estrogen alone (Premarin), preliminary results showed no increased risk of breast cancer or heart disease but did find a slightly increased risk of stroke. Taking either estrogen-progestin or estrogen alone also didnít prevent dementia or mild cognitive impairment, as was previously believed. Rather, the new data show a trend toward the development of cognitive impairment. Using estrogen replacement therapy to prevent dementia or MCI is no longer recommended for women 65 years of age or older. Estrogen replacement therapy with Premarin increases the risk for stroke.

Soy, estrogen, Isoflavones, and phytoestrogens
Research in monkeys suggests that the natural plant estrogens found in soy do not increase markers of breast cancer risk in postmenopausal women. In fact, they may provide a protective effect in some women. Even at high doses, there was no evidence that the estrogen -like compounds in soy, called isoflavones, stimulate cell growth or other markers for cancer risk in breast tissue.

Estrogen dominance
Young women who have estrogen dominance begin menarche with difficult and painful periods, and doctors sometimes give these teenage girls birth control pills to help regulate the frequency and severity of their periods. Some women will develop the estrogen dominance syndrome much later in life, sometimes as a result of diet, liver impairment, or environmental factors or also as a result of anovulatory cycles before menopause -- that is, menstrual cycles in which no ovulation has occurred.

Pregnancy
The pregnant woman at term produces more estrogen in one day, than a nonpregnant woman produces in 3 years! Estrogen is responsible for enormous changes during pregnancy. During pregnancy, there is a large increase in the amount of estriol in relationship to estrone and estradiol. Increased levels of estrogen that occur during pregnancy may be associated with improvement in psoriasis.

Estrogen for man
Men normally have some estrogen, albeit at levels usually much lower than in women. Within the body, there is an enzyme called aromatase. It converts certain amounts of testosterone into estradiol (an estrogen). With aging, a man's body will produce larger amounts of aromatase. Larger amounts of aromatase mean more conversion of testosterone to estradiol. This will change the ratio of testosterone to estrogen.
     Higher levels of estrogen are associated with an increased risk of cognitive decline and Alzheimer's disease in older men. Dr. Mirjam Geerlings, from the University Medical Center Utrecht, and colleagues evaluated hormone levels and cognitive function in 2974 older men who were followed, on average, for 6 years as part of the Honolulu-Asia Aging Study. During follow-up, 134 men developed Alzheimer's disease and 44 men developed another type of dementia. With increasing levels of estrogen, the risk of Alzheimer's disease rose. In addition, men with higher estrogen levels scored a few points lower on a standard cognitive function test than those with the lowest levels. By contrast, testosterone levels seemed to have no impact on mental functioning. Overall, the results suggest that contrary to other reports, androgen replacement therapy would not help prevent cognitive decline in healthy men. Annals of Neurology, July 24, 2006.

Estrogen progesterone
Within a few months of starting estrogen plus progesterone hormone replacement therapy (HRT), there is an elevated risk of urge and stress incontinence in postmenopausal women.

Estrogen pill
Premarin, made from a combination of estrogens, including conjugated estrogens derived from pregnant mareís urine, has been the most commonly prescribed estrogen supplement in the U.S. for the past 50 years and is the estrogen used in many well-publicized studies, including the Womenís Health Initiative study (where Premarin and Prempro were used.). It is important to note that the conjugated estrogens in Premarin are not bioidentical (natural) hormones, but must be converted by the body into active estrogens. Therefore, the results of studies using Premarin can not necessarily be applied to bioidentical estrogens.
     Women using the Ortho Evra birth-control patch have double the risk of developing blood clots than those who take the pill.

Symptom of estrogen dominance - High level
Symptoms of estrogen dominance include swollen breasts, bloating, food cravings, mood swings, cyclical migraine headaches, lack of sexual desire, short cycles, heavy bleeding cycles, and fibroids growing.

Estrogen and the Immune System
This hormone has important impact on the immune system and on bone. The effects on bone to a large extent are mediated via its action on immune cells. Estrogen has a dichotomous impact on the immune system by downregulation of inflammatory immune responses but simultaneous upregulation of immunoglobulin production. Consequently, immune-mediated diseases in humans and in animal models are modulated by estrogen. Estrogen deficiency after ovariectomy in mice and after menopause in women is associated with significant bone loss. In rheumatic diseases such as rheumatoid arthritis (RA), osteoporosis is frequent, and in patients with postmenopausal RA, the degree of bone loss is dramatically increased. Hormone replacement therapy (HRT) in murine and human arthritis has beneficial effects on bone loss, as expected, but it also ameliorates inflammation and inflammation-triggered joint destruction.

Estrogen and weight gain
Menopause tends to be associated with an increased risk of obesity and a shift to an abdominal fat distribution with associated increase in health risks. Changes in body composition at menopause may be caused by the decrease in circulating estrogen, and, for fat distribution shifts, the relative increase in the androgen-estrogen ratio is likely to be important. Clinicians need to be aware of the likelihood of weight gain during the perimenopausal and postmenopausal years because behavioral strategies for weight loss can be effectively used in this population. Weight loss or prevention of weight gain is likely to have significant health benefits for older women.

In the Environment and Water
Septic systems may not remove natural hormone-disrupting chemicals -- like estrogen excreted in women's urine -- from wastewater before it gets into groundwater, which feeds many drinking water supplies.

Natural Herbs and Estrogen
Extracts from Schizandra chinensis fruit activate estrogen receptors: a possible clue to its effects on nitric oxide -mediated vasorelaxation.
Biol Pharm Bull. 2004.
Schizandra chinensis fruit has long been used for the treatment of cardiovascular symptoms associated especially with menopausal symptoms in Korea. To provide a scientific rationale for such uses, we have investigated the vasorelaxant effects of Schizandra chinensis fruit on the vasomotor tone of the rat thoracic aorta in an organ bath. Our data show that extracts of schizandra chinensis fruit act as a weak phytoestrogen.

Questions
Q. Have you heard of this product: 6-OXO conquers estrogen, the first effective all aatural aromatase inhibitor.
     A. We have not heard of this " anti estrogen " product and have not seen any clinical trials of any significance in an established medical journal.

Q. Is estrogen found in food?
     A. Phytoestrogens are found in food, but estrogen itself is not found in any significant amount in common foods that are normally consumed.

Q. I take estrogen hormone daily, I was wondering if it was okay to also take DHEA hormone, pregnenolone hormone, curcumin from turmeric, serrapeptase enzyme, nattokinase enzyme and lyprinol.  Does glucosamine for healthy joints have an effect? 
     A. Each person is unique in their response, but I would caution against using dhea, pregnenolone along with estrogen unless the estrogen dosage is reduced significantly. Research with Lyprinol, serrapeptase and nattokinase is very limited but I would guess low dosages with frequent breaks would be fine if your doctor approves.

Q. Whenever I read something that refers to estrogens, I'm amazed that it refers to "estrogen" instead of either conjugated estrogens, bioidentical estradiol, bioidentical estriol, bioidentical estrone ....or perhaps a form of estrogen I know nothing about. Since I take bioidentical estriol, which is quite common in Europe, combined with bioidentical progesterone and bioidentical testosterone, to keep my hormone levels normal post-hysterectomy / oophrectomy, I have to assume that the dangers talked about for "estrogen" refer to conjugated estrogens. It would be most helpful
if articles could be made more specific as to what kind(s) of estrogen the data refers to; somehow the assumption seems to be made that if a woman takes "estrogen," she is taking conjugated estrogens from horse urine. Not every woman takes that fake and dangerous estrogen, and those of us who don't have no idea whether to take the data presented as applying to us. I've read that estriol is actualy protective for breast cancer, and I'd personally appreciate more data associated with estriol. It would be most helpful if, instead of "estrogen" a more specific reference was mad as to the type of estrogen being discussed. Thank you for your newsletters; you seem to be one of the saner people out there doing this.
     A. The source of the estrogen can make a difference in how the body reacts to it. However, we cannot simply assume that bioidentical estrogen is inherently safer than synthetic or horse derived estrogen or whether one form of estrogen such as estriol is preferable to another form of estrogen. Hormones, no matter the source, can still be dangerous if misused. The problem is that there is so little research done comparing various forms of estrogen and the risks and benefits that it is difficult to make any statements with confidence. It takes decades to do such studies.

Q. On Estrogen and its effects, I was not able to find anything on the web site in regard to extremely high estrogen levels and their causes. My Estrogen blood level came back 837 and in three weeks again at 817. My doctor said this high estrogen level is unheard of and is mystified. I am 39 and all my hormones tested normal except for this. I had an mri and nothing showed up in terms of a tumor causing this. Just interested to know Dr. Sahelians opinion of possible causes that maybe could cause this high estrogen level. I stopped all vitamins and supplements and creams. It doesn't appear to be anything from the outside. But everything tested was normal on the inside. I do take progesterone from a compounding pharmacy and synthyroid.
     A.  Pregnancy is the most common reason for a high level of estrogen, mostly as estradiol (the predominant type of estrogen circulating in the body). During menstruation estradiol levels are around 40 pg/ml. By the time of ovulation, levels rise to around 400 pg/ml, then fall rapidly, then rise slowly to about 250 pg/ml before dropping again. During pregnancy, estradiol levels are about 100 times higher.
     Another cause for a high estrogen level is estrogen replacement. After menopause, in women not on hormones, estradiol levels are 10-20 pg/ml. In order to interpret a high estrogen level, it must be evaluated in the context of several of the above factors. It is difficult to know whether the progesterone you are taking is causing a high estrogen level, very unlikely but still something to consider especially if the progesterone made by the pharmacy has some estrogen in it by mistake. Some tumors may cause a high estrogen level. Lab analysis may be wrong, labs do make mistakes.

Q. Dear Dr. Sahelian / Research Staff, My organization specializes in the design of research Science projects for school students. The principal objective of our programme is the promotion of career path development, and we established Junior Medical School South Africa to facilitate that. I just received information that the levels of estrogen is very high in our drinking water [municipal water] where we live in Pretoria, South Africa. This is apparently due to the fact that our water resources is heavily polluted with human excrement. Although the water is put through a purification process, it is [apparently] not as "clean" as it should be. I have given this project to students to do. We have 3 questions: Is it possible that drinking water can contain high levels of estrogen, after being purified? If there is a high level of estrogen in our water, will it have a detrimental effect on us, or be dangerous for us, as consumers? Is it possible for estrogen to affect one's DNA, after a prolonged period of consumption? Thank you very much for your help.
   A. I am not an expert in this topic but based on my knowledge thus far, my answer to your 3 questions would be possibly, probably, possibly. That is the best I can say at this time.

Q. I heard a study reported in the New England of Medicine that estrogen use lowers the risk for hardening of the arteries, it that true?
   A. Yes, among women 50 to 59 years old treated with estrogen, the calcified-plaque burden in the coronary arteries was lower in women given estrogen than in those assigned to placebo. However, estrogen has a wide range of effect: It influences the cardiovascular system in different ways, both beneficial and harmful, and since it raises the risk for breast cancer, the overall mortality rate may not be higher with the use of estrogen replacement therapy.

Q. Last year, I had 2 estrogen producing - fibrothecoma tumors removed from the outside of each ovary. They were benign. My estrogen level was running at 850 at the time. Although it dropped in the first 6 months to about 190, it has now began to elevate again (at 450 as of October 16). I am a 49 year old who has never taken any type of birth control or estrogen supplements. My periods have been especially erratic since my surgery November 2006. I can't seem to find any information on the web regarding estrogen-producing tumors or fibrothecoma. Can you give me some information or direct me to a resource? I have thyroid cancer 14 years ago and had a complete thyroidectomy and some lymph nodes removed. I have been on Synthroid and Cytomel ever since.
   A. You can find more research on estrogen and fibrothecoma at http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed

Q. Can you tell me what natural products are available for men that will lower estrogen levels in men. I have been on hormone replacement therapy using testosterone and have been told that it will aromatise and create excess estrogen in the body causing hair loss and mood swings. Can you direct me towards a product for estrogen reduction not just a receptor blocker?
   A. We are not familiar with a specific natural product that lowers estrogen levels. Testosterone can convert into DHT and cause hair loss. The first thing to do is to make sure the testosterone dosage is not too high. Weight loss can lead to lower estrogen levels, at least in women, since fat cells make and release estrogen.

My alternative doctor has given me his own concoction of estrogen and progesterone cream. Although when I used it every night, my nipples became hard and tender and I had pains in the area of my ovaries, the dryness in my vagina decreased and my libido increased. Also, when my bladder was full - as when I first wake up in the morning - I would have severe pains in my ovaries. I have cut back to using the cream, maybe once every two weeks, and do not have issues with the pain, but my libido has also decreased.