Estrogen (drug interactions)
Estrogen serves as a therapeutic supplement primarily in the form of estradiol, commonly utilized in birth control pills and in the management of menopause-related conditions, such as osteoporosis and heart disease. It is available through various trade names, including Alora, Estrace, and Vivelle, as well as in conjugated forms like Premarin. While estrogen can provide significant health benefits, it is essential to be aware of potential interactions with other supplements and herbs. For instance, combining estrogen with ipriflavone may enhance bone protection but could elevate risks associated with uterine cancer.
Conversely, substances like boron and resveratrol might increase estrogen side effects or interfere with its effectiveness. Additionally, estrogen use could deplete essential nutrients such as magnesium and folate, making supplementation advisable in some cases. Individuals considering estrogen therapy should consult healthcare professionals to navigate these interactions and optimize treatment safely, recognizing the importance of personalized care in managing hormonal health.
Estrogen as a therapeutic supplement
- DEFINITION: Used as a component of birth control pills and for preventing osteoporosis and heart disease in menopausal women.
- INTERACTIONS: Boron, chasteberry, dong quai, folate, indole-3-carbinol, ipriflavone, resveratrol, rosemary
- TRADE NAMES: Medications containing a form of estrogen called estradiol include Alora, CombiPatch, Delestrogen (injectable), DepGynogen (injectable), Depo-Estradiol Cypionate (injectable), Depogen (injectable), Esclim, Estrace, Estraderm, Estra-L (injectable), Estring, Femtrace, FemPatch, Gynogen L.A. (injectable), Menostar, Vagifem, Valergen (injectable), and Vivelle
- RELATED DRUGS: Premarin, Cenestin, Prempro, and Premphase contain another form of estrogen called conjugated estrogens. Other forms of estrogen and some of their brand names include diethylstilbestrol diphosphate (Stilphostrol), estrone (Kestrone-5), esterified estrogens (Estratab, Menest), estropipate (Ogen, Ortho-Est), and ethinyl estradiol (Estinyl)
Folate
Effect: Supplementation Possibly Helpful
Some evidence suggests that estrogen may interfere with the absorption of folate. Since folate deficiency is fairly common, even among those not taking estrogen, taking a folate supplement on a general principle may be beneficial.
Ipriflavone
Effect: Potential Benefits and Risks
When the two are taken together, ipriflavone may increase estrogen’s ability to protect bone. This may allow one to use a lower dose of estrogen and still receive its beneficial effects. However, there may be risks involved. Although ipriflavone itself probably does not affect tissues other than bone, some evidence suggests that when it is combined with estrogen, estrogen’s effects on the uterus are increased. This might mean that risk of uterine cancer would be elevated by the combination.
It should be possible to overcome this risk by taking progesterone along with estrogen, which is standard medical practice. However, this finding does make one wonder whether ipriflavone-estrogen combinations raise the risk of breast cancer as well, an estrogen side effect that has no easy solution.
Boron
Effect: Theoretical Harmful Interaction
In some studies, boron has been found to elevate levels of the body’s own estrogen. This might lead to an increased risk of estrogen side effects if boron is combined with estrogen therapy. Other research indicates that boron may improve menopause symptoms by regulating estrogen production, but this is unconfirmed.
Resveratrol
Effect: Possible Harmful Interaction
The supplement resveratrol has a chemical structure similar to that of the synthetic estrogen diethylstilbestrol and produces estrogenic-like effects. For this reason, it should not be combined with prescription estrogen products.
Rosemary
Effect: Possible Harmful Interaction
Weak evidence hints that the herb rosemary may enhance the liver’s rate of deactivating estrogen in the body. This could potentially interfere with the activity of medications that contain estrogen.
Indole-3-Carbinol
Effect: Theoretical Harmful Interaction
Indole-3-carbinol (I3C) is a substance found in broccoli that is thought to have cancer-preventive effects. One of its mechanisms of action is thought to involve facilitating the inactivation of estrogen, as well as blocking its effects on cells. The net result could be decreased effectiveness of medications containing estrogen.
Chasteberry
Effect: Theoretical Harmful Interaction
Because of its effects on the pituitary gland, chasteberry might unpredictably alter the effects of estrogen-replacement therapy.
Dong Quai
Effect: Interaction Unlikely or Probably Insignificant
The herb dong quai (Angelica sinensis) is used for menstrual disorders.
Because dong quai contains beta-sitosterol, a phytoestrogen, there have been concerns that taking the herb with estrogen might add to estrogen-related side effects. However, a twenty-four-week, placebo-controlled study of seventy-four postmenopausal women found no estrogen-like effects or reduction of menopausal symptoms associated with taking dong quai. Therefore, dong quai seems unlikely to increase estrogen-related side effects.
Other Nutrients
Effect: Supplementation Possibly Helpful
Estrogen use may decrease blood levels of magnesium, folate, vitamin C, and zinc. This may mean that supplementation is advisable. Vitamin C (ascorbic acid) may cause a minor reaction when taken with estrogen, increasing the most potent estrogen called estradiol. Some research indicates vitamin C may improve endothelial function and help regulate hormones. St. John's wort and quercetin may decrease estrogen levels, while grapefruit juice may increase estrogen levels.
Bibliography
Bacon, Janet, L., et. al. "Estrogen Therapy." Medscape, 13 Mar. 2024, emedicine.medscape.com/article/276107-overview. Accessed 1 Oct. 2024.
Bradlow, H. L., et al. “Multifunctional Aspects of the Action of Indole-3-Carbinol as an Antitumor Agent.” Annals of the New York Academy of Sciences, vol. 889, 1999, pp. 204-13.
Gammon, Katherine. "It's Time to Rethink Hormone Replacement Therapy for Women, Says Heart Health Specialist." University of Southern California, 2021, news.usc.edu/trojan-family/benefits-hormone-replacement-therapy-women-estrogen-usc. Accessed 14 Dec. 2022.
Meng, Q., et al. “Indole-3-Carbinol Is a Negative Regulator of Estrogen Receptor-Alpha Signaling in Human Tumor Cells.” Journal of Nutrition, vol. 130, 2000, pp. 2927-31.
Preston, Claire L. Stockley’s Drug Interactions. 12th ed., Pharmaceutical Press, 2021.
Pronsky, Z. M., and J. P. Crowe. Food Medication Interactions. 19th ed., Food-Medication Interactions, 2018.
Yuan, F., et al. “Anti-Estrogenic Activities of Indole-3-Carbinol in Cervical Cells: Implication for Prevention of Cervical Cancer.” Anticancer Research, vol. 19, 1999, pp. 1673-80.