Treatments Based On Your Body’s Individual Needs
By Mark Gunderson, MD |
What is Menopause?
Menopause refers to that time in every woman’s life when menstruation ceases completely. The ovaries output of estrogen and progesterone diminishes severely. In addition to signifying the end of a woman’s ability to have children, changing hormonal levels affect the entire endocrine system. Menopause is considered complete when a woman has had no periods for a full year. This varies but is normally complete in the early fifties. The perimenopausal period is that period prior to menopause when hormonal levels may be declining which may start in the early thirties!
In addition to diminished levels of estrogen and progesterone, testosterone levels are reduced during menopause and may be suboptimal during the perimenopausal period. It is considered within the normal range for 40 year old women to have a testosterone level of zero! Changing levels of hormones affect the entire endocrine system that controls growth, metabolism and reproduction. The diminution of hormone levels during menopause affects the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract, and skin.
Age Management Medicine (AMM) follows blood chemistries that include a complete blood count, lipid panel, comprehensive chemistry panel, urinalysis and a complete hormonal assessment including follicle stimulating hormone (FSH), total testosterone, thyroid panel including thyroid stimulating hormone (TSH), free T-3, and free T-4, estradiol, progesterone, leutinizing hormone (LH), and dehydroepiandrosterone (DHEA) levels.
In the past, traditional doctors tended to treat menopause rather than the person experiencing menopausal symptoms. Often, patients were treated without any hormone levels checked. Doctors routinely used fixed dosages of hormones such as Premarin taken orally and synthetic progesterone such as medroxyprogesterone. Premarin is a product of pregnant mares urine (hence the name) containing 30 plus horse estrogens. It is NOT bioidentical to human estrogens. Additionally, there is nothing natural about taking horse estrogens orally. The many known side effects can be diminished by using bioidentical hormones that present the hormone to the body that mimics the natural process. This can be done with transdermal preparations using natural and bioidentical molecules. The current controversy and bad outcomes that have been in the popular and scientific press regarding the Women’s Health Initiative on hormone replacement therapy has been detrimental for the health and quality of life for many women. Doctors are now reluctant to prescribe hormones for women. AMM and leaders in the anti-aging medical community believe that these studies have been flawed from the beginning. Additionally, pharmaceutical companies have traditionally not been interested in producing natural, bioidentical hormones as these molecules are not able to be patented. Practitioners of Age Management Medicine believe that hormonal replacement can be beneficial to both the overall health of women and improve the quality of life by using bioidentical hormones and delivering them to avoid first passage through the liver-which occurs with oral preparations. Additionally, there are supplements such as indole-3-carbinol that can lessen the known carcinogenic metabolic end-products of estrogen. AMM believes in using an estrogen mixture mimicking the normal levels of estradiol and estriol. The major component is estriol which is not carcinogenic. AMM physicians believe that rational hormone replacement therapy can be done without increasing the risk of cancer and heart disease beyond the normal baseline disease rates.
What effects can I expect from this bioidentical hormone replacement?
• Hot flashes can be significantly reduced or eliminated.
• The thinning and loss of elasticity of the vagina and urinary tract can be improved. Painful intercourse can be improved.
• The loss of libido that is related to declining levels of testosterone can be helped as well as increasing energy and maintaining body composition.
• There can be emotional changes that occur with menopause that can mimic depression that may be helped.
• Osteoporosis (decrease in bone mineral density) is drastically accelerated after menopause and can be improved with hormone replacement and nutrition and weight bearing exercise.
• Reduce the risk of cardiovascular disease and may improve cholesterol ratios.
Progesterone in the Practice of Age Management Medicine
Progesterone is the most underused essential hormone in female replacement programs. It is a natural diuretic-it can help eliminate bloating and excess fluid and puffiness. It is a natural anti-depressant. It helps with mood, sleep, bone growth and balances estrogen. It is probably a natural anti-cancer agent. Modern medicine only looks at progesterone protecting the uterus from estrogen induced cancer. In reality, progesterone has hundreds of functions in the human body. Estrogen and progesterone therapy must be balanced to ensure optimal health. Additionally, women need some testosterone as well for optimal health. Bone health, libido and weight gain can be improved with testosterone.
Disease in women starts with the onset of declining hormones. Risk factors for heart disease, osteoporosis, stroke, and dementia start at this time. HRT can decrease the rate of dementia by 5 fold if started early enough. If you wait until age 75, you are too late. The average 85 year old female has a 50% chance of dementia currently.
It is vital for women to have all the information in order to make an informed decision on treatment options. It is a confusing time for women. The reality is that negative media coverage distorts adverse effects in a small minority. The Women’s Leisure Study in 2007 showed lower overall mortality in women on estrogen replacement therapy.
Age Management Medicine and bioidentical hormone replacement have tremendous benefits in improving quality of life and ensuring optimal health and youthfulness.
Physicians who practice AMM treat every patient as unique and you can be sure that your program will not be a “one size fits all” model. You will receive just the hormones you need. There are treatment programs that utilize bioidentical natural products whenever possible that are delivered to the body in a way that mimics the normal process.
1. Natural Hormone Balance for Women By Ussi Reiss, MD/OB GYN, with Martin Zucker. Pocket Books, 2001.
2. Life Extension Revolution, Phillip Lee Miller MD And the Life Extension Foundation. Bantam Dell Publishing Group, 2005.
For more info, call Age Management Institute at (775) 787-8300.