Balancing Female Hormones

Fred M. Bogan D.C.

Balancing female hormones with natural hormone replacement therapy can be a real challenge, but when done properly it can be a life-changing experience for the patient and her family, and a rewarding experience for the clinician.

Advantages of natural hormone replacement therapy is that female problems such as excessive bleeding, no bleeding (amenorrhea, or no menses), ovarian cysts, uterine cysts, endometriosis, infertility, and menopausal symptoms can all be treated safely and effectively without risking the health of the patient.

Estrogen & Progesterone

Many factors are important in female hormone physiology, including the adrenals, the liver, thyroid, digestion, diet and lifestyle. However, there is no question that the hormones estrogen and progesterone are most critical. First, let’s explain that there is no such hormone as estrogen. What we consider to be estrogen is really a complex mixture of three female hormones called estrone, estriol and estradiol. Of the three, estradiol is far more powerful in its estrogenic effects than the other two. Progesterone is used in the body to balance or counteract the negative effects of estradiol. It is important to understand that balance between estradiol and progesterone does not mean that there are equal amounts of each hormone. Instead, your body requires 28 or more progesterone molecules circulating in the tissues to control the effects of just one estradiol molecule. It always reminds me of balancing feathers and lead. It’s going to take a lot more feathers than lead to balance the two.

Tissue Hormones vs Blood Hormones

Notice that I said “tissues” rather than blood when referring to the circulation of the hormones. This is a very important point when it comes to testing for hormones because the difference between tissue levels and blood levels can be profound; as much as several hundred percent. So it is very important to examine the right body compartment to get the correct reading on active hormone levels. Hormones circulating through the tissues are in their active form. Hormones circulating through the blood are in their inactive, or transport form. I compare it to WalMart and Teddy Bears. If WalMart has 50 Teddy Bears on the truck being transported to the store they may technically have 50 Teddy Bears but they cannot be sold because they are not in a place where they can be used. Hormones are the same way. If they are in the blood they are being transported. They are not in a usable compartment while in the bloodstream. Therefore blood levels of hormones are practically useless in understanding hormone function in the body, but tissue levels is what we really want to know, because hormone activity occurs at the tissue level, not in the blood compartment.

Why Salivary Hormone Testing

That is why we use salivary testing of hormones rather than blood tests. Saliva is a tissue fluid, and as such carries a much more accurate level of active hormone than blood does. To us it makes no sense to test blood levels of hormones for two reasons: 1) blood hormones are inactive as explained above; 2) blood levels could be several times more or less than the tissue levels so their accuracy cannot be assumed.

Another good reason for using salivary testing of hormones is that they can be collected at home by the patient themselves. That offers a huge advantage over blood tests because it allows us to send a kit home with the patient and they can collect a sample every other day or so for a month. For a cycling woman we actually collect eleven samples through a woman’s cycle. Those eleven samples are then sent to the lab by Fed Ex, where each one is tested for estradiol and progesterone. One of the samples is also tested for testosterone. The results of eleven estradiol and eleven progesterone tests are then plotted on a 26 to 30 day graph (depending on the length of the test subject’s menstrual cycle), where it is easy to compare to the normal graph below. Compare this to most clinics, even fertility clinics who should know better, who take one blood test which they claim will give them adequate information to analyze a woman’s menstrual cycle over twenty-eight days. This always reminds me of the old story of three blind men trying to describe an elephant by analyzing only one part of the elephant.

A woman’s cycle is (or should be) divided into three phases. The first phase is the proliferative phase lasting 12 to 14 days. The proliferative phase is controlled by estrogen (actually estradiol) and has the purpose of causing one of the eggs in the ovary to “ripen”, or become ready for fertilization by a sperm cell. This phase is also called the Follicular Phase because the follicle in which the egg lies proliferates or ripens until time to rupture and release the egg.

The second phase of the cycle is ovulation. Ovulation should occur on day 12-14. This phase is accompanied by a rise in temperature of approximately one degree Fahrenheit and begins at the moment of follicular rupture.

As soon as the follicle ruptures it becomes the corpus luteum and the third phase of the cycle begins. The purpose of the Luteal Phase is to secrete progesterone which prepares the uterine lining for pregnancy and to nurture
any embryo that might develop, or to prepare the system for the next cycle in the event there is no pregnancy. A graph of these hormone cycles looks like this:

Menstrual Cycle- hormones, temperature, ovulation


Variations from this graph not only indicate that there is an abnormality in the cycle, but also gives the clinician a very good starting point for treatment to balance the hormones and restore a normal cycle.

Bio-Identical Hormones

In our office we use only natural bio-identical hormones because these are the ones that God intended for you to have. There are many good scientific reasons to use bio-identical hormones as well. First, the natural hormones can be altered in your body depending on your own body’s needs. All of the sex hormones are derived from cholesterol. (And you thought cholesterol was all bad.) Cholesterol is first converted to pregnenalone, the “Mother Hormone”. From pregnenalone your body is able to make any male or female sex hormone it needs, including “estrogen” and progesterone. In addition, if your body decides that it has too much of a certain hormone then it can re-convert that hormone into another hormone that it needs more at that time. For example, if the body decides that you have too much estradiol then it might convert some of that estradiol into estrone or progesterone or any other hormone needed at the time. That’s because your body knows these hormones and understands how to modify them as needed.

Comparing Natural & Synthetic Hormones

But synthetic prescription hormones are man-made and are a completely different hormone. They have a totally different molecular structure than the natural hormones, and the end result is that the body does not recognize them as anything but an intruder. These “hormone-like” molecules have an effect on the body even if it is not needed, and the body is helpless against them, except for excreting these foreign chemicals out of the body as quickly as possible. There is only one reason for using synthetic hormones-MONEY! Pharmaceutical companies are in the business of selling chemicals for the body. They make the most money when they have a chemical that performs a function in the body that no one else can sell. In other words, they want a chemical that they can patent and corner the market. No company can patent a naturally occurring molecule such as natural estradiol or natural progesterone. Therefore they go to great lengths to create a molecule that has the effect of hormones but not the same structure as the original so that they can put their name on it and sell it at a huge profit, all to the detriment of the body and the person in that body. The same applies to almost any drug on the market.

The pharmaceutical industry has worked very hard to create these synthetic hormones. One of these is Progestin. I am amazed at how many medical doctors do not know that Progestin is not the same as natural progesterone. In my practice I have had numerous women come to my office who have told their medical doctor that they wanted natural female hormones and were told that Progestin is a natural molecule. Nothing is further from the truth. In fact, if you are taking Progestin and become pregnant you are putting your baby at serious risk for birth defects or death because progestins do just the opposite of nurturing the embryo-they kill it. That’s how different Progestin and natural progesterone are. Another example is Conjugated Estrogens. Many, if not most medical physicians believe that this form of estrogen is the natural form. Not so.

For all these reasons I believe that natural hormone replacement therapy is a refreshing approach to some difficult female problems. One side note: if you are taking birth control we cannot use natural hormones to balance your hormones because you are intentionally creating a hormone imbalance to prevent pregnancy.