Some women are surprised to learn that oral contraceptives have more estrogen than standard hormone replacement with estrogen.
The lowest dose of oral contraception available contains 20 micrograms of ethinyl estradiol. This is 4 times that in a standard hormone replacement regime, which contains 5 micrograms of ethinyl estradiol (equivalent to 0.625 mg of conjugated equine estrogens).
Q: Why does a birth control pill have more estrogen than hormone replacement therapy? Why would a younger woman who is still menstruating, need more estrogen than an older, menopausal woman?
A: There is an elaborate and exquisite connection between a woman??™s brain and her ovaries. This system is called the hypothalamic pituitary ovarian axis.? When a woman is perimenopausal, her ovaries are aging and are not routinely producing a functional egg that can secrete predictable amounts of estrogen like it did when she was younger.? However, the ovaries are still able to function at times, especially when they have more FSH (follicle stimulating hormone).
When FSH levels rise, this causes increased ovarian follicular production of estrogen. This increase in the estrogenic state sends a message back to the brain that estrogen is present and the ovaries don??™t need to work as hard.? Therefore, less FSH is produced in a subsequent cycle, which then causes less stimulation of follicular development and as a result, less estrogen to be produced.
This is really a beautifully intricate system that causes a virtual roller coaster of estrogen levels. In order to turn off this roller coaster, or hypothalamic pituitary axis, and provide more steady levels of estrogen, healthcare providers may prescribe very low-dose oral contraceptive pills to healthy, nonsmoking perimenopausal women who don??™t have medical reasons to avoid this therapy.
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