Menopause - Hormone Replacement Therapy for Women

Do you want to regain the joy of your life? Read this.

Women approaching middle life notice that their bodies are changing. In the first 2 years of menopause women lose 90% of their sexual hormones. Main sexual hormones are: estrogens (estradiol, estriol, estrone), progesterone, testosterone, DHEA, and DHT.

Estrogens are a group of 3 related hormones (estrone, estradiol, estriol), each with a unique profile of activity. There are often prescribed to re-establish a normal physiologic balance. The use of one or more of these hormones is referred as Estrogen Replacement Therapy (ERT). Estrogens have about 400 functions. In clinical trials, estrogens have shown to be helpful for the treatment of menopausal symptoms, for the treatment of postmenopausal problems including vaginal dryness, atrophy, or vaginal infections, painful intercourse, and various conditions of the urinary tract. They are also helpful in decreasing the risk of osteoporosis and colorectal cancer, and in preventing Alzheimer's disease. They improve metabolic rate and insulin sensitivity, regulate body temperature, help prevent muscle damage and maintain those muscles, improve sleep, reduce risk of cataracts, help maintain the elasticity of arteries and also dilate them, increase blood flow, inhibit platelet stickiness, decrease the accumulation of plaque on arteries, enhance magnesium absorption and its utilization, maintain the amount of collagen in the skin, decrease blood pressure, help maintain memory, increase reasoning and new ideas, help with fine motor skills, increase the water content of skin, and are responsible for its thickness and softness, increase HDL by 10-15%, reduce the overall risk of heart disease by 40-50%, improve mood, increase concentration, maintain bone density, decrease wrinkles, protect against macular degeneration, help prevent tooth loss, aid in the formation of neurotransmitters in the brain, such as serotonin, which in return decreases depression, irritability, anxiety and pain sensitivity. Despite studies reporting the risks associated with synthetic hormones, conjugated equine estrogens remain the most frequently prescribed form of ERT. Published clinical trials have reported that the risk of breast cancer is increased by use of conjugated equine estrogens, and in addition, further increases when the synthetic progestin (medroxyprogesterone acetate) is added to the regimen. Therefore Bio-identical hormones are preferred.

Progesterone is commonly prescribed for perimenopausal women to counteract "estrogen dominance". It minimizes the risk of endometrial cancer in women who are receiving estrogen. Progesterone may enhance also the beneficial effect of estrogen on lipid and cholesterol profiles and exercise-induced myocardial ischemia (reduced oxygen supply to the heart muscle) in postmenopausal women (in contrast to medroxypogesterone acetate {synthetic progesterone, called progestin}). Increased stress contributes to progesteron deficiency. It is converted to cortisol, which in turn competes for progesteron receptors and helps to produce the effects of progesteron deficiency. Thus, stress of all kinds may lead to progesteron deficiency and contribute to estrogen dominance. It is a hormone of pregnancy. It prepares the endometrium for implantation, and supports gestation. During the mid-luteal phase (2nd portion of the menstrual cycle, i.e. after the ovulation). During the 3rd trimester of pregnancy 300 mg of progesteron is produced daily.

Progesteron has a wide margin of safety.

Androgens like testosterone and DHEA (dehydroepiandrosterone), may be added to women's BHRT to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes. There are age related gender dependent declines in DHEA. BHRT may cause a relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement.

Here are some of those hormones functions:

Estradiol (E2) protects against and helps the following functions:

  • osteoporosis
  • heart disease by 40-50% (maintains arterial elasticity, decreases blood pressure, decreases LDL and prevents its oxidation, increases HDL by 10-15%, decreases Lipoprotein A, reduces homocysteine levels, decreases plaque formation, decreases triglycerides)
  • Alzheimer's disease
  • colon cancer
  • urine incontinence
  • raises serotonin and endorphins levels in the brain (decreases depression, irritability, anxiety and pain sensitivity)
  • enhances mental acuity, memory and concentration
  • lessens menopausal symptoms
  • improves insulin sensitivity
  • regulates body temperature
  • helps maintain muscle mass
  • increases deep sleep
  • enhances magnesium uptake and utilization
  • maintains skin collagen
  • increases fine motor skills
  • enhances energy
  • improves mood
  • increases sexual interest
  • increases metabolic rate
  • reduces risk of cataracts
  • helps maintain the elasticity of arteries
  • dilates small arteries
  • increases blood flow
  • inhibits platelets
  • decreases plaque accumulation
  • increases reasoning and new ideas
  • acts as a natural calcium channel blocker to keep arteries open
  • decreases wrinkles
  • protects against macular degeneration
  • helps prevent tooth loss
  • works as an antioxidant
  • turns on progesteron receptors

Estrogens have 400 functions in the body.

Estrogens = memory

Progesterone protects against and helps the following functions:

  • diminishes uterine cancer risk
  • improves wellbeing and decreases anxiety, irritability, mood swings, and depression
  • reduces premenstrual tension symptoms (PMS)
  • regulates water distribution
  • balances estrogen
  • counters proliferative effects of estradiol on endometrium (down regulates estrogen receptors)
  • is neurologically protective
  • is anti-inflammatory
  • relaxes smooth muscles
  • lessens or eliminates insomnia
  • reduces pain and inflammation
  • osteoporosis
  • reduces excessive menstruation
  • reduces chemical sensitivity
  • reduces weight gain
  • improves libido
  • increases HDL (good cholesterol)
  • is eliminated by the body quickly
  • lowers high blood pressure
  • helps the body to eliminate fat
  • lowers cholesterol
  • may protect against breast cancer
  • helps balance fluids in the cells
  • increases scalp hair
  • increases metabolic rate
  • is a natural diuretic
  • is a natural antidepressant
  • acts as an anti-inflammatory
  • stimulates the production of new bone
  • enhances the action of thyroid hormones
  • is neuroprotective
  • functions as a precursor to numerous steroid hormones

Low progesteron has been associated with:

  • PMS
  • anovulation
  • infertility
  • spontaneous abortion
  • hypoadrenalism
  • polycystic ovarian syndrome (PCOS)
  • estrogen-dominant conditions
  • luteal phase defects

Testosterone in women:

  • builds and strengthens muscles
  • increases sexual drive
  • strengthens bones

Menopause treatment considerations should be:

  • hormone replacement should not be considered without a thorough understanding of how all of the body's hormones interact with each other
  • hormone response is unique to each person as their own fingerprints
  • the normal age to go through menopause ranges from 35-55, and therefore a woman can live half of her life without a menstrual cycle, cycling after age 55 increases a woman's risk of breast cancer
  • synthetic hormones waste body's resources by giving incomplete massages to cells, which then fail to produce a balanced hormonal response

Bio-identical hormonal treatment should consider the relief of symptoms, prevention of memory loss, maintenance of heart health and bone production, improvement of growth and repair. During menopause menstrual cycles become irregular. Women begin to experience hot flushes, sudden mood changes, insomnia, fatigue, a dry vagina, loss of libido and memory disturbances, loss of past interests, loss of perseverance, loss of energy and vigor. In addition, symptoms like night sweats, urinary incontinence, weight gain, appearance of acne and facial hair, swollen and tender breasts, depression, dry hair and skin, gas pains, migraines, oily skin, hair loss, gum disease, joint pains, loss of muscle strength, palpitations, brittle nails, and may also contribute to menopausal symptoms. Women go through this period in unique ways, nevertheless, in all of them, hormonal levels decrease. Nonetheless, nearly half of menopausal women actually experience no symptoms at all.

The right balance of hormones is vital to woman's health, but in menopause when levels are dropping, a deficiency of one hormone can actually appear as a relative excess of another, resulting in symptoms of hormone imbalances.

The official start of menopause typically occurs around the age of fifty. Nevertheless, it is not uncommon to see symptoms much sooner, even as early as mid to late 30s. Menopause can also be induced through removal of the ovaries and can also be precipitated by hysterectomy, chemotherapy, or radiation.

When taking a test it is important to remember, that the results are merely an indication that a woman might be entering into a stage of menopause, as abnormal hormone levels may signal other problems and are associated with specific symptoms.

Understanding the impact of menopause, by testing and later by periodic monitoring hormone levels, can help women to work with her physician to find appropriate solutions that will lead to wellness.

A healthy lifestyle has been shown to be associated with higher hormone levels, and higher hormone levels induce a more active, healthier lifestyle. When hormone levels decline, we become less active and gain weight. As we gain weight, hormones are stored in fat and become unavailable to meet the body's demands. Lack of exercise, excessive alcohol use, and many diseases can reduce bio-available hormone levels. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of supplements.

Too many hormones or too little may also be detrimental to a woman's health. In July 2002, the conclusion of clinical studies were published in Women's Health Initiative (WHI). It was said that medication called Prempro (previously the most commonly prescribed hormonal medication) which contained estrogens derived from the mare's urine and synthetic progesterone (progestine), caused an increased risk of heart attacks, strokes, blood clots and breast cancer. It suggested that the same, identical dose of hormones is not an appropriate dose for everybody. By contrast, synthetic hormones are intentionally different. Drug companies cannot patent a bio-identical structure, so they invent synthetic hormones that are patentable (Premarin, Prempro and Provera being the most widely used examples). Drug companies are dependent on hormonal replacement therapy profits, and they push doctors to use hormone substitutes and to ignore our natural hormones and their benefits.

Bio-identical Hormones

Though bio-identical hormones have been known for years and used in the United States and Europe for about 70 years, most practitioners are unfamiliar with them. There are several brand name versions now available for use in the kind of hormone replacement therapy ("HRT") typical of synthetic hormones. This is generally a one-size-fits-all dosage regimen.

Today hormones are available in bio-identical form, i.e. in the form they normally exist in our body. They can be given in different ways (orally, transdermally, intravaginally, sublingually or intrarectally). A woman should make decisions regarding bio-identical hormonal supplementation with her physician based on results of the blood or saliva tests. The great appeal of bio-identical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing their potential side effects. Moreover, the compounded bio-identical hormones can be matched to the individual needs of each woman's or man's needs-approach that is almost impossible with mass produced products. On the contrary, synthetic hormones often produce intolerable side effects. European medical studies suggest that bio-identical hormones are safer than synthetic versions. I recommend them only with a complete risk assessment on the individual basis. I also do not support the notion that bio-identical hormonal therapy be used indefinitely as some kind of "fountain of youth".

Hormones constantly interact among themselves. The hormonal profile of every woman is unique. This means that the amount of hormones taken is dependent on every individual and the dosage right for one woman may be too high or too low for another. The need for hormones changes as we age. Therefore, interval tests to determine their current levels need to be undertaken.

There is no doubt that hormones prevent osteoporosis. Osteoporosis is a disease that is the result of a depletion of bone cells, making bones more fragile and susceptible to fracture. Nearly half of women over 50 are likely to suffer from osteoporosis over the course of their lifetime.

Supplementation of missing hormones decreases colon cancer risk by 35%, increases libido, improves memory, mental acuity, insomnia as well as the quality of skin, hair, bones, teeth, muscles and in general, prolongs one's life.

Sex steroid hormones also play a role in controlling and regulating your metabolism and blood sugar, your energy output, digestion, and the way your body stores and burns fat. They help to regulate fluid and mineral balance, thyroid function, dramatic mood swings that lead to food cravings, erratic eating and weight gain. Hormone replacement may encourage weight loss and support your body's insulin response, energy levels, and lipid profile. I think that the greatest success lies in an individual approach. I begin with laboratory test of hormone levels ("female hormone panel"). When warranted I then prescribe a precise dosage of bio-identical estrogen, progesterone, testosterone or DHEA that is made up at a compounding pharmacy. Each patient is then monitored carefully through regular follow-up hormone panels to ensure adequate levels of hormones. Initially I do a hormone panel every three months, then every 6 months. Once balance is restored, I perform hormonal panels once a year at the time of the annual exam.

Cortisol and melatonin are two additional hormones of paramount importance. When experiencing stress of any kind, your body releases cortisol, one of your steroid hormones, into your blood stream to help you cope. Cortisol is actually called the stress hormone and functions to help your body to mobilize the energy you need to manage the stressful experiences in your life. It also assists your body in maintaining blood pressure and suppressing reactions like pain, allergy and inflammation. Elevated cortisol levels can lead to abdominal weight gain, loss of memory, insulin resistance and type II diabetes.

Melatonin is the hormone responsible for maintaining the day and night cycle and many body functions. Beginning in our thirties melatonin levels fall and in perimenopause often manifest as insomnia. Melatonin increases killing of cancer cells and also makes us look younger.

Symptoms of menopause include:

  • hot flushes
  • night sweats
  • vaginal dryness, itching, and odor
  • mood swings, irritability, insomnia, depression
  • facial hair
  • pain during intercourse (dyspareunia)
  • panic attacks
  • lethargy
  • tension/irritability
  • anxiety
  • fears of aging/health deterioration
  • loss of confidence
  • loss of feminity
  • depression
  • loss of concentration
  • loss of libido (sex drive)
  • muscle/joints pains
  • weird dreams
  • urinary tract infections, urinary leakage, frequent urination
  • bloating, indigestion, flatulence
  • aching joints
  • sore breasts
  • varicose veins
  • low back pain
  • osteoporosis
  • hair loss
  • snoring
  • palpitations
  • dizzy spells
  • crawly feeling skin
  • migraine headaches
  • memory lapses
  • sleep disturbances

Balanced hormones may prevent obesity. They can help to lose weight, promote insulin work, maintain or increase energy, and maintain the appropriate level of cholesterol, improve memory, and our look.

Post-Menopausal Hormone Panel

Menopause means the cessation of the monthly menstrual cycle and signals the end of a woman's natural childbearing years. This transition produces a variety of bodily manifestations and symptoms.

Hormone levels should be sufficient and balanced but their levels vary from woman to woman from 200 to 1,500%. The right balance of sex hormones is of paramount importance. Too much or too little is not assuring the long term emotional, mental or bodily health. Many women need only one hormone, while others require a few different ones. Menopausal hormonal panel allows customizing natural hormone dosing to meet individual needs and optimize hormone levels for a minimum dose to relieve symptoms and achieve appropriate levels to increase sense of well-being.

Saliva testing reflects the tissue concentration of your hormones. Blood contains total (bounded, biologically ineffective) hormones, but the tissues contain the active and effective fractions of hormones (as found in saliva), and their measurements in saliva are superior, more affordable and less expensive to measurements in blood. This aids in both diagnosis and treatment. Results can lead to an individualized and customized treatment plan using bio-identical hormones. One can minimize overdosing and under-dosing. This will insure the use of proper hormones in the appropriate amounts.

On the other hand, arbitrarily given hormones, usually given in fixed dosages, may deal with the symptoms, but may pose other serious health risks.

With salivary hormone testing guesswork belongs to the past.


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Marek Gawrysz, MD

Marek Gawrysz, MD

I earned my medical degree from the Medical Academy in Krakow (Collegium Medicum of the Jagiellonian University), Poland in 1978. My training requirements were fulfilled at the Medical Academy in Krakow, Poland, Swedish Covenant Hospital and Columbus-Cuneo-Cabrini Medical Center in Chicago. I am board certified and have dual fellowship (extra training) in Family Practice and Anti-aging, Regenerative and Functional Medicine.

I am practicing medicine for 35 years.

I am also a recipient of 2012, 2011 and 2010 People's Choice, Most Compassionate Doctor 2011, and 2003 Physician of the Year awards.

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American Academy of Anti-Aging MedicineFellowship in Anti-Aging, Regenerative & Functional MedicineAmerican Academy of Family PhysiciansAmerican Board of Physician SpecialtiesJagiellonian UniversityPolish-American Medical Society
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