Measurement of estrogen metabolites can be used by both women and men to assess the risk of various pathological conditions associated with estrogen metabolism imbalances, such as breast cancer, cervical dysplasia, cervical cancer, endometrial cancer, and prostate cancer.
Estrogens are hormones produced in both men and women. They are released into the bloodstream and are bound to specific hormone receptors in various target organs. When estrogens complete their action, they are removed from their receptors and through the bloodstream reach the liver where they are broken down (metabolized) and finally are removed from the body with the urine. There are several different biochemical pathways through which estrogens can be metabolized in the body. The two main metabolic pathways are via 2-hydroxy-estrone (2-OHE1) and via 16-alpha-hydroxy-estrone (16-OHE1). These breakdown products are called "estrogen metabolism products or estrogen metabolites".
The estrogens that are broken down by the 2-hydroxy biochemical pathway end up having little or no estrogenic effect, so they do not "stimulate" the estrogen-dependent cancer cells to grow. Some studies even suggest that 2-OHE1 may actually inhibit estrogen-induced growth of cancer cells. The CYP1A1 enzyme system is involved in this biochemical "pathway" of the liver.
Estrogens that are broken down by the 16-alpha-hydroxy biochemical pathway have a stronger estrogenic effect and may therefore promote the development of hormone-dependent cancers. Some studies show that 16-OHE1 can alter the genetic makeup of cells. The enzyme system CYP1B1 is involved in this biochemical pathway.
It is now well established that when the Estrogen Metabolite Ratio (EMR) of 2-OHE1 to 16-OHE1 in the urine is greater than 2, there is a lower risk of certain diseases (breast, cervical, prostate cancers, etc.) and is also associated with lower severity of the disease in case of its occurrence. Maintaining a balance in favor of 2-hydroxy-estrogens helps maintain optimal levels of health.
Pathological conditions associated with estrogen metabolism imbalance
Several studies show that women with breast cancer have a lower ratio of 2-OHE1 to 16-OHE1 than women of the same age without breast cancer.
Cervical dysplasia refers to the condition where precancerous cells are found on cervical cytology (Pap test). The data show that the severity of dysplasia is higher the lower the Estrogen Metabolite Ratio in urine.
Prostate cancer patients are more likely to have lower EMR than men without the disease.
Recurrent respiratory papillomatosis
Recurrent respiratory papillomatosis is a condition in which non-cancerous tumors develop in the larynx, vocal cords, and trachea. The disease is caused by the human papillomavirus (HPV) and various studies show that the severity of the disease increases in patients with a lower estrogen metabolite ratio.
Why is it useful to monitor Estrogen Metabolites?
- Because some pathological conditions are affected by the ratio of 2-hydroxy-estrone to 16-hydroxy-estrone. Measuring the ratio of estrogen metabolites provides important information about the relative risk of these conditions appearing.
- Knowing the increased risk of certain hormone-dependent conditions provides the necessary motivation to choose healthier lifestyles.
- Monitoring the estrogen metabolite ratio is simple as only one urine sample is needed in which both 2-OHE1 and 16-OHE1 metabolites are measured.
The measurement of estrogen metabolites are especially suitable for women and men:
- Who want to act proactively looking for optimal health levels
- With a family history of breast, endometrium, cervix, or prostate cancers
- With a family history or risk factors for developing osteoporosis
How can the Estrogen Metabolite Ratio be improved?
Taking certain supplements and specific lifestyle changes can be used to increase the Estrogen Metabolite Ratio. Unfortunately, there is no absolute certainty that increasing the ratio guarantees a reduced risk of developing hormone-dependent diseases. However, we know from epidemiological studies that men and women with a higher ratio of 2-OHE1 to 16-OHE1 are much less likely to develop a hormone-dependent disease. We also know that many of the supplements, foods, and lifestyle changes that increase EMR have documented health benefits. Thus, it is reasonable to assume that adding these supplements, foods, and lifestyle changes will reduce the risk of disease.
Supplements: There are some natural products that help improve the Estrogen Metabolite Ratio such as Indole-3-carbinol (I3C), di-indolyl-methane (DIM), flaxseed, omega-3 fatty acids, soy isoflavones, rosemary oil which increase 2-hydroxy-estrone thus increasing EMR.
Additionally, taking progesterone and thyroid hormones (T4) has been found to improve Estrogen Metabolite Ratio.
Exercise: Levels of the "bad" metabolite 16-OHE1 increase with obesity and therefore weight loss and exercise are important factors in regulating EMR.
Lifestyle: Exposure to toxins can increase levels of the "bad" metabolite 16-OHE1, with a consequent reduction in EMR, and therefore it is important to minimize exposure to toxic chemicals. Excessive alcohol consumption can also reduce EMR.
Diet: Increased consumption of cruciferous vegetables such as broccoli, Brussels sprouts, cabbage, and cauliflower can increase EMR by increasing the amount of the "good" metabolite 2-OHE1. Increasing dietary fiber intake and reducing saturated fat intake also helps increase EMR.