Menopause

MenopauseAll women who reach middle age and beyond will go through menopause – a point in time when a woman stops having her monthly period. This is a normal part of aging and it marks the end of a woman’s reproductive years.
About 70 percent of women experience a range of menopause symptoms in NZ due to the declining hormone levels. Some women suffer terribly, with hugely distressing changes and symptoms, such as the following:

Hot Flashes and Night Sweats – This is a sudden feeling of heat in the upper body, which may start in the chest, neck, or face, then spreads downward or upward. The skin on the “heated” area may redden and become patchy, and the woman typically starts to sweat. This occurs generally when a woman is in the first year of her final period.
Moodiness and Irritability – During menopause, changes in hormone production affect the mental stability of women. Some report mood swings, irritability, and even depression, and others go from severe lows to extreme highs in a short period of time.
Poor Sleep – Those in the period of menopause may experience difficulties falling asleep and staying asleep. Some might wake up earlier than they intended and have trouble going back to sleep. Relaxation and breathing techniques, as well as regular exercises, can help women cope with this symptom.
Urinary Problems – It is common for menopausal women to lose control of their bladder. There would be constant need to urinate even without a full bladder, as the lining in the vagina thins and the tissues in the urethra lose elasticity.
Decreased Libido – Women often feel less interested in sex during the menopausal stage. Some of the causes include the changes (brought by reduced estrogen), such as a delayed clitoral reaction time, vaginal dryness, and slow (sometimes absent) orgasmic response.

What can be or should be done?

family in fieldAbout 30 percent of women pass through this phase without menopause symptoms and progress gradually and inevitably into old age. Other women suffer from the experience for a few months to many years of unpleasant symptoms.
Dr Bill Reeder offers Female Hormone Replacement and other menopause treatments that may help women cope with menopausal symptoms. Call us today to schedule a consultation with Dr Reeder.

Considerations

For full assessment take the Female Hormone Questionnaire on the Downloads page

pmsBy menopause, most of the original 2 million ovarian eggs are used up and since they and the ovaries are the principle estrogen producers, estrogen levels fall quickly resulting in problem symptoms for over 70% of women. Effects include complete change of character, moods, body shape, flushes, night sweats, weight gain, breast lumps or tenderness, loss of libido, poor concentration, muscle aches, joint aches, strange skin sensations and so on.

There are certain times when imbalances of estrogens and progesterone can result in mild to very severe problems for many young and older women. Vivid examples include PMT, Post Natal Depression, Endometriosis and mood changes.

Diet

Good eating habits are essential for health. Weight gain is common with unbalanced hormones, less exercise and increased recreational  eating habits – the cafe culture. Soy products may help mild symptoms as soy contains diosgenins (natural substances) which act a bit like estrogens and can activate ‘receptor sites’. Debate rages as with almost any food these days as to whether soy is good or bad. Some believe it may promote inflammation and auto-immune disorders. On balance, modest intake should be fine. I don’t think its good for children especially babies because of the hormone-like activity. On balance, I am not a fan of soy unless as fermented products.

As said before, the Mediterranean type diet is the best all-rounder as its low in processed foods, low in carbs (the weight factor) high in polyunsaturated fats (oils like olive oil) and modest in protein and of course high in vegetables. Try for as much raw food as possible. Epidemiological research appears to show that the more plant based foods we eat the better.

Herbs – many possibilities. Most common are : Black Cohish, Vitus agnes, Red leaf clover.

Supplements – Certain bioflavonoids like Hesperidin with vitamins can be good for flushes.

Exercise – always part of a good anti-ageing program.

Hormones – what are they

They are chemical substances secreted by endocrine glands to cause an effect on target cells by attaching to a specific receptor site. They pretty much ‘run the show’. In other words hormones are part of the body’s communications systems – other communications can be direct ‘hardwiring’ via nerve fibres, local chemical release such as prostaglandins, and cell-to-cell ‘talk’ via glycoproteins. Of course the brain is in overall control, we hope.

Certain hormones very well researched and well known for benefits by replacement. It is most important to understand that no hormones should be prescribed and taken in what is termed supra-physiological doses. Simply put, do not take excess amounts. Why not? Because the whole purpose is to restore levels to a healthy younger  adult range say 30-35. At this age hormones have ‘settled down’ to a healthy level. Children and especially adolescents can have very high hormones – don’t think we want that life stress again!

Did nature intend us to have low levels

Good question. Some have the opinion they would prefer to have deficient hormone levels because that’s natural, so accept the degenerative conditions that result as well as the not-so-subtle mind changes. Well, that’s ageing, but with this natural deficiency comes consequences. Many are now choosing to optimise ageing by retaining healthy hormone levels, so all cells can benefit. Same as with a diabetic who is insulin deficient; we don’t hesitate to give her insulin. Same as a thyroid depleted individual; we wouldn’t think twice about restoring thyroxine to healthy young adult levels. These examples are life threatening, these other hormones are threatening life quality.

Its about ageing well!

And the key is : only replace with exactly the same biochemical molecules. In other words, we use Bio-identical hormone replacement therapy (BHRT) – not synthetic altered hormones which most pharmaceutical companies supply for commercial reasons. I have no problem with that freedom; I just do not want to have my patients use these while better options are available.. The human system is too delicate and side-effects commonly result – hence all the trouble with past HRT.

The Medical Politics of Natural Hormones

As with many non-mainstream health options, there are factions who remain highly sceptical and want to eliminate availability of molecular-identical, or BHRT hormones. Whether this is based on scientific fact, ideological opinion, personal vendetta or whatever  – the result is the same; some want to remove personal choices.
Read more on this recent battle in the US >>>>

Which hormones are safely available naturally, apart from insulin.

  • Thyroid hormones – T4 and T3
  • Estrogens – Estradiol E2 | Estriol E3 | Estrone E1
  • Progesterone
  • Testosterone
  • DHEA
  • Cortisol – (under specific situations)
  • Melatonin

Important Note

All natural hormones are extracted from plants such as the giant Mexican yam. They are then finally converted into complete bio-identical human hormone. Humans cannot convert yam cream into hormones in the body, contrary to what some natural cream manufacturers may imply.

Usually there no side-effects. Its putting back in what you had most of your life. Some women may experience changes when having hormones back after a long absence, or if still not balanced properly with other hormones. So its important to start with low doses especially if she has a known sensitivity to estrogens in particular.

Q. Are there risks of breast cancer or heart attacks because I have been told that HRT is dangerous and my doctor wont prescribe it for me?

imagesA. This is very interesting and a good question. The medical literature and profession has been battling this since 2002 – when the famous Women’s Health Initiative study showed increase risk of heart attack risk, breast cancer, stroke and other effects. The % increases in these disease were high – 28%, 25% and so on. But % statistics can be used to distort. Real figures showed and increase in breast cancer from 30 per year per 10,000 women NOT on HRT to 37….hence the 25% increase.

I shall deal with this topic in another article.
Suffice to say – Bio-identical Hormone Replacement is a VERY safe treatment as long as prescribed by doctors knowledgable in the field. AND women are assessed for any increased risk beforehand.

Hormonal supplementation should always be prescribed and monitored by a doctor properly trained in this field.

Treatment Strategies

Other Hormones

Estrogens and Progesterone

These are the classic female hormones. All mammalian species require these for feminisation and fertility. Across many species, there are shared similar, even some identical estrogens. Science or rather pharmaceutical industry has capitalised in this by producing prescription medicines by either using other species hormones or synthesizing hormones bearing a close similarity to human types. Both men and women share the same hormones but obviously in far different concentrations.

Estrogens and Progesterone have complimentary and opposite effects and are required together for this balancing of nature. When out of balance from disease, ageing causes or incorrect prescribing, then consequences may develop.

There are many estrogens but in particular three:

  • Estradiol – E2 – is the most potent or active of the three. It can convert into Estrone then Estriol.
  • Estriol – E3 – is least potent yet the most abundant. It is extremely safe and has not been known to stimulate cancer cells for example. Temed the forgotten oestrogen being overlooked for the strong E2.
  • Estrone – E1 – 10 times less potent than Estradiol. It can more easily convert into less useful waste products called metabolites. We prefer to avoid prescribing E1. Its also produced from fat cells – even in those big pot belied men. Thats not good.

Estrogens are produced mainly in the ovaries but also in fat tissue as mentioned. Again, the brain controls production via pituitary hormones LH and FSH. (just like TSH is to the Thyroid and ACTH is to Adrenals)

By menopause, most of the original 2 million ovarian eggs are used up and since they and the ovaries are the principle estrogen producers, estrogen levels fall quickly resulting in problem symptoms for over 70% of women. Effects include complete change of character, moods, body shape, flushes, night sweats, weight gain, breast lumps or tenderness, loss of libido, poor concentration, muscle aches, joint aches, strange skin sensations and so on.

There are certain times when imbalances of estrogens and progesterone can result in mild to very severe problems for many young and older women. Vivid examples include PMT, Post Natal Depression, Endometriosis and mood changes.

These can be treated naturally, for example:

  • Teenage changes – moods, anger, poor coping, anxiety, acne, weight gain, menstrual problems
  • Premenstrual changes – PMT – irritability, depression, weight gain, cravings, breast pain and more
  • On the ‘pill’ – various side effects are common, some even dangerous. Most women have no problems at all.
  • Menopause, Endometriosis

Menopause – Symptoms can begin years before the actual periods cease. Progesterone production falls and finally ceases. Estrogens often fluctuate wildly before finally reducing to very low. During these swings many symptoms can develop, typical are flushing and night sweats. Many other complaints are suffered but often it is not realised that hormones are the cause. Whilst 30% of women sail though menopause with few symptoms most do not. It is not necessary to put up with these debilitating consequences as a variety of natural options is available from nutrients and herbs to safe bio-identical natural hormones.

Women who have early surgical menopause from ovary removal, will tend to have far worse hormone deprivation symptoms. The really need quick response with BHRT.

The burning question is: Are these normal or natural states or disorders? Well there are many view points depending on whether you have actually suffered these life-changing symptoms! Of course it is not normal. Normal is to go through life without adverse symptoms and a feeling of constant wellness!

Is menopause natural? Of course! But when hormones are deficient or out of balance with one another then the symptoms that result suggest a problem. We rush to supplement other hormones like insulin, thyroxin and cortisol – so it is commonsense to treat ovarian failure the same, as long as we use natural substances. Beneficial effects on quality of life can be enormous for the young or older woman.

Toxic Estrogens – whats this !

Environmental scientists find that there are many other sources of estrogens or oestrogen-like substances from the environment – some are very potent whilst others very mild like soy or clover. These non-human estrogen-like chemicals are termed xeno-estrogens. Sources are:

  • Industrial chemicals, agro-chemicals,  flowing through the food chain or by direct exposure
  • Naturally occurring plant derived such as red clover, soy, black cohish
  • Oral contraceptives, HRT in waterways

Some estrogen-mimicking or ‘hormone disrupter‘ chemicals can be thousands of times more potent than natural ones, and have been linked to many animal sexual aberrations as well as human sexual and reproductive disorders (read the controversial “Silent Spring”)

In the body these go through detoxification via the liver – called Estrogen biotransformation. Breakdown products are formed, of which some are considered to increase risk of cancer and cardiovascular disease.

Examples are 2-hydroxy-estrones which are low or no risk but 4- and 16-hydroxy-estrones are high risk. These can be measured in the urine. Refer to lab tests available in the side-bar

Estrogen excess, imbalance or its metabolites and xenon-estrogens are said to be associated with multiple disorders:

  • Breast and prostate cancer
  • Endometriosis, fibrocystic breast disease, uterine fibroids
  • Depression, anxiety, PMT, obesity
  • Graves disease of thyroid, SLE

How to counter the effects of xeno-estrogens and bad estrogen metabolites – refer to side-bar.

Do you have symptoms of estrogen and progesterone imbalance or deficiency – refer to Hormonal  Questionnaire.

Testing Hormones

Testing you for imbalances

The most important factor is not the test but you!  You see we want to assess the person not a lab result. Lab tests are a guide only to ensure blood levels are kept in a physiological (normal healthy adult) range. Of course in certain situations and hormones (eg diabetes) blood test levels are vital in monitoring a treatment.

Laboratory blood testing indicate current levels of hormones. They can fluctuate during the day as well as day to day. Its important to know that labs give a result and compare yours with averages of persons your age. Sensible, but this strikes at the heart of wellness versus ageing ‘illness’. Do you want the hormone levels of an older person or a healthy young adult of say the 30’s? Most would say 30’s please. Critics say ‘its not natural’. It really depends on whether you want to retain health and vitality or get old with its infirmity. You choose.
It is important to note that the natural level of certain hormones is way lower as we age compared with a young fertile woman. As the title suggests, it can be more about the balance of the hormones than actual amounts present. One, for example oestrogen, can ‘dominate’ another such as progesterone – with health consequences.

One more thing – there is great discussion about whether saliva tests or blood testing is better. Blood tests and saliva testing especially as we age and particularly post-menopause or andropause in males – are quite inaccurate for monitoring hormone treatment. I repeat, inaccurate.
In both cases, too much emphasis is placed on a “result”. Levels change by the hour, the day. Ideally several tests should be taken over a day or days – even a month in tricky cases – to establish the trends.

So please dont get hung up on blood testing. OK to do at the start and maybe 3-6 monthly – AS A GUIDE to see not too high or way low.

More extensive testing can be done to asses how you process your hormones through the liver. Is your metabolism healthy? Are you making too much of  the ‘bad’ 4 and 16 hydroxy-estrogens etc.

The best test to establish your individual hormone processing and safety is currently a 4 x urine sample test taken over 24 hours. Its the DUTCH test. A great website with tutorials and video clips is www.precisionhormones.com

Treatment

Following assessment and laboratory evaluation, options are presented. At all times it is best practice just to ensure good nutrition, specific nutritional supplementation and then the hormonal options later. Some women have already done all that and still have major symptoms – they need safe, low dose, natural hormone replacement.
Balancing all hormones is preferable; it makes no sense to try to be smarter than nature; best just to do what nature has always done!

Progesterone
  • Micronised Oral Capsules – This is preferred when women are also supplementing with estrogens and still have their uterus (womb).
  • Transdermal creams – progesterone is dissolved in a safe cream base and applied to the skin daily. The hormone passes through the skin directly into the blood stream and on to the ‘target cells’ throughout the body. An extremely safe and efficient way of taking hormones.
  • Troches (tro-shays) – the hormone is dissolved into a lozenge which is placed inside the upper cheek and LEFT to dissolve, NOT sucked or chewed. Hormone passes through the membranes of the mouth lining and into the blood stream. My reservation is that an unknown part is swallowed and more can end up in the liver to become altered estrogen – which may be a bad thing depending on your genetics.
  • Some women who have a horrendous time with menopause, may need oral estrogens to get control. The safety of this will be covered elsewhere.
Estrogens
  • Transdermal applications – are the most preferred as estrogens taken by mouth all pass through the liver first. What   happens there is very much an individual process for each woman. Some can produce a lot of estrogen breakdown products (metabolites)   called hydroxy-estrones. There are good ones (2-hydroxy estrones) and potentially bad ones (16-hydroxy estrones). These may be responsible   in susceptible at risk women of triggering cancer cells, clotting or heart problems. In spite of this the risks of this still remain   extremely low – after all, women have had these same estrogens and metabolites for hundreds of thousands of years.You see, transdermal creams with estrogens go directly into the bloodstream, just as if the ovary secreted estrogen into the blood stream. In nature, hormones are not swallowed. Progesterone taken orally however does not have his problem.
    There are two types:
  • Creams applied each day
  • Pharmaceutical once or twice weekly stick on patches.

 

  • Troches – are the next most effective method (the oral lozenges) – but the drawback is the unknown amount swallowed hence ending up in the liver.
  • Oral capsules – can be used sometimes when symptoms are very severe and need higher doses for a while. We prefer to use E3 or Estriol in this case. Then back to cream or troches once everything settles. We will always add progesterone even if a woman has had her womb removed (hysterectomy)!

 

 

T - Hormone of Desire
  • Testosterone is just as important for women as for men. It has many roles, some are :
    • Improving mood, assertiveness; reduction of depression and anxiety.
    • Improving bone density and muscle size and strength. Affecting healthy skin oil secretion.
    • Enhances sex drive, sexual sensitivity including orgasm.
    • Maintains the female genital system; nipples, genitals especially clitoris and female body hair pattern.
    • May protect against arterial atheroma – new studies.

    In the female, half of the T production is from a hormone called DHEA in the fat and other tissues, a quarter from the ovaries and a quarter from the adrenals. Women make 20 – 30 times less than men. Perhaps just as well.

    The pituitary gland under the brain controls production in the ovaries by the hormones LH. T levels decrease with age so at 40 there is only half that of a 20 year old.

    Factors reducing T production:

    • Age
    • Intense emotional stress
    • Vigorous exercise like long distance running etc
    • Very high fibre diets (fibre soaks up T secreted in the bowel)

    Factors increasing T production:

    • Higher fat and protein diets

    What are the effects of T deficiency

    Refer to the Hormone Questionnaires for a full list, some are:

    • Losing muscles and strength
    • Reducing sex drive and sensitivity. Harder to orgasm
    • Losing interest in sports or activities
    • Depression a lot, excessive anxiety, fears
    • Low resistance to stress
    • Increasing cellulite, becoming more overweight

    Testing for Testosterone

    • Blood levels – the most commonly done and a reasonable guide only. Because female T levels are much lower than for men, blood tests are not very accurate.
    • Saliva testing – some believe this to be better
    • 24 hour urine testing for total androgens (testosterone and related hormones) are possibly best but not always available

    Treatment

    1. The traditional method was to insert long-acting testosterone pellets under the skin. Apart from the discomfort and cost, the daily release is not as natural and dosage not easy to adjust.
    2. Transdermal creams and gels – very effective, applied daily and far more physiological (natural). Of course only use bio-identical testosterone. Doses are easy to adjust.

    Dosage is based on blood test monitoring and response.

    Side-effects

    Q. Women may ask “will I grow a beard, or my voice deepen?”

    A. Did you when you were younger and had much higher levels of testosterone? Of course not. As long as doses remain just as nature intended then you will not grow whiskers!

    Rarely, a woman may intentionally overuse T gel just to get the ‘aggressiveness she thinks she needs at the workplace’. That may be asking for trouble, yet even if T levels get very high, it does take a long time to develop masculinising effects.

    Women who need to be cautious are those who:

    • Tend to have bad acne, very greasy skin
    • Are prone to hairiness (hirsuitism)
    • Have male pattern hair loss
    • Breast cancer – no T should be used

    Testosterone is said to be ‘The Hormone of Desire’.

DHEA

Pregnenolone

Thyroid

Adrenal

Estrogen Biotransformation Management

The ability for women (and men) to recycle and clear excess and transformed estrogen metabolites is very dependent on many factors.

There are enzymes present in the breast and liver which convert estrogen into various metabolites. These enzymes can encourage both good and bad breakdown metabolites.

Certain foods and supplements can be beneficial as they contain lignans and isoflavones which modulate enzyme activity or encourage excretion of unwanted hormones:

  • Soy and flax seed are converted by bowel bacteria into active compounds – so good bacteria like lactobacillus acidophilus and Bifidobacterium lactis are needed.
  • Red clover and Kudzu – these compete with natural estrogens and are less potent substitutes
  • DIM – Di-Indole Methane. Helps reduce the bad estrogens being made. (Bad means non methylated breakdown products. Its also found in brassica vegetables.
  • Chrysin – from plants – inhibits conversion (by aromatase) of androgens into estrogens which is a main source of estrogens in older women.
  • Rosemary – also reduces bad 4,10-OH estrones and increases good 2-OH Estrones.
  • Indole-3-Carbinol (I3C) from the brassica vegetables converts into DIM (Di-indole methane) increases good 2-OH E and also increases excretion of estrogen waste products through the bowel.

In addition

  • have a high fibre diet (safe grains, vegetables) organic is possible
  • avoid chemical contact, non-natural perfumes and skin care products, hair dyes, pesticides and herbicides, household cleaners, chlorine pools and tapwater
  • avoid dairy foods

There are many supplement combinations which support optimum Estrogen Biotransformation