Topics of Interest  >  Menopause NATURAL HORMONE REPLACEMENT WITH ESTRIOL (E3) AND PROGESTERONE Estriol (E3) is one of three estrogens normally produced in the body. Estradiol (E2) is another, and it is the one most commonly found in commercially available estrogens prescribed for the treatment of menopause. Estradiol is 1000 times more potent in its effects on breast tissue than estriol. This effect is responsible for the breast tenderness and possibly the increased risk of breast cancer associated with the use of estradiol in hormone replacement therapy. For this reason, Natural Hormone Replacement Therapy, or NHRT, often utilizes estriol, so as to get the benefits of estrogen without the side effects and risks seen with the use of estradiol. NHRT involves the use of estrogens that are identical to the estrogens made by your body. These are referred to as "bio-identical" hormones. They are obtained from soy or yams, where they are called phytoestrogens, and chemically altered into the same chemical structure as your body's estrogens. NHRT with estriol is most commonly prescribed in the form of a trans-dermal cream, but other forms are available. The cream is rubbed into the skin of the upper arm or thigh on a daily basis, usually after showering or before bedtime. For women with a uterus, Natural Progesterone is also prescribed, to balance out the effects of estrogen. Many women will use the estrogen cream for the 1st 25 days of the month, and add the progesterone cream on days 12 through 25, repeating this cycle the 1st of the month. If symptomatic relief is not achieved with the use of estriol, combinations of estrogen are available. One is a combination consisting of 80% estriol and 20% estradiol, known commercially as Bi-Est. Another consists of 80% estriol, 10% estradiol, and 10% estrone (E1), and is known commercially as Tri-Est. The content of your Natural Hormone Replacement is determined by your alternative care provider, and made by a compounding pharmacist. One of the beauties of this arrangement is the greater degree of flexibility in dosing as compared to commercially available estrogens, where the dose is decided upon by the pharmaceutical company.

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