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From the Townsend Letter
February / March 2019

Hormone Therapies to Cure Female-Related Disorders: Practical Tips
by Thierry Hertoghe, MD
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Endometriosis: Can a patient get rid of endometriosis without surgery? The development of endometrial mucosa inside the abdominal cavity is also, in my experience, due to a multiple hormone deficiency syndrome with thyroid, cortisol, and progesterone deficiencies. Hypothyroidism and cortisol deficiency do not allow good ovulation, resulting in progesterone deficiency. One of progesterone's roles is to relax the uterine wall and prevent unwanted uterine contractions. It is very useful during a pregnancy, for example, as otherwise excessive contractions could lead to a miscarriage. It is also useful to avoid endometriosis. With progesterone deficiency, the uterine body and tubes contract too frequently and anarchically so that islets of endometrium detach from the inner wall of the uterus, penetrate the fallopian tubes, and from there enter into the abdomen and implant themselves in places where they do not belong. Additionally, cortisol deficiency increases the inflammation around the endometrial islets inside the abdominal cavity, increasing pain and suffering.
In my experience, the best treatment is to correct the hormone deficiencies in the same way as for polycystic ovarian syndrome by using hydrocortisone, desiccated thyroid, and progesterone. If pain and inflammation predominate, I prefer using a synthetic cortisol derivative such as prednisolone (5 mg/day) with 15-20 mg/day of DHEA for the first six to nine months of treatment and then later switch to bioidentical hydrocortisone.
Tip: Insist that the patient follow a healthy diet that makes her have a flat belly free of bloating and inflammation and does not irritate the gastrointestinal system. A bloating abdomen is sick, inflamed, and aggravates the endometriosis. Suggest that the patient eat boiled vegetables and ripe fruits. Make her eat fruits in the first half of the day at a distance from the meals (1/2 an hour before or 3 hours after meals). Suggest she consume protein-rich foods such as meat and fish as early as possible in the day so that with gravity and movement the foods go down in the gut quicker and get digested in the different parts of the gastrointestinal system. Proteins should not be consumed in the evening as they then unnecessarily stagnate the whole night in the stomach, overloading the gastrointestinal system and causing inflammation in the same abdominal cavity where the islets of endometriosis are located. The patient should also avoid junk foods: not only fast foods, sweets and soft drinks, but also unsprouted grains (bread, muesli, porridge, pasta, and rice) and dairy products (milk, yoghurt, and cheese) that are too irritating for the human digestive tract.
Fibroids are mainly due to progesterone deficiency, by allowing excessive tumor cell proliferation, although iodine deficiency (hypothyroidism) by causing progesterone deficiency may contribute to fibroid formation. The best treatment is to prevent fibroid development by correcting progesterone deficiency on time (100 to 200 mg/day from the 15th or 18th day to the 25th day of the menstrual cycle).
What to do when major fibroids are already developed? Prevent further aggravation. In premenopausal women, further aggravation can be prevented by providing 50 (to rarely 100) mg/day of micronized progesterone from the 5th to the 14th day of the menstrual cycle, and then 100 to often 200 mg/day from the 15th to the 25th day of the cycle. If a patient needs estradiol, too, then do not exceed 1.5 mg/day of transdermal estradiol. In postmenopausal women, a smaller dose of estradiol is recommended such as 0.75 to 1.5 mg/day and a relatively higher progesterone dose such as 150 mg/day. It works better with synthetic derivatives of progesterone because of their more prolonged 24-hour action (whereas bioidentical progesterone has an average 16-hour action). Dydrogesterone (Duphaston®) is the only safe one I know of, but is, to my knowledge, not available in North America.
An alternative is to apply transdermally a 10% progesterone liposomal cream in the morning and evening on the skin areas with the highest hormone absorption such as the zones rich in blood vessels where we flush – the upper chest and the face. One gram of a 10% liposomal cream corresponds to progesterone caps of 100 mg. Liposomal creams are better absorbed than other forms. High-dosed progesterone treatments may also partially reduce the fibroids, but a near-total cure is generally only obtained by using gonadotropin agonists for six months, which put the ovaries in menopause. This artificial menopause can be partially compensated by adding the synthetic tibolone, which relieves menopausal symptoms and does not stimulate fibroid development.
Vulvar lichen sclerosis: This type of inflammation of the vulvar lips is very painful and can lead to a fusion of the vulvar lips and an impossibility of having intercourse. It is mainly due to androgen deficiency. If it is in a not too advanced stage, then the lichen sclerosis may be cured by applying on the vulvar lips a topical testosterone cream. Avoid using gels as the alcohol may irritate the skin of the vulvar lips. Testosterone is a potent anti-inflammatory hormone for genital, muscular, and tendon tissues, not in other areas. A 0.5% testosterone cream twice a day applied in a very thin layer on the vulvar lips may suffice. If the inflammation is very active, addition of a 1% hydrocortisone cream may be necessary. Ideal is even to use the more potent dihydrotestosterone creams, but they are to my knowledge no longer on the market. Studies have also shown that progesterone creams may help improve lichen sclerosis to a lesser degree than androgens, but this is likely due to its conversion into testosterone, and from the testosterone to dihydrotestosterone. After curing the lichen sclerosis, a systemic testosterone treatment should be continued to avoid recurrence (of course, combined with female hormone treatment to avoid virilization)
Tip: Recommend the patient wear loose underwear made of natural fiber such as cotton. She should avoid wearing underwear made of synthetic fiber to avoid excessive sweating and irritation that would aggravate the vulvar inflammation. Daily application of a topical vitamin A solution (e.g., the patient can open and use high-dosed 25,000 IU caps) may help, too, as it reduces lichen sclerosis.
Table 3 reviews the sex hormone treatments of the most important female-related disorders.

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SUPPORTThe Townsend Letter is dedicated to examining and reporting on functional and integrative medicine. Our editorial content depends on support from readers like you, and we would appreciate your help to keep this content forthcoming. Please take this opportunity to contribute $50, or choose one of the other amounts listed on the next page, and ensure that our independent voices keep up the good fight against the skeptics, who would like to silence us and eliminate your medical freedoms.

1.      MacNaughton J, et al. Age related changes in follicle stimulating hormone, luteinizing hormone, oestradiol and immunoreactive inhibin in women of reproductive age. Clin Endocrinol (Oxf). 1992 Apr;36(4):339-45.
2.      Lau WN, et al. The effect of ageing on female fertility in an assisted reproduction programme in Hong Kong: retrospective study. Hong Kong Med J. 2000 Jun;6(2):147-52.
3.      Windham GC, et al. Ovarian hormones in premenopausal women: variation by demographic, reproductive and menstrual cycle characteristics. Epidemiology. 2002 Nov;13(6):675-84.
4.      De Souza MJ, et al. High frequency of luteal phase deficiency and anovulation in recreational women runners: blunted elevation in follicle-stimulating hormone observed during luteal-follicular transition. J Clin Endocrinol Metab. 1998 Dec;83(12):4220-32.
5.      Kaplan JR, Manuck SB. Ovarian dysfunction, stress, and disease: a primate continuum. ILAR J. 2004;45(2):89-115.
6.      Westhoff C, et al. Predictors of ovarian steroid secretion in reproductive-age women. Am J Epidemiol. 1996 Aug 15;144(4):381-8
7.      Rojansky N, Halbreich U. Prevalence and severity of premenstrual changes after tubal sterilization. J Reprod Med. 1991 Aug;36(8):551-5
8.      Alvarez-Sanchez F, et al. Pituitary-ovarian function after tubal ligation. Fertil Steril. 1981 Nov;36(5)

Born in Antwerp, Belgium, Dr. Hertoghe practices his medicine in his clinic in Brussels. With his sister, Dr. Thérèse Hertoghe, they proudly represent the fourth successive generation of physicians working with hormonal treatments – and this since 1892 (after Eugène Hertoghe, former vice president of the Royal Academy of Medicine in Belgium, and Luc and Jacques Hertoghe, endocrinologists). Dr. Thierry Hertoghe devotes his life to the promotion of a better, patient-oriented, and evidence-based medicine.
Author of numerous books, Dr. Thierry Hertoghe also travels a lot to take part in numerous conferences and congresses throughout the world. He co-organizes many of these specialized gatherings and holds important positions in several international and national medical organizations (which usually tend to fight against aging). He is the president of the International Hormone Society (over 2500 physicians), and of the World Society of Anti-Aging Medicine (over 7000 physicians), as well as the supervisor of two important postacademic trainings for doctors.

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