Bio-Identical Hormone Replacement Therapy 

 

What are the symptoms of menopause?


Menopause symptoms may include:

 

  • Hot flashes

  • Vaginal dryness

  • Low libido

  • Weight gain

  • Irritability

  • Sleep problems

 

If you have these symptoms you may be:


Perimenopausal: Defined as the time leading up to menopause. Your body stops making as much estrogen and progesterone as it used to, which can result in you experiencing many of the typical symptoms of menopause.  Some women experience this in their mid-to-late thirties but there is no magic age.  You can still get pregnant during this stage.

 

Menopausal: This typically occurs between the ages of 45-55 and is defined as when your body skips 12 or more consecutive monthly periods. Your body makes extremely low levels of estrogen and progesterone and stops menstruating permanently.  The average age of menopause is 51.

 

What is hormone replacement therapy (HRT)?


   If you are experiencing these menopause symptoms, I may recommend, after appropriate testing, that you start a program of hormone replacement therapy.  Hormone replacement therapy involves replacing levels of estrogen and progesterone to relieve the symptoms of perimenopausal and menopausal women.  HRT also helps prevent osteoporosis. Although HRT is an effective treatment for menopause symptoms including hot flashes, insomnia, and vaginal dryness, as with many treatment regimens, there are side effects and potential risks which we will discuss. Traditionally women have only had the choice of using synthetic hormones for this treatment, now there are other options to help meet patients' individual needs.

 

What are bio-identical hormones?


   Bio-identical hormones are a natural alternative to synthetic hormones.  Based on your hormone levels, we can customize plant-derived hormones to address your unique needs. 

Why would I use bio-identical hormones instead of synthetic hormones?
   You may find that the synthetic hormones are not meeting your needs because they are only available in a certain form or dosage.  Customization can occur in the form in which they are administered including: gels, creams, capsules, troches (a small lozenge), or sublingual drop. Customization can also occur in the dosage of the bio-identical hormones.

Why do I need hormone testing?


   One size does not fit all when it comes to hormones! For decades western medicine has prescribed HRT as if everyone needed the same thing and the same amount. Nothing could be further from the truth. Your hormones are like your fingerprints and in order to achieve optimal health, you need to know what your specific imbalances are.
   To find out about your hormonal status you’ll need to have lab tests performed. But what kind? There are several ways to test (saliva, serum and urine), but the state-of-the-art testing is through saliva. This is because it measures only the active portions of your hormones and it is these portions that determine how you feel. So if you’re seeking bio-identical hormone replacement (BHRT), you’ll need to know active hormone levels. In addition, if you’re using a topical (transdermal) hormone preparation for treatment, saliva testing is the most accurate tool to measure and monitor your hormone status.

Which hormones need testing?


   The major players in the sex hormone arena are estradiol, progesterone and testosterone. The main adrenal hormones are DHEA and cortisol. These five hormones will provide crucial information about your deficiencies, excesses and daily patterns, which then results in a treatment approach specifically tailored for you and one far more beneficial than the old “shotgun” approach. Below is a brief description of each of these five hormones to refresh your memory about what each one does and how they interact.

Estrogen: there are three forms made by the body: estrone, estradiol and estriol. The form used in past hormone replacement therapies is estradiol, often in the form of concentrated pregnant mare’s urine (premarin). It is a proliferative hormone that grows the lining of the uterus. It is also a known cancer-causing hormone: breast and endometrial (uterine) in women and prostate gland in men. It will treat menopausal symptoms like hot flashes, insomnia and memory-loss. With the bio-identical formulas estriol is matched with estradiol (biest) to provide protective effects and additional estrogenic benefits. The other major protector in keeping estradiol from running amok is progesterone. Estradiol increases seratonin and endorphin levels.  It enhances mental acuity and memory.

Progesterone is called the anti-estrogen because it balances estradiol’s proliferative effects. It is considered preventive for breast and prostate cancers as well as osteoporosis. Low levels of progesterone promote depression, irritability, increased inflammation, irregular menses, breast tenderness, urinary frequency and prostate gland enlargement (BPH). It enhances mood and has a calming effect.  It is frequently deficient in patients with insomnia. It regulated fluid balance.

Testosterone is an anabolic hormone (builds tissue) that is essential for men and women. The proper level of testosterone is necessary for bone health, muscle strength, stamina, sex drive and performance, heart function and mental focus. It will increase libido.

DHEA is an important adrenal gland hormone, which is essential for energy production and blood sugar balance. DHEA is a precursor to other hormones, mainly testosterone. It helps protect against heart disease, osteoporosis, diabetes, cancer, alzheimer's disease, lupus and rheumatoid arthritis. It can increase and enhance energy levels, libido, memory and immunity.  It protects against stress.  It aids in weight loss and healing of burns.  It helps to prevent wrinkles and dry eyes.

Cortisol is your waking day hormone (highest in the morning and lowest at night). It is necessary for energy production, blood sugar metabolism, anti-inflammatory effects and stress response.

   Some of the common imbalances identified through testing include estrogen dominance, estrogen deficiency, progesterone deficiency, androgen (testosterone and DHEA) excess or deficiencies, adrenal dysfunction and adrenal fatigue.

Some Final Comments


   Although menopause is a natural passage, it is often difficult for many women to carry out their day-to-day responsibilities if the symptoms become too distressing.  Our discussions will help confirm that the symptoms are related to menopause and rule out any other potential problems.  One recommendation is to keep a journal of the symptoms, what seems to make them worse, and which symptoms are causing you the most distress.  Because mood swings are often a part of menopause it is important to monitor how you feel and communicate as much as possible to me. In addition, I may also recommend ways of controlling environmental factors to help with specific symptoms, for example dressing in layers to help hot flashes and beginning an exercise program to assist with mood swings and weight gain.

© 2014 by Nancy Lentine Integrative Family Medicine. 

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