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Menopause
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Hormones are wonderful chemicals when in balance and not so wonderful when the balance is off. Many of you know exactly what I mean. Treatment involving hormones should never be done lightly. There are other treatment avenues that can be explored before using hormones to manage the symptoms of menopause. However, some women only find relief when using hormones. Also, some women find hormones are easier to incorporate into a busy lifestyle.
Having spent a lot of time studying hormones, I have a few beliefs regarding how I use them. The first is I always use the lowest levels of hormones that can alleviate the symptoms. This low level dosing makes the most biochemical and physiological sense. Excess hormones in the body will require that the body use energy to process them. Doesn't it make more sense to save this energy for other events in life? The liver also gets involved with processing hormones. Now I guarantee, your liver already has plenty of work given the toxic world we live in. Why add more jobs for your body than needed.
My second rule in hormone prescribing is each patient is an individual. Unfortunately, standard medicine usually treats all women the same. Thin build or heavy build is rarely taken into account. However, in reality, body shape can relate to many important biochemical markers, such as peripheral adipose tissue converting DHEA to sex hormones. The biochemical pathways involving hormone metabolism vary, sometimes greatly, in individuals. YOU are unique and this must be taken into account.
My third rule is natural hormones make more sense. Unfortunately they have few studies to back this up this belief and they are often faulted for this reason. However, no one will fund the studies since natural hormones can not be patented Money is a strong driver of many aspects in medicine. Drug companies have definately contributed to medicine, however, in this area I think they have fallen short. Does it make more sense to use human bio-identical natural hormones or the hormones taken from a horse (Premarin)? While I will acknowledge, few studies have shown this belief to be absolutely true, it simply makes more sense to me.
My fourth rule is testing. I recommend testing to help determine how your biochemical pathways are working and where the problems are. This investigation into your uniqueness helps custom tailor a treatment plan. A female hormone panel runs about $225 approximately. I prefer a 24hr urine collection over salivary testing as I get many more sex hormones and metabolites in addition greater accuracy. This test shows the varies forms of estrogens and their metabolites, testosterone, DHEA, androstenetriol, progesterone, pregnenolone, cortisone, cortisol and its various metabolites. These are all important in determining biochemical patterns. This is not to say hormones and other treatments can not be prescribed without testing. Testing just makes treatment faster and more efficient.
These are the important components I use to help get your hormones back into their natural balance. If you have specific questions about your case, then call and leave a message.
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Some common prescription meds
Premarin = Conjugated equine (horse) estrogens made up of 50% estrone (E1) with 10-12 other conjuated estrogens.
Provera = Synthetic progesterone (Progestin). Appox up to 40% of women have side effects.
Prempro = Combination of synthetic estrogen and sythethic progesterone.
Estratest = estrogen and testosterone.
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Who's taking my hormones?
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The WHI study
A lot has been said in the news about the lastest study results regarding female hormones. Several points are worth discussing. The first being the study was only done with the medication Prempro. This medication is a blend of synthetic estrogen and progesterone. The study was not done using any natural hormones. Secondly, the numbers can be misleading. This is true of any medical study. A researcher can make any study look any way he/she wants it to. Always be careful when getting medical information from the news media.
Here is what the numbers that alarmed everyone look like. Increase of 29% in heart attacks and 41% increase in strokes and 26% increase in breast cancer. Now these sound bad, and they are, but when you look at the absolute numbers they may not be as bad as the percentages indicate. Absolute risk turns out to be low. It shows that 38, instead of 30, women in 10,000 would develop breast cancer. This is 8 more women in 10,000. That is not a large amout, esp when you think cancer rates may just be increasing in general due to many other environmental factors. Seven more women would have heart attacks, and 8 more have strokes, and 18 more have blood clots. These absolute numbers are per year. Thus, the longer a woman is on Prempro the more risk she will have.
So, considering the absolute numbers the risk is lower than one might initiately think. Remember though, this study was done with synthetic hormones. Would it be different with natural hormones? We do not know for sure, but we are hopeful and confident it would be. One indication that the results may be different is that women typcially report a much lower rate of side effects with natural hormones. This certainly stregthens the belief that natural hormones are a better choice and will contribute less to the development of the problems this study brought to light.
However, other approaches to menopause exist and can be dramatically effective for some women. This inlcudes lifestyle and diet changes, homeopathy, nutritionals, and botanicals. As a Naturopathic doctor I can guide you through any of these choices. As I doctor I see my role as providing you with options, information, and suggestions. You make the decision as to which option feels right to you.
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Perimenopause usually starts around the age of 46, but can begin anytime from ages 40-51. It usually last on average 5 years, but can last for 2-8 years. Menopause is the cessation of menstruation due to loss of ovarian follicular activity for 12 consecutive months without menses. Currently apporximately 20 million women are experiencing menopause and by 2010 projected to be up to 60 million.
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