Someone asked me to blog on the topic of estrogen and IC. When I wrote my doctoral dissertation. In my earlier years of my practice, I beleived that using bio-identical hormones-especifically a certain type of estrogen was very important to the balancing of the ecology in the vagina and it would therefore optimize the microbial balance. From my dissertation: 

The GAG layer is a mucosal layer that protects the bladder wall by preventing adherence of bacteria. Both nitrofurantoin and DMSO were tested as possible triggers for the breakdown of the GAG layer. Neither chemical was shown to initiate interstitial cystitis (Ruggieri, Hanno & Levin, 1987). This is interesting because, Gillespie (p.104), one of the most well-known researchers in the filed of interstitial cystitis, states that nitrofurantoin is a bacteria static antibiotic and part of a hormone disrupting family of chemicals known as polychlorinated biphenyls which can interfere with hormone and glandular function, thereby breaking down the body’s own estrogen and other steroid hormones. Gillespie further stipulates that chronic antibiotic therapy can compromise gastrointestinal absorption. More recent research involves polychlorinated biphenols with transepithelial migration of tumor cells, (Eum et.al, 2006).  

Because of the correlation between menopausal urinary disturbance and IC, often hormone therapy is administered for treatment. This therapy may be effective by rebalancing estrogen that in turn will assist in the stabilization of urogenital tissue its the microbial population as the vaginal chemistry is dependent upon estrogen for balance.

When properly applied, hormones can make a significant difference. If used under inappropriate circumstances, however, they can also make someone much worse if inappropriately used. If there is not truly an estrogen deficiency and there is an overgrowth of microbes in the vagina, estrogen will make everything worse.

Vulvadynia is another very important factor with regards to HRT. Often patients will complain of vulvadynia and the problem is intertwined with an estrogen deficiency. An estrogen Deficiency can be enough to change the ecological environment in the vagina creating an atmosphere conducive to the proliferation of an otherwise low level of bacteria. That proliferation may lead to chronic inflammation and pain and the syndrome vulvadynia. Vulvadynia may also be caused by other etiological factors, even so, hormones must be ruled out as a factor even though they are not always the culprits. Vulvadynia and IC often come together. This author’s opinion is that one is simply an extension of the other, and they are definitely not separate issues.

It has been this author’s experience with those having hormonal deficiencies and IC and additionally requiring some form of HRT that Natural or “bio-identical” HRT seem to work much more effectively than does standard HRT. In fact, within the context of the Integrative Approach, standard HRT has been found to exacerbate symptoms to the extent that a patient may feel that the treatment is not working at all. In most cases, when natural HRT is substituted, the symptoms change for the better dramatically. However, over time, this author has found that herbs may be equally effective in duplicating the kinds of effects that bio-identical HRT delivers without the risk for adverse effects.

Gillespie (1986) contrasts the differences between progestins (a synthetic form of progesterone, and natural progesterone, clarifying the fact that progestins have been linked with elevated triglycerides and therefore increased risk of heart disease, increased carbohydrate cravings due to their increasing the body’s resistance to insulin, and the correlation between progestins and their effect on the modification of amine turnover which is correlated to sudden bladder pain. This is due to its effect on parasympathetic nerve responses, and increased leaky bladder (meaning an increase in the permeability of the bladder lining). She further stipulates that the natural form of progesterone in your body does not cause these unwanted affects. Gillespie (pp.172-3) goes on to say that those experiencing bladder problems of this nature should strongly consider not taking progestins and should consider taking estrogen, a hormone, which is greatly repairing to body tissue. However, she reiterates the medical profession’s hesitation to use estrogen a hormone, which is greatly repairing to body tissue. However, she reiterates the medical profession’s hesitation to use estrogen, as it has been associated with higher incidence of endometrial and breast cancer.   

Gillespie affirms the idea that adequate estrogen levels will act to protect the body from the growth of unhealthy bacteria and yeast by keeping the vaginal tissues in balance. The loss of estrogen will thin the lining of the vaginal walls; increase susceptibility to these infections as well as urinary tract infections. Estrogen deficiency will also decrease commensal organisms present in the vagina. The most commonly known example of this is lactobacillus. Lactobacillus is also present in our intestines. This and other good bacteria in our bodies are critical to the homeostatic balance in our systems.

Estrogen loss in the body can also have a particular affect on the bladder. There is an area in the bladder referred to as the trigone. This is the area that receives the signal that you have to urinate. This is also an area that has many estrogen receptor sites assisting in maintaining the GAG layer. When these receptor sites are adequately filled with estrogen, the estrogen protects the tissues (in the same way that it acts as a protective agent in the vagina) against the hostile contents of urine. These receptor sites may become Deficient in menopause as well as with exposure to overuse of antibiotic therapy.

Kanne and Jenny (1977) conducted a randomized double blind study in Germany

with vaginal tablets containing 3 mg of estriol and lactobacillus acidophilus that was found to return the vaginal milieu completely. It also returned the urethral epithelium to normal. This study, although very old, is a fantastic example substantiating this author’s experience and theories of some forms of IC. She has also used an estriol acidophilus combination in numerous patients.

Raz & Stamm (1993) conducted another double blind placebo study over an eight month period. Thirty-six women suffering from chronic UTIs due to atrophic vaginal changes were given estriol. Before treatment began, the vaginal chemistry was assessed and found to be completely absent of lactobacillus acidophilus. Enterococcus was present in a number of these patients. After the eight month period, the incidence of UTIs were reduced significantly, lactobacillus was returned to normal in 22 out of the 36 patients after only one month, and the vaginally present Enterococcus was reduced from 67 to 31 percent with the estriol treatment alone! This is yet another classic example of returning homeostasis as a method of treatment. An alternative treatment may have been to give antibiotics for the Enterococcus or to simply supplement with the lactobacillus. However, the cause of the problem was the atrophic condition of the vagina. Treating the underlying cause corrected the problem.

I used to subscribe to giving estrogen, and in fact I do have a couple of patients on it for very specific reasons. There are defintiely certain situations in which it is imerative or helpful. Overall over the years, however, I started to connect that one could manipulate the levels of hormones via the use of supplements, most especially probiotics. I also started to connect that women seemed to be making much better improvements with their micro-organism imbalances without the additional hormones in the mix. I began to notice that in actuality, the hormones may have helped a bit with pain and in some cases evern more than a bit, but overall it was holding people back in other ways and then the sum of their health was not improving. And I do think that the addition load of outside hormones into the body creates the risk for cancererous cells to grow. As I was writing my dissertation, this was a point that I disagreed with one of my professors one quite strongly and I felt sure he was wrong. In the end, I came around to his thoughts completely despite the literature supporting the use of estrogen and everything that I had read.

In any case, I am writing about this today because someone had sent me an article on estrogen and bladder health and she asked me to post an update.

I hope it added some food for thought.

Dr.M