A Way To Take HRT …. That Reduces Health Risks


I want relief from my symptoms....without increasing risks to my health

Ever since 2002 …. when the WHI (Women’s Health Initiative) study found that conventional HRT increased a woman’s risk of breast cancer, heart attack and stroke …. women have been looking for effective treatments for their menopause symptoms, that do not bear the levels of health risks found by the researchers.

As HRT is the most effective treatment at relieving hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms …. I am often asked about the different methods of taking it and their relative safety.

Methods of taking conventional HRT and bioidentical HRT

  • a pill or tablet taken daily is the most frequently utilized method of hormone therapy in the world. We have become accustomed to taking pills and it is easy to take
  • transdermal (through the skin) patch is a delivery system that allows the hormone to be gradually absorbed by the skin. It is applied to the skin and replaced once or twice weekly as contrasted to the daily estrogen pill
  • transdermal gel – A measured amount of gel is rubbed on the skin once daily. It is absorbed and the skin, acting as a reservoir, releases it gradually into the bloodstream
  • transdermal cream – It acts much in the same way as transdermal gel. It has to be put on thin areas of the skin, such as the inner arms, to get into the blood stream. If put on fatty areas such as the buttocks, the hormones may sit in the fat cells, immediately beneath the skin, and not get into the bloodstream.

    Some women apply it to the vagina. When used in that way, it acts as a lubricant during intercourse. It also strengthens the walls of the vagina, which become weaker during menopause because of lower levels of estrogen

  • pellets – They are inserted into the fatty tissue directly under the skin of the abdomen or buttock, usually at 3-6 month intervals. It is a convenient delivery system, inasmuch as you dont need to bother with taking your hormones regularly.

    There is a downside to using this method. Once they are injected under the skin, they don’t come out. A woman is stuck with those hormone dosages for months. If she’s getting too much of a particular hormone, she may suffer months of unwanted side effects such as bloating, breakthrough bleeding, insomnia, weight gain and so forth

  • intramuscular injection is a common method of hormone replacement and is used by many physicians. It is usually given at 2-4 week intervals.

    It has the disadvantage of relatively high levels soon after the injection, which decline rapidly after a week or so. Unfortunately, this may perpetuate menopausal symptoms which are often associated with declining hormone levels

Health risks associated with the different methods of HRT delivery

  1. pills or tablets, taken orally, carry the highest health risks. If you swallow hormones, only 10-15 percent will eventually reach the target tissues and you will need to take an oral dose that is 500 percent higher than you need. A hormone pill has to travel through the digestive system and liver before being delivered to the blood, so as much as 80 to 90 percent of it is lost in this process.

    HRT taken orally carries a higher risk of heart attack and stroke. Oral hrt increases risk of thrombosis, whereas transdermal does not

  2. creams, gels and patches are presently the most effective hormone delivery system, because hormones enter the bloodstream directly and gradually. Virtually all of the hormone in the cream, gel or patch gets into the bloodstream.

    Transdermal delivery of HRT permits the correct dosage of hormones to be administered, whereas hormone therapy taken orally requires higher dosages than needed…..because only 10%-15% of the dosage makes it into the bloodstream.

    It is the safest way to take hormone replacement therapy. HRT taken orally carries 2-3 times higher risk of blood clots and strokes than transdermal HRT. Studies have found that there is no increase of blood clot and stroke risk when HRT is taken transdermally


What You May Not Know About Bioidentical HRT and Conventional HRT

bioidentical HRT

Should I take BHRT?

Bioidentical hormone therapy (BHRT) is a form of HRT that has become increasingly popular since 2002.

Prior to 2002, 13 million women in America were taking conventional HRT to relieve their menopause symptoms. It was the favored treatment for menopause symptoms. In 2002, an extensive WHI (Women’s Health Initiative) study found that conventional HRT increased a woman’s risk of breast cancer, heart attack and stroke. These findings had wide media coverage and with that women abandoned the use of conventional HRT in droves.

However conventional HRT is effective at relieving hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms. Women want relief from their menopause symptoms, but without the health risks now associated with conventional HRT. Bioidentical hormone therapy promises this.

Definitions of conventional HRT and bioidentical HRT products

The most popular form of conventional HRT is a product consisting of synthetic estrogen plus progestin (a synthetic form of progesterone). This is sometimes referred to as combined hormone therapy. Another form of conventional HRT is estrogen only (also synthetic).

It is a little more difficult to describe bioidentical HRT products

The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body”.

Advocates of bioidentical HRT describe the estrogen and progesterone that they use as natural, as opposed to synthetic. They say that they are biologically identical to the hormones made by a woman’s body, whereas the hormones taken in conventional HRT are not. They say that when you take bioidentical hormones, they function in the same way as the hormones made by your own body. Furthermore, they say that synthetic hormones do not function in the same way as the hormones made by your own body.

For these reasons, advocates claim that bioidentical HRT is safe from the health risks associated with conventional HRT.

What medical authorities say about conventional HRT vs Bioidentical HRT

Most medical doctors prescribe conventional HRT, and not BHRT, when hormone therapy is appropriate for a woman. If you want to take BHRT, you will have to go to a medical doctor who practices holistic medicine or to an alternative medicine practitioner.

Leading medical authorities give more credence to conventional HRT over BHRT. They say that whereas conventional HRT has had medical studies done to support its claims, medical studies have not been done to support the claims made by advocates of BHRT.

I think that this position on BHRT, taken by leading medical authorities, should be taken with a grain of salt

  • almost all medical studies are funded by pharma companies and they are not about to fund studies that support BHRT. Pharma companies view the providers of BHRT as competitors. Pharma companies have billions of dollars invested their conventional HRT products
  • pharma companies do not invest in their own bioidentical hormone products, because they cant patent a bioidentical hormone. They cant patent something that is natural. It would be like trying to patent air.

    Without a patent, they cant make money from a product. Their synthetic HRT products are patentable. This is why they produce, promote and defend their patented synthetic HRT products against accusations that they can cause health risks to users

  • leading figures in medical academia and in prominent medical organizations have had financial relationships with pharma companies, in connection with pharma HRT products. They have either been paid consultants to pharma companies or they have allowed their names to used by pharma companies in articles written by pharma companies or their agencies

I hope that this post has provided you with an increased understanding of some of the issues connected with bioidentical HRT and conventional HRT.


Does HRT Save Lives Or Threaten Lives?


Is HRT right for you?

HRT is controversial. Some women say that it has saved their lives. Others say it can kill.

The viewpoint that you have on this issue will be influenced by the following factors

  1. the circumstances in your life now
  2. your tolerance level of menopause symptoms
  3. your beliefs
  4. your personal life values

The experiences of women during the menopause journey varies greatly. Some women experience mild symptoms, while others experience moderate symptoms, while others experience debilitating severe symptoms. Some women are done with menopause in a year or two. For other women, it can last for 10-20 years or more.

The life circumstances of women going through menopause also varies greatly

  • What age did you enter perimenopause? Were you in your 30s, 40s, or 50s?
  • do you have to care for children?
  • do you have to care for elderly parents
  • how supportive is your husband/partner of your menopause symptoms? How supportive are the other people with whom you live?
  • are you employed? If yes, does your job require peak performance for all or a lot of the time?
  • what is your personal health history?
  • what is the health history of your parents and siblings?

Your tolerance level of the symptoms you are experiencing will have an influence on your decision to take HRT. Just as we each have a different tolerance level of pain, every woman has her own unique tolerance level of the symptoms she experiences during menopause. Some women have a high tolerance level; others have a low tolerance level and some others are in between. There is no right or wrong, or good or bad tolerance levels. Your tolerance level is what it is.

Your beliefs are a major factor in arriving at your view about HRT. Women hold differing beliefs about

  1. the value of natural vs synthetic treatments and remedies
  2. the value of conventional medicine vs CAM
  3. the integrity of the pharma industry
  4. the influence that the pharma industry has with conventional medicine bodies and individual doctors

Personal life values also play a significant role in this, as well. Is your long term health more important to you or is your quality of life now, and in the immediate future, more important to you? Of course both are important to you, but your view about HRT will be influenced by which of these factors is more important to you.

The benefits of hormone replacement therapy

  • it is very effective in providing relief from menopause symptoms…..during the period of time that you are taking it. It eliminates/reduces hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms. However, as doctors recommend that it should only be taken for a short period of time, many women experience a return of menopause symptoms when they stop taking HRT
  • with the elimination/reduction of menopause symptoms, comes a return to normal living …. life as it was prior to the onset of menopause, or close to it
  • all studies show that it reduces the risk of osteoporosis, while you are taking it. 50% of menopausal women are likely to experience osteoporosis, after menopause. The falling levels of estrogen during menopause, and low levels after it, weakens your bones.

    The effect that HRT has on bone density, after treatment has ended, is inconclusive. There is some evidence to show that it can offer a protective effect on bone density for several years after treatment is stopped. Other evidence shows that it only offers a protective effect on bone density while it is being taken

The risks of taking hormone replacement therapy

According to the National Cancer Institute, research from the WHI studies has shown that HRT is associated with the following harms

  1. Urinary incontinence. Use of estrogen plus progestin increased the risk of urinary incontinence
  2. Dementia. Use of estrogen plus progestin doubled the risk of developing dementia among postmenopausal women age 65 and older
  3. Stroke, blood clots, and heart attack. Women who took either combined hormone therapy or estrogen alone had an increased risk of stroke, blood clots, and heart attack. For women in both groups, however, this risk returned to normal levels after they stopped taking the medication
  4. Breast cancer. Women who took estrogen plus progestin were more likely to be diagnosed with breast cancer. The breast cancers in these women were larger and more likely to have spread to the lymph nodes by the time they were diagnosed. The number of breast cancers in this group of women increased with the length of time that they took the hormones and decreased after they stopped taking the hormones

There can be no doubt that taking HRT, in the form of estrogen plus progestin or estrogen only, increases the risks of these health conditions.

However, there are different ways of interpreting the risks associated with taking HRT. Many statistics, about these health risks, are bandied about by various individuals, groups and organizations with vested interests. It is advisable to interpret the statistics yourself, rather than relying upon the interpretation provided by these vested interests.

This post is the first of a series of posts, that will be forthcoming about hormone therapy. The subjects include HRT vs BHRT (bioidentical hormone therapy), pros and cons of BHRT, methods of taking hormone therapy, efficacy and safety of taking hormones by the various methods, and what happens when you stop taking hormones.


Hot Flashes – FDA Approves First Non Hormonal Drug Treatment

Hot Flashes

My hot flashes are debilitating

Until now, the only FDA approved products proven to reduce hot flashes have been estrogen based prescriptions. Now for the first time, doctors can prescribe an FDA approved non hormonal drug for women who are averse to taking synthetic estrogen products for their hot flashes.

The drug is Brisdelle. It is a low dose of paroxetine, which is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Paroxetine had been approved by the FDA for treatment of depression, but not for hot flashes.

Doctors have known for quite a while that paroxetine significantly reduces hot flashes.
They have been prescribing it “off label” to treat it. “Off label” is the practice of prescribing a drug approved by the FDA for treatment of a specific condition….for a different condition for which it does not have FDA approval.

The fact that paroxetine now has FDA approval for hot flash treatment, will please many doctors who had been prescribing it off label. Because it had FDA approval just for use as an antidepressant, it was only available at a higher dose than what is needed for hot flash treatment. The higher dosage is needed to treat depression. Now it will be available at low dosage.

One physician said this about the news

I, like many physicians, have in the past prescribed paroxetine “off label”. There are two reasons why I am glad I can now prescribe a low dose FDA approved version as opposed to generic paroxetine

  1. Paroxetine at higher doses is intended for, studied and FDA approved only for the treatment of depression, not hot flashes.

    Many of my patients have received a prescription and then also had the experience of their insurance company giving them a diagnosis of depression even though they are not depressed. Just hot.

    I had one patient for whom I prescribed Paxil for hot flash relief (clearly documented on her electronic medical record) who was contacted by her insurance company to see if her “depression” was improving and to offer psychotherapy!

    Brisdelle 7.5 mg is FDA approved only for treatment of moderate to severe hot flashes as a result of menopause. It cannot, and should not, be prescribed for treatment of depression and therefore is not interpreted as a treatment for depression on your medical record

  2. The doses of generic paroxetine available for treatment of depression are higher than needed to relieve hot flashes.

    With higher dosage, comes a greater risk of side affects. As an example, Paxil and other SSRI’s are associated with an increase in sexual problems and an increase in pounds. The last thing a menopause women needs is a drug that might sabotage her diet or an already waning sex drive.

    In clinical trials, Brisdelle, with only 7.5 mg of paroxetine, did not demonstrate a decrease in libido or an increase in weight

The use of Brisdelle to reduce hot flashes, may be of interest to many women who seek relief from them….from their medical doctors. HRT is the only other treatment prescribed by conventional medical practitioners and just a very small % of women who experience hot flashes, take HRT.

HRT (synthetic hormone products manufactured by pharmaceutical companies) is effective at relieving hot flashes and other menopause symptoms. 13 million women in America were taking it to relieve their menopause symptoms, until the 2002 findings of the WHI study, which examined health risks associated with taking HRT, were announced. It was the favored treatment for menopause symptoms.

The WHI study found that the increase in the relative risk for breast cancer was 26%, for heart attack 29%, for stroke 41%, for blood clots 100%, and for Alzheimer’s or dementia, over 100%. Since that time less than 15% of menopausal women take HRT.

Since 2002, women, who are concerned about the health risks of taking HRT, have been looking for hot flash treatments and remedies for menopause symptoms that are free of those health risks. In fact, just 7% of women who experience hot flashes take HRT to relieve them. Most of the rest of the women “grin and bear” them …. some with humor, many without it.

If you have been toughing it out with respect to your hot flashes….and you are not averse to taking non hormonal drugs to reduce them….Brisdelle may be a treatment option for you to consider.


HRT Vs Going Natural – Which Is Better?


Which way is better for me?

This question can generate an emotional, and often heated, response from advocates on both sides. HRT is controversial. Some say that it has saved their lives. Others say it can kill.

Some advocates of the natural route suggest that it is nobler to go natural. They imply that it is a matter of personal strength and that those who take HRT are weaker than those you go natural. Some advocates of HRT are incensed by attitudes like this.

What has brought about this divide?

HRT (synthetic hormone products manufactured by pharmaceutical companies) is effective at relieving many of the menopause symptoms. 13 million women in America were taking it to relieve their menopause symptoms, until the 2002 findings of the WHI study, which examined health risks associated with taking HRT, were announced. It was the favored treatment for menopause symptoms.

The WHI study found that the increase in the relative risk for breast cancer was 26%, for heart attack 29%, for stroke 41%, and for blood clots 100%. Since that time less than 20% of menopausal women take HRT.

Since the release of these findings, sales of HRT products by pharma companies have plummeted. Pharma companies have resorted to using unscrupulous marketing techniques in an attempt to boost sales. These marketing techniques were brought to light during court cases against pharma companies, brought by women who have experienced serious health problems as a result of taking HRT.

The media revelation of the use of these unscrupulous marketing techniques by pharmas, plus the revelation in the media that most OB-GYNs do not receive training about menopause and do not understand it, causes many women to be suspicious when doctors recommend HRT for their menopause symptoms.

Since 2002, women, who are concerned about the health risks of taking HRT, have been looking for “natural” treatments for menopause symptoms that are free of these health risks. “Natural” treatments are classified as CAM (complementary and alternative medicine) and holistic medicine.

CAM is an acronym for complementary and alternative medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.

Holistic medicine is also referred to as integrative medicine. Holistic medicine physicians combine conventional and CAM treatments. Many holistic physicians also prescribe bioidentical hormone therapy (BHRT) to treat menopause symptoms.

Advocates of BHRT say that bioidentical hormones are natural and that they exactly duplicate the hormones that are produced by your body. They say that it without the health risks associated with taking synthetic HRT, but this has not been verified by studies. However proponents of HRT present the argument that their synthetic HRT products are natural, as well. Some advocates of the natural approach to menopause consider BHRT as natural; others consider it to be part of HRT.

Is going natural better than taking HRT?

The horse racing community has a maxim that appropriately answers this question

different horses for different courses

The experiences of women during the menopause journey varies greatly. Some women experience mild symptoms, while others experience moderate symptoms, while others experience debilitating severe symptoms. Some women are done with menopause in a year or two. For other women, it can last for 10-20 years or more.

Also, the life circumstances of women going through menopause varies greatly

  • how old is she when she enters perimenopause? Is she in her 30s, 40s, or 50s?
  • does she have to care for children?
  • does she have to care for elderly parents
  • how supportive is her husband/partner of her menopause symptoms? How supportive are the other people with whom she lives?
  • is she employed? If yes, does the job require peak performance for all or a lot of the time?
  • what is her personal health history?
  • what is the health history of her parents and siblings?

Personal life values enters the picture as well. Is long term health more important to her or is her quality of life now, and in the immediate future, more important to her?

There is no right or wrong, or good or bad, way to go through menopause. There is only
a best way to go through menopause for each individual woman ….. and that is based upon the above factors.

I believe that each woman needs to come to her own conclusion about the best route for her to take through menopause. I also believe that it is best to maintain a non judgmental attitude to the choices made by others, in connection with menopause …. and other events in life, because you do not know the circumstances that led to their choices.


Hair Loss During Menopause – What Can You Expect?

Hair Loss During Menopause

Will I go bald, if I keep losing hair at this rate?

Does it worry you when
  • hair falls out in large clumps when washing it?
  • large clumps of hair appear in your brush or comb?
  • you notice a visible thinning of your hair on the front, sides or top of your head?

If you are experiencing any of the above, you are in the majority…..not the minority.

Please let me put your mind at ease…..it is extremely unlikely that you will go bald. Going completely bald is a man’s thing.

Female hair loss usually begins at around the age of 30 and even as early as in the 20s or earlier. 40% percent of women have visible hair loss by the time they are age 40, according to the American Academy of Dermatology. It may get even more noticeable after menopause. By the age of 50, 50% of women will experience some degree of hair loss. 80 % of women will have noticeable hair loss by age 60.

The growth and loss of hair

Hair growth and hair loss occurs in a cycle that has 2 main phases
  1. Anagen – this is the hair growth phase. Normally, hair grows about a half inch a month for 2-6 years, and then it goes into a resting phase. Approximately 85% of the hair on your head is in this phase
  2. Telogen – this is known as the resting phase. Hair loss occurs during this stage. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Approximately 15% of the hair on your head is in this phase

According to MedlinePlus, which is a service of the U.S. National Library of Medicine and National Institutes of Health, the average scalp has 100,000 hairs and each person loses approximately 100 hairs daily. Each hair grows an average of about half an inch a month and grows on average for 2-6 years. After a cycle of rest, the hair falls out and a new strand begins to grow in its place.

Why you lose more hair as you age

Doctors know that hair thickens in pregnant pre-menopausal women due to increased levels of estrogen. Increased estrogen increases the ratio of actively growing hair (anagen) to resting hair (telogen). The exact opposite happens to women after entering menopause.

While estrogen helps hair grow faster and stay on your head longer …… leading to thicker, healthier hair ….. falling levels of estrogen during menopause and low levels after menopause are not he only cause of hair loss. Other hormones contribute to hair loss

  • testosterone – during menopause testosterone levels fall, but not as much as estrogen. This creates testosterone dominance. A form of testosterone, known as DHT, is damaging to your hair and contributes significantly to hair loss during menopause
  • progesterone – it functions as a natural DHT blocker. Prior to perimenopause, it protects your hair from DHT. During perimenopause and after that, low levels of progesterone makes your hair more susceptible to damage from DHT
  • thyroid hormone – hypothyroidism (underactive thyroid – the body is producing insufficient thyroid hormone) is a common condition during menoapause. It causes hair loss, not just on the scalp, but also anywhere on the body. A unique and characteristic symptom of hypothyroidism is loss of the hair on the outer edge of the eyebrows

What you can do to reverse hair loss during menopause and after that

Hair loss often has a greater impact on women than on men, because it’s less socially acceptable for them. It can be absolutely devastating for self image and emotional well-being. Many women with hair loss suffer in silence, altering their hairstyle to hide thinning hair.

If you are in perimenopause and you want to reverse your hair loss, here is what I recommend

  1. get the levels of your hormones tested
  2. rebalance your hormones, under the supervision of a hormone expert

If you are in postmenopause

  1. get your thyroid tested. If the test finds that you have an underactive thyroid, your doctor can remedy that
  2. take bioidentical estrogen therapy to increase your estrogen levels. Conventional medicine practitioners may prescribe synthetic estrogen therapy. If you increase your estrogen levels by taking synthetic estrogen therapy, you increase your risk of breast cancer. You do not increase your risk of breast cancer by taking bioidentical estrogen therapy

Menopause Joint Pain – What You May Not Know About It

Menopause Joint Pain

I am so stiff after sitting for a while

More women than you may think experience menopause joint pain and aches. 41% of women approaching menopause and 57% of women 2 years past menopause, report that they experience significant joint pains and aches.

Menopause joint pain can make you feel as if you have been petrified. It can make you feel old …. it can make you feel like things are falling apart and that the warranty on your body is up. I can understand it if, on some days, all you want to do is lie in bed all day.

Joint pain is caused by inflammation. Is menopause joint pain arthritis? Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. Also, the derivation of the word arthritis provides us with a clue to the answer. It comes from the Greek “arthron” meaning joint and the Latin “itis” meaning inflammation.

The term “arthritis” encompasses more than 100 diseases and conditions. Osteoarthritis is the most common form. It is estimated that the majority of people have it by age 65 and that 80 percent of people over 75 years of age have it.

The North American Menopause Society says this about joint pain

Whether the cause is loss of estrogen, the aging process, or a combination of the two remains unclear. We do know that after menopause there is an increase in both severity and frequency of some kinds of arthritis

However, here are 2 telling facts about arthritis

  1. the onset of arthritis is gradual and usually begins after the age of 40
  2. more women get arthritis than men. 60% of the sufferers are women

These facts, plus several medical studies, lead me to think that falling levels of estrogen during perimenopause and low levels of estrogen after menopause are very significant factors in menopause joint pain. Postmenopause estrogen levels are 10% of what they are prior to perimenopause.

Estrogen and menopause joint pain – the evidence

  • In 2005 two noted researchers, David T. Felson, M.D., of Boston University Clinical Epidemiology Unit, and Steven R. Cummings, M.D., of California Pacific Medical Center Research Institute and University of California, San Francisco, concluded that there is a link between estrogen deprivation and joint pain
  • One study conducted in 2010 found that reduced levels of estrogen causes menopause joint pain
  • A review conducted this year, of the now well known WHI study, found that postmenopausal women who received estrogen-only medication reported significantly lower frequency of joint pain
  • A case study from a medical doctor

    Joyce is a 52 years old, post menopausal typist who came to see me in the office because of joint pain in her hands which keeps her up at night with aching, and interferes with her job as a typist. She was fine until about three years ago when she went into menopause and stopped her menstrual cycles.

    I explained to Joyce that she had fairly classical Menopausal Arthritis caused by an inflammatory response associated with declining estrogen levels. I have noted this in many of my patients. The inflammatory process is usually relieved by bio-identical estrogen as a topical cream. Joyce’s lab panel showed low estrogen levels, and Joyce was started on her bio-identical hormone program. Six weeks later, Joyce reports complete relief of symptoms. Her arthritis pains have gone. In addition, Joyce reports that she went off the bio-identical hormone cream for a week to see what would happen, and sure enough, the arthritis came back, only to be relieved again by resuming the hormone cream. This is a fairly typical story that I have seen over and over again.

What you can do to relieve menopause joint pain

  1. include a stress reduction technique in your life. Do yoga or meditation, or some other stress reduction technique, regularly. Physical pain causes stress. Your body increases its production of cortisol – the stress hormone – during times of stress. Cortisol acts as an inflammatory agent. Sustained stress (the kind that you experience with joint pain) can cause inflammation to spread at a rapid rate
  2. consider estrogen therapy to increase you estrogen levels.

    Conventional medicine practitioners may prescribe synthetic estrogen therapy to treat joint pain, in the form of a pill or cream. The pill taken orally, enters the blood stream. It increases your risk of breast cancer. The cream can be applied to your joints. It carries a lower risk of breast cancer, because it is localized. It doesnt enter your blood stream.

    CAM practitioners are more likely to favor natural estrogen therapy…. bioidentical estriol therapy…. taken as a cream that is applied locally to your joints. Estriol is one of 3 estrogens that your body produces naturally. Advocates of natural estriol therapy emphasize that it does not bear the health risks of synthetic estrogen therapy and that researchers have found that it actually protects against breast and uterine cancers

  3. do some type of aerobic exercise every day. I would be surprised if you dont react to this by saying something like “You must be joking. Exercise is the last thing that I want to do … with the way I feel”.

    Here is what the Mayo Clinic says about exercise and joint pain

    Though you might think exercise will aggravate your joint pain and stiffness, that’s not the case. Lack of exercise actually can make your joints even more painful and stiff. That’s because keeping your muscles and surrounding tissue strong is crucial to maintaining support for your bones. Not exercising weakens those supporting muscles, creating more stress on your joints.

  4. eliminate all processed food from your diet. They contain sugar, which exacerbates inflammation. Eat only real food. Real food does not need labels – ie – unprocessed meat, fish, milk, eggs, legumes, fruits, grains and vegetables.

    Make a special effort to include foods rich in omega 3 fatty acids. They decrease the level of inflammation around your joints. Two foods that are richest in omega 3 fatty acids are flaxseed and walnuts. Fish is a rich source of it as well, especially salmon, herring, mackerel, sardines, halibut, scallops, shrimp, and rainbow trout

  5. If you are not averse to taking supplements, there are 2 supplements that have helped many women to relieve joint aches and pains….glucosamine sulfate and methylsulfonylmethane, or MSM. Glucosomine relieves pain and heals joints by building up the cartilage that protects the ends of bones. MSM reduces the inflammatory chemicals called cytokines that causes joint aches and pains during menopause

Weight Loss During Menopause – What You May Not Know

Weight Loss During Menopause

I cant seem to lose this ..... no matter how much exercise I do

Kate opened her session by saying

I have not changed my diet or exercise routines during menopause…but I have gained weight

So many menopausal women have said the same thing to me. To which I respond

That is exactly the problem. You need to change with “the change”. You need to change the way in which you eat and your exercise routines with the onset of menopause….not keep them the same

On average, women gain 12 – 15 pounds during menopause. Many woman gain much more.

Most women think that menopause causes weight gain. It does not. A comprehensive review by the International Menopause Society has found that going through the menopause does not cause a woman to gain weight. However, the hormonal changes at menopause are associated with a change in the way that fat is distributed, leading to more belly fat. Prior to perimenopause, women tend to store fat on their hips and thighs. During perimenopause, and after it, women tend to store fat around their mid-section.

What causes weight gain during menopause?

Two events — menopause and the natural aging process – coincide at this time. Menopause merely becomes the suspect because it happens, as many women notice weight gain. The actual cause of weight gain during menopause is aging. However, the symptoms of menopause do contribute to it.

Aging is associated with a slowing of the body’s metabolism

  • your metabolism actually starts to slow down sometime in your 30s
  • the reason for this decrease in your metabolism is a decrease in your muscle mass
  • you tend to lose a 1/2 pound of muscle a year after the age of 30. Between the ages of 30 and 70, you are likely to experience a 40 to 50% reduction in your muscle mass
  • loss of muscle mass decreases the rate at which your body uses calories
  • as you lose muscle mass, you gain weight in fat. If you do not change your eating routines, the same caloric intake is not going to burn off. Those unburned calories will be stored as fat

If you continue to eat as you always have and don’t increase your physical activity, you’re not likely to experience weight loss during menopause.

How do your menopause symptoms contribute to weight gain?

A majority of women experience protracted periods of stress and disturbed sleep during menopause. Stress and disturbed sleep have a significant impact on your weight.

When you are under stress, your body produces cortisol ….known as the stress hormone. Protracted stress results in high levels of cortisol in your body. High levels of cortisol in your body causes your body to store more fat. It also prevents your body from burning fat. In the presence of high levels of cortisol, regular exercise will not burn fat and you will not lose weight.

Protracted disturbed sleep leads to insulin resistance. It also leads to high levels of cortisol. High levels of cortisol brings about insulin resistance.

Insulin resistance, is a condition where the cells of your body become insensitive to insulin. Insulin is the key that unlocks body cells to allow glucose inside. Glucose provides your cells with energy. Your body makes glucose from the food that you eat. When your cells won’t ‘open’ for glucose, the glucose gets stored…..as fat. Insulin resistance also prevents fat loss. Even if you exercise daily, you will not lose weight.

How to lose weight during menopause

At the risk of sounding trite, weight loss during menopause does come down to diet and exercise, plus stress reduction. However…….you have to know HOW to diet and HOW to exercise. While diet does involve what you eat, another major component of diet is HOW you eat

  1. include a stress reduction technique in your life. Do yoga or meditation, or some other stress reduction technique, regularly. This will help to modulate the cortisol level in your body. It will also help you to sleep better
  2. eliminate all processed food from your diet. They contain sugar, which exacerbates insulin resistance. Eat only real food. Real food does not need labels – ie – unprocessed meat, fish, milk, eggs, legumes, fruits, grains and vegetables. You will find real food in the outer aisles of your supermarket. Stay away from foods in the inner aisles. They are the processed foods. Try to eat organic as much as possible
  3. time management of eating – do not eat 3 meals per day. You should be eating something every 2-3 hours, during waking hours. Eat a smaller breakfast, lunch and supper, than you have been accustomed to eating. In between each meal, and also after supper, eat a healthy snack…ie a piece of fruit, nuts, yogurt etc
  4. do not eat double carbohydrates in any meal. Do not eat bread with meals containing potatoes or rice or pasta. Eat just 1 of those carbs per meal. Another no – no is cereal and toast for breakfast. Just have one or the other
  5. reduce your consumption of alcohol. Keep it to a minimum
  6. do at least 30 minutes of aerobic activity/exercise every day. It is best to do it in the morning, if your schedule permits it. To achieve weight loss, the intensity level MUST be moderate. Do not do high intensity exercise for weight loss. You will lose more weight faster, if you can fit in 2 daily sessions of aerobic activity/exercise …. even if the second session is only for 15 minutes

I hope that you implement these steps. They will help you to achieve weight loss during menopause, and after it.


Does Sleep Improve After Menopause?

Postmenopause Insomnia

My overnight reading has increased

“I am tired all day long. I go to bed tired, but I have trouble falling asleep. When I finally do fall asleep, I have trouble staying asleep. How I miss the days when I could sleep 9-12 hours like the dead.”

Could it be you saying this?

If you are expecting your sleep problems to vanish naturally when you reach menopause, you may be disappointed.

Before providing some details about postmenopause insomnia, it may be helpful to first discuss what happens to the levels of estrogen and progesterone during postmenopause. They affect your sleep even more during postmenopause, than during perimenopause.

Estrogen and progesterone levels during postmenopause

Perimenopause is characterized by fluctuating estrogen levels. In postmenopause, estrogen levels bottom out and stay low. About 6 months before menopause, estrogen levels drop significantly. Estrogen levels continue to fall during postmenopause, but not to zero. While your ovaries no longer produce estrogen, your body makes estrogen in other ways.

During postmenopause, progesterone levels fall more than estrogen levels. While your ovaries no longer produce progesterone, your adrenal glands produce a very small amount of progesterone.

How low levels of estrogen and progesterone affects postmenopause sleep

  • low levels of estrogen causes a decrease in the levels of the hormone serotonin, which is used to create melatonin – a sleep hormone
  • low levels of estrogen slows down the intake and secondary production of magnesium, a mineral that helps muscles to relax. Muscle relaxation helps you to fall asleep
  • low levels of estrogen is linked to sleep apnea, which disturbs breathing during the night and therefor disturbs sleep as well
  • low levels of estrogen is linked to hot flashes and night sweats, which disturbs sleep
  • low levels of progesterone inhibits sleep. Progesterone helps you to fall asleep and fall back to sleep when your sleep is disturbed

Another factor that affects sleep during perimenopause is aging. A Sleep Foundation study has found that as women age, increasing numbers of women encounter sleep difficulties. More females between the ages of 25 and 34 experience disturbed sleep than females between the ages of 18-24. More women between the ages of 35 and 44 experience sleep problems than women between the ages of 25 and 34. The postmenopausal age group is more prone to insomnia than all younger female age groups.

The Sleep Foundation reports that 61% of women experience postmenopause insomnia.

Treatment options for postmenopause insomnia

As low levels of estrogen and progesterone cause postmenopause insomnia, you may want to consider hormone therapy to raise your levels of these hormones.

Coventional HRT can reduce disturbed sleep during postmenopause, but it carries increased risk of breast cancer, heart attack and stroke. An alternative is BHRT – hormone therapy that uses bioidentical hormones. According to Dr John Lee, MD, the foremost authority on bioidentical hormones, bioidentical hormone therapy relieves menopause symptoms, including insomnia, without increasing the health risks mentioned above. It will relieve postmenopause insomnia.

If you are averse to hormone therapy of any kind, there are many other natural treatments that have been proven to reduce insomnia

  1. There is compelling evidence that exercise can improve your sleep during menopause. Exercise even improves the sleep quality of menopausal women who experience hot flashes at night
  2. Studies have also shown that valerian, a herbal remedy, has improved the quality of sleep for menopausal women
  3. The Mayo Clinic reports that “the weight of scientific evidence does suggest that melatonin decreases sleep latency (the time it takes to fall asleep), increases the feeling of sleepiness, and may increase the duration of sleep”. You can increase your melatonin level by including certain foods in your regular diet or by taking a melatonin supplement
  4. Serotonin is a neurotransmitter (chemical messenger) that sends signals between nerve cells in the part of the brain responsible for the sleep-wake cycle. Low levels of serotonin cause insomnia. Eat foods rich in calcium, magnesium, and vitamin B to help with serotonin production. These include most fruits and vegetables, almonds, beans, cheeses (particularly Cheddar and Swiss), chicken, eggs, fish (especially high-oil fish such as herring, mackerel, salmon, sardines, and tuna), milk, peanuts, soy foods, turkey, and yoghurt. You can also increase the level of serotonin in your body by taking a serotonin supplement
  5. A review of 46 trials, covering 3,800 patients, has found that acupuncture is effective at relieving sleep disturbance
  6. Studies have found that yoga improves sleep quality and reduces feelings of fatigue. A new study conducted by MsFLASH has found yoga to be effective in reducing menopause insomnia. MsFLASH is an acronym for Menopause Strategies: Finding Lasting Answers for Symptoms and Health

Postmenopause insomnia tends to get progressively worse without treatment. It is important to have and follow a treatment strategy for it.


Is Your Doctor In The Dark About Menopause?

Doctors Who Understand Menopause

A woman can tell if her doctor understands menopause

Have you come away from a visit to your doctor with the feeling that he or she does not really know much about menopause?

If you feel this way, it is not surprising. You share this feeling with the majority of menopausal women. This is because there are few doctors who understand menopause. They are not at fault for this, since they receive little to no medical training about menopause.

In May 2013, a survey of ob-gyn resident doctors, conducted by the Johns Hopkins University School of Medicine, found that there is a lack of understanding by ob-gyn residents in matters connected with menopause.

510 resident ob-gyns, from all over the country, were surveyed. Only 100 (20%) reported that they had received formal training in their ob-gyn curriculum in regard to menopause matters and only 78 had reported that they participated in a practical menopause clinic. That means that just 15% of those being trained as ob-gyns are receiving practical training to help you with issues that you are facing during menopause.

A positive take from this survey is that approximately 70% of the participants expressed a desire to learn more about menopause, its symptoms and its treatment.

The lead study author Mindy S. Christianson, a clinical fellow in the Division of Reproductive Endocrinology and Infertility in the Department of Gynecology and Obstetrics at the Johns Hopkins University School of Medicine said

It’s clear from the results that the residents who responded admit that their knowledge and clinical management skills of menopause medicine are inadequate

The results of this survey explains why women are finding it hard to find doctors who understand menopause. If just 15% of ob-gyn residents have received practical training in menopause, what do you think is the likelihood that your GP has received any training at all in menopause?

An earlier study of ob-gyn residents found that most residents did not feel comfortable managing menopause patients with 75.8% reporting feeling “barely comfortable” and 8.4% feeling “not at all comfortable.”

Now researchers have examined more closely the menopause training received by ob-gyn residents. They reported their findings in the November 2013 edition of the Menopause journal. Most residents reported that they had limited knowledge and needed to learn more about these aspects of menopause medicine

  • menopause symptoms (67.1%)
  • hormone therapy (68.1%
  • nonhormone therapy (79.0%)
  • bone health (66.1%)
  • cardiovascular disease (71.7%)
  • metabolic syndrome (69.5%)

Only 20.8% of residents reported that their program had a formal menopause medicine learning curriculum, and 16.3% had a defined menopause clinic as part of their residency.

What can you do if your GYN or GP is not helping you to relieve your menopause symptoms?

You need to find a GYN or GP who can help you.

What to look for in a doctor who can help you with menopause

  1. You want a doctor who has received training about menopause
  2. You want a doctor who has experience in helping menopausal women
  3. You want a doctor who listens to you and is a caring human being

1 above, may be easier to find than you may think. 2 may be a little more difficult to find than 1. Unfortunately, 3 is not taught in medical curriculums. It is a case of “suck it and see”.

How to find doctors who understand menopause …. in your vicinity

The North American Menopause Society (NAMS) has recognized this gap in the training of doctors. It has developed a menopause competency examination. All licensed healthcare providers (including doctors, nurses, and physician assistants) are eligible to sit for this examination. Those who pass this rigorous competency examination, have demonstrated their expertise in the field and are awarded the credential of NCMP, which stands for NAMS Certified Menopause Practitioner.

There is a directory of menopause healthcare providers, on the NAMS site, that will help you find doctors who understand menopause. Just enter your zip code and the search results will reveal doctors in your vicinity. It is advisable to tick the box that limits the search results to NCMP practitioners, because the NAMS directory also contains details of doctors who do not have the NCMP credential.

What to do if there are no NCMP practitioners near you

Get appointments with several doctors in your local area. Interview them to determine their understanding of menopause and their experience in helping menopausal women. Some questions that are good to ask are

  • What kind of menopause-specific training have you had?
  • For how long have you been helping menopausal women?
  • What is your approach to treating women who are in menopause? (What kinds of menopause treatments do you prefer?)
  • What is your view about treating menopause symptoms using complementary medicine therapies?
  • What is your view about treating menopause symptoms using alternative medicine therapies?

After the interview, decide if you will feel comfortable talking with that doctor about very personal issues, including sexuality. You’re not bound to stay with the same doctor. If you find that you’re not getting the care you need, you can start your search again.

Good luck in finding doctors who understand menopause.


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