Menopause Happens

Every woman will go through menopause. It will happen either naturally or surgically. Some women will make the transition without much notice, while others will experience all the unpleasant symptoms that come with menopause. What is important to know is how crucial a woman’s hormones are to her mind and body and why replacing them is paramount to her health and wellness regardless of her symptoms. Estrogen, progesterone, testosterone and thyroid are some of the hormones every woman should maintain for physical, mental and physiological health.

Estrogen is a hormone produced in the ovaries and adrenal glands. There are three types of estrogen: Estrone, estradiol and estriol. Estradiol is the primary estrogen hormone and it is metabolized into estrone and estriol. With the onset of menopause, the levels of estrogen drop dramatically and the symptoms of menopause and the diseases of aging begin. Estradiol is vitally important for the female body, and to help eliminate the symptoms of menopause.

Progesterone is also a hormone produced by the ovaries. Natural progesterone enhances the action of estrogen and has a symbiotic relationship that maintains a normal hormonal balance. Progesterone must be taken when estrogen is given. Regardless of whether a woman has a uterus or not, progesterone should be taken during peri-menopause and menopause for relief of menopausal symptoms.

Testosterone is not just a male hormone. Testosterone is also a female hormone that is produced in the ovaries and adrenal glands. Testosterone is critically important for the physical and emotional health of women. Testosterone helps eliminate the symptoms of menopause.

Thyroid hormone is a metabolic hormone secreted by the thyroid gland. Thyroid hormone is important for regulating metabolism, temperature and brain function. Thyroid affects every cell in the body.

Mental Health- Estrogen helps prevent depression and protects the brain from cognitive dysfunction. Progesterone has a calming effect on the brain. Testosterone helps prevent depression and Alzheimer’s disease; it enhances memory, increases a sense of well being and psychological status. Thyroid hormone has been shown to help fight depression.

Bone Health- Estrogen helps maintain bone density by mediating the metabolism of vitamin D, which is needed for bone formation. Studies have shown that women taking estrogen have 50% less risk of hip fractures and 90% less risk of vertebral fractures compared to women that did not take estrogen. Estrogen does not build bone, but helps maintain bone. Progesterone helps stop bone loss and helps maintain bone mass and bone density. Some studies have shown progesterone actually restores bone loss and increases bone density. Testosterone also helps increase bone mineral density.

Cardiovascular Health- Estrogen is the primary hormone that provides cardiovascular protection. Estrogen and progesterone can help lower “bad” cholesterol (LDL) and raise “good” cholesterol (HDL). Progesterone has been shown to help reduce heart disease by preventing coronary artery constriction. Having low levels of thyroid hormone is a risk factor for atherosclerosis leading to myocardial infarction in older women.

Breast Health- Progesterone has been proven to be the best hormone to protect the breast and the uterus. Studies have shown that progesterone has an anti-cancer affect on breast tissue. All perimenopausal and menopausal women regardless of whether they have a uterus or not should take progesterone to maintain healthy breasts.

Endocrine Function- When a woman has subclinical hypothyroidism, restoring thyroid hormone to an optimal level helps maintain proper metabolism which will contribute to weight loss. Testosterone helps decrease visceral fat which contributes to weight loss as well.

Muscle Function- Muscle tone and strength are improved when testosterone is replaced. The ability and desire to exercise returns when low levels of testosterone are restored. Body composition improves by increasing lean muscle.

Genitourinary Health- Incontinence, vaginal atrophy, vaginal dryness and painful intercourse are all improved when estrogen levels are restored. When a woman replaces the estrogen and testosterone she is no longer producing, her libido will return to what it used to be.

Felling Well- Quality of life studies have shown that women with mild to severe menopausal symptoms that chose hormone replacement therapy enjoyed a higher quality of life than women who did not chose hormone replacement. Women’s hormone levels begin to decrease as they age. When a woman’s hormones are not balanced they don’t “feel” like they used to. Many times they will consult a physician about these changes and are offered a prescription for an anti-depressant. We feel replacing your hormones is a safer and healthier method to feeling better.

Estrogen, progesterone and testosterone levels usually maintain regular cyclical patterns throughout childbearing years. When a woman begins to enter menopause her estrogen, progesterone and testosterone levels fluctuate. These fluctuations bring about a myriad of conditions and symptoms that include cardiovascular disease, osteoporosis, hot flushes, irritability, fatigue, cognitive decline, vaginal dryness, decrease muscle tone, decrease libido, and skin tone changes.

Thyroid hormone levels can begin to change at any time in a woman’s life, and the majority of women will suffer from a decline in thyroid hormone. Some of the signs and symptoms that correlate to low levels of thyroid hormone are weight gain, low energy, fragile and thinning hair, cold hands and feet, cognitive decline and a decrease in metabolism.

Medical Concerns- Breast tenderness can occur. This is dose dependent and will subside by lowering the dose of estrogen. Acne and excess hair growth seldom occur and this is dose dependent as well. By lowering the dose of testosterone these side effects resolve. If fluid retention should occur which is dose dependent, adjusting estrogen, progesterone and thyroid hormone will resolve this as well.

Hormone Levels- Listed below are laboratories normal reference ranges for the following hormones. Note the difference between non-menopausal and menopausal estrogen and progesterone levels.

NON-MENOPAUSAL MENOPAUSAL
Estrogen 12.5pg/mL-498.0 Estrogen 6.0 pg/mL-54.7 pg/mL
Progesterone 0.2ng/mL-27.0ng/mL Progesterone 0.1ng/mL-0.8ng/mL
Testosterone 3ng/dL-41ng-dL Testosterone 3ng/dL-41ng/dL
TSH (thyroid) .45uIU/mL- 4.50uIU/mL TSH (thyroid) .45uIU/mL-4.50uIU/mL

Hormone Replacement Therapy-There are two types of physician supervised female hormone replacement therapies available. There is Bio-identical hormone replacement therapy and synthetic hormone replacement therapy. Bio-identical hormones have the same molecularity or chemical structure as the hormones the body once produced. Bio-identical hormones are metabolized by the normal metabolic pathways of the body therefore having the identical effect on the body. Bio-identical hormones are safe as they do not produce harmful metabolites that synthetic hormones can. Bio-identical hormones should never be confused with synthetic hormones. They are not the same. Synthetic hormones are manufactured with a different chemical structure to that normally produced by the human body. They are produced to mimic hormones and ultimately be patented, not because they are better or more effective. Unfortunately synthetic chemically altered hormones and their metabolites have been shown to cause harm such as breast cancer, osteoporosis, endometrial cancer, excessive vaginal bleeding, liver cancer, kidney cancer, and blood clotting disorders.

Hormone Replacement Methods- There are numerous routes of administration for hormone replacement including patches, vaginal inserts, gels, creams, sublingual troches, oral tablets, injections and subcutaneous pellets. Patches are not user friendly, injections are painful, and vaginal inserts can be uncomfortable. Pellets are surgically inserted under the skin. Sublingual troches and oral tablets are taken daily and sometimes twice a day. Creams also, are to be applied one to two times per day. The methods that we recommend and are most effective for elevating hormones to optimal levels are subcutaneous pellets, oral administration, or transdermal creams. Once implanted, the pellets deliver a slow steady dose of estrogen and testosterone. Within 3-6 months the pellets have been depleted and must be implanted again. Progesterone is delivered through a sublingual troche or an oral tablet. This method of delivery provides the most optimal progesterone levels. Estrogen can be administered through subcutaneous pellets, transdermal cream, or an oral form. Testosterone is administered either through the pellet or transdermal cream. With subcutaneous pellets or daily administration the body receives a constant supply of these essential hormones day after day, month after month year after year.

In summary- Medical literature continues to demonstrate the health benefits that hormone replacement with estrogen, progesterone, thyroid and testosterone provides. Restoring hormone levels with bio-identical hormones is nothing new. Physicians worldwide have utilized this method for decades. Because bio-identical hormones cannot be patented there has never been a “push” to prescribe bio-identical hormones. Synthetic hormone replacement became more popular and with it came all the negative side effects. Having low levels of these hormones is a precursor to many age related diseases and increased mortality. We feel it is imperative for women to know their hormone levels and restore them with bio-identical hormones.

J.Arden Blough, M.D.
Todd Farris, D.C.
Anna Cottle, A.R.N.P.
Allyson Kraker, P.A.-C

Physician supervised Bio-identical Hormone Replacement Therapy (BHRT) is available at The Broadway Clinic.