Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

Estriol for MS

Ronda Voskuhl Estriol Multiple SclerosisBioidentical Hormone Estriol

Beneficial For Multiple Sclerosis MS

by Jeffrey Dach MD

Multiple sclerosis affects about a million people worldwide.  It is an auto-immune neuro-degenerative disorder characterized by demyelinating plaques thought the brain and spinal cord, visible on MRI scans (Magnetic Resonance Imaging) and CAT scans.   The demyelinating plaques interfere with neuron function, and cause focal neurologic symptoms which wax and wane over time.

Symptoms include double vision, weakness in the arm or leg, difficulty with balance or walking, tingling, numbness etc.  Conventional treatments with anti-inflammatory medications are sometimes useful, however, they come with serious adverse side effects.  There is a need for safer and more effective treatments for multiple sclerosis.  Previous studies in animals and humans have shown that a from of Estrogen called Estriol, a bioidentical hormone, is a promising new treatment of Multiple Sclerosis. (2-5)

Pregnancy_confers_Protection_MSPregnancy Confers Protection In MS

Dr. Rhonda Voskuhl, a UCLA neurologist, who holds a patent on Estriol for MS (4), has made the observation that pregnancy confers relative protection from relapse in multiple sclerosis patients.  Based on this observation, she theorized that the pregnancy hormone, Estriol may be protective agent.  Pregnancy Photo courtesy of this page.

50% Reduction in MS Symptoms With Estriol

At a recent neurology meeting, Dr. Rhonda Voskuhl reported on her preliminary findings on her study using the bioidentical hormone, Estriol.(1)  She found a nearly 50% reduction in relapse rate in MS patients given Estriol (8 mg day oral pill) (1)

Watch the You Tube Video:

We routinely include Estriol in our HRT program for all women.

This is our approach to natural treatments for multiple sclerosis:

1) Wheat Gluten Could be the Culprit

Firstly, MS is an auto-immune disease, therefore Wheat Gluten sensitivity should be suspected and  testing for the anti-gliadin antibody carried out.  Wheat gluten ingestion may be causative for the auto-immune process. Many MS patients find that their symptoms improve on a Gluten Free Diet.  See my previous article on Wheat Gluten And Autoimmune Neurologic Disease

MS-Brain_MRI SCanLeft Image courtesy of Medscape: MRI of the brain in multiple sclerosis showing typical distribution of  periventricular white matter lesions. (shown as white spots). These fixed lesions correspond to edema, demyelination, gliosis, and axonal loss.

2) Vitamin D

Vitamin D deficiency is thought to be a causative factor in Multiple Sclerosis.  Vitamin D for MS has been extensively studied and benefits reported in the medical literature.   A review by Dr. Brown reported that Vitamin D supplementation prevented the development and progression of experimental autoimmune encephalitis, an animal model of MS, in mice. A large, prospective, cohort study found that vitamin D supplementation was associated with a 40% reduction in the risk of developing MS. Four small, non-controlled studies suggested that vitamin D supplementation may decrease exacerbation of MS symptoms.  MRI studies of multiple sclerosis lesions show improvement during summer months and worsening during winter months suggesting a Vitamin D link.

Many MS patients report improvement of their neurological symptoms with vitamin D3 supplements.  We routinely test Vitamin D3 levels and provide supplements to raise serum levels to the upper third of the normal range. Avoid Vitamin D2, use D3 instead.  See more details in my previous article on Vitamin D for Multiple Sclerosis.

3) Vitamin B12

Vitamin B12 deficiency can mimic the clinical presentation of multiple sclerosis, so we test for and supplement with B12 injections in many of our MS patients.  See my previous articles:

Vitamin B12 Deficiency and Neuropsychiatric Disorders.

and Vitamin B12 Deficiency Part One.

4) LDN Low Dose Naltrexone

Low dose Naltrexone is an FDA approved drug which has been found very useful for MS patients.  We have seen excellent results  and routinely recommend it for all MS patients.  LDN is obtained as capsules from a compounding pharmacy, which are taken at night before sleep.  There are no known serious adverse side effects.  See my previous articles on LDN: Low Dose Naltrexone Part One

Header image courtesy of Dr. Rhonda Voskuhl and  UCLA

Articles with related interest:

Vitamin D for Multiple Sclerosis

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314

Links and References

Preliminary clinical trial shows great promise for new multiple sclerosis treatment.  Female hormone estriol reduces relapse rate by nearly 50 percent, UCLA neurologist reports

A study conducted by Dr. Rhonda Voskuhl, a UCLA neurologist, shows that combining estriol, a female hormone, with Copaxone, a medication currently used to treat multiple sclerosis, reduced the relapse rate of MS by nearly 50 percent with only one year of treatment.  Voskuhl presented the results of the preliminary Phase II clinical trial today at the annual meeting of the American Academy of Neurology in Philadelphia.

The randomized, double-blind, placebo-controlled trial involved 158 women with relapsing-remitting MS. At 16 sites across the U.S., one group of women was treated with Copaxone, a commonly prescribed, standard-of-care drug for MS, and an 8 milligram estriol pill each day; others received Copaxone and a daily placebo pill. After 12 months of treatment, the relapse rate for the Copaxone-plus-estriol group was 47 percent lower than that of the group that took Copaxone plus a placebo.

2)   free full text
J Immunol. 2003 Dec 1;171(11):6267-74.
Immune modulation in multiple sclerosis patients treated with the pregnancy hormone estriol.
Soldan SS1, Alvarez Retuerto AI, Sicotte NL, Voskuhl RR.
The protective effect of pregnancy on putative Th1-mediated autoimmune diseases, such as multiple sclerosis and rheumatoid arthritis, is associated with a Th1 to Th2 immune shift during pregnancy. The hormone estriol increases during pregnancy and has been shown to ameliorate experimental autoimmune encephalomyelitis and collagen-induced arthritis. In addition, estrogens induce cytokine changes consistent with a Th1 to Th2 shift when administered in vitro to human immune cells and in vivo to mice. In a pilot trial, oral estriol treatment of relapsing remitting multiple sclerosis patients caused significant decreases in enhancing lesions on brain magnetic resonance imaging. Here, the immunomodulatory effects of oral estriol therapy were assessed. PBMCs collected longitudinally during the trial were stimulated with mitogens, recall Ags, and glatiramer acetate. Cytokine profiles of stimulated PBMCs were determined by intracellular cytokine staining (IL-5, IL-10, IL-12 p40, TNF-alpha, and IFN-gamma) and cytometric bead array (IL-2, IL-4, IL-5, IL-10, TNF-alpha, and IFN-gamma). Significantly increased levels of IL-5 and IL-10 and decreased TNF-alpha were observed in stimulated PBMC isolated during estriol treatment. These changes in cytokines correlated with reductions of enhancing lesions on magnetic resonance imaging in relapsing remitting multiple sclerosis. The increase in IL-5 was primarily due to an increase in CD4(+) and CD8(+) T cells, the increase in IL-10 was primarily due to an increase in CD64(+) monocytes/macrophages with some effect in T cells, while the decrease in TNF-alpha was primarily due to a decrease in CD8(+) T cells. Further study of oral estriol therapy is warranted in Th1-mediated autoimmune diseases with known improvement during pregnancy

Ann Neurol. 2002 Oct;52(4):421-8.
Treatment of multiple sclerosis with the pregnancy hormone estriol.
Sicotte NL1, Liva SM, Klutch R, Pfeiffer P, Bouvier S, Odesa S, Wu TC, Voskuhl RR.
Multiple sclerosis patients who become pregnant experience a significant decrease in relapses that may be mediated by a shift in immune responses from T helper 1 to T helper 2. Animal models of multiple sclerosis have shown that the pregnancy hormone, estriol, can ameliorate disease and can cause an immune shift. We treated nonpregnant female multiple sclerosis patients with the pregnancy hormone estriol in an attempt to recapitulate the beneficial effect of pregnancy. As compared with pretreatment baseline, relapsing remitting patients treated with oral estriol (8 mg/day) demonstrated significant decreases in delayed type hypersensitivity responses to tetanus, interferon-gamma levels in peripheral blood mononuclear cells, and gadolinium enhancing lesion numbers and volumes on monthly cerebral magnetic resonance images. When estriol treatment was stopped, enhancing lesions increased to pretreatment levels. When estriol treatment was reinstituted, enhancing lesions again were significantly decreased. Based on these results, a larger, placebo-controlled trial of estriol is warranted in women with relapsing remitting multiple sclerosis. This novel treatment strategy of using pregnancy doses of estriol in multiple sclerosis has relevance to other autoimmune diseases that also improve during pregnancy.

4) //
Estriol therapy for multiple sclerosis and other autoimmune diseases
US 6936599 B2
Inventors    Rhonda R. Voskuhl
The present invention discloses administering steroid hormones to mammals to treat autoimmune related diseases, more particularly, Th1-mediated (cell-mediated) autoimmune diseases including: multiple sclerosis (MS), rheumatoid arthritis (RA), autoimmune thyroiditis and uveitis. Most preferably the invention is used to treat a patient with a therapeutically effective amount of estriol of 8 milligrams once daily via oral administration to treat the symptoms or prevent the onset of multiple sclerosis.

Medscape Medical News from the      American Academy of Neurology (AAN) 66th Annual Meeting Adding Estriol Reduces MS Relapse Rate


YouTube Video

6) Published on Apr 29, 2014
Female hormone estriol reduces relapse rate by nearly 50 percent, UCLA neurologist reports
A study conducted by Dr. Rhonda Voskuhl, a UCLA neurologist, shows that combining estriol, a female hormone, with Copaxone, a medication currently used to treat multiple sclerosis, reduced the relapse rate of MS by nearly 50 percent with only one year of treatment.
Voskuhl presented the results of the Phase II clinical trial today at the annual meeting of the American Academy of Neurology in Philadelphia.
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Preliminary Research on Estriol Looks Promising for MS Treatment  By Jody Smith HERWriter


Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314

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