DHEA: Is It As Effective As HRT In Relieving Menopause Symptoms?

DHEA

Could it be an effective alternative to HRT?

DHEA is a natural hormone produced by your adrenal glands. Your body uses it as the starting material for making estrogen and testosterone. It’s also available at health food stores, and on-line, as an over-the-counter supplement.

Your body makes its own DHEA; we get very little in our diets. Your body’s production of it peaked in your twenties. As you aged, there has been a gradual decrease in the production of it. By the time you reach 60, your body produces just 5% to 15% as much as when you were 20.

The Your body uses DHEA to raise estrogen levels. If the level of it is raised, the levels of estrogen are raised. As the basis of HRT is to raise estrogen levels, which are naturally falling during perimenopause and naturally low during postmenopause, DHEA therapy may be able to perform the same function as HRT.

A 2011 study compared the effectiveness of DHEA to HRT in relieving menopause symptoms. It found that it was as effective as HRT. It was particularly effective in relieving vaginal atrophy. The researchers concluded that it can help women who cannot take HRT because of other health conditions or who are not willing to take HRT because of the health risks associated with taking it.

Vaginal atrophy is the thinning, drying, and inflammation of the vaginal walls. It is caused directly and indirectly by declining levels of DHEA….directly because it is associated with a thinning of the vaginal walls and indirectly because it stimulates the production of estrogen, which keeps the vaginal area healthy. For many women, vaginal atrophy makes intercourse painful — and if intercourse hurts, your interest in sex will naturally decrease.

Declining levels of DHEA during menopause not only causes vaginal atrophy, but it also causes declining libido. One study found that women who took a 25mg dose of testosterone weekly, experienced a significant increase in their libido. They had nearly three more sexual encounters per week after the treatment compared to before the study.

Declining libido is associated with falling testosterone levels. If a woman is experiencing a decline in libido due to falling testosterone levels, often it is declining DHEA levels that are at the root of the testosterone deficiency. It is the main ingredient the body uses to manufacture testosterone.

DHEA is currently approved as a treatment for vaginal atrophy in Europe. It is not approved by the FDA as a treatment in America. However it is currently undergoing testing to be an FDA-approved treatment for vaginal atrophy.

DHEA has other health benefits

  • there is growing evidence that it is effective in reducing the risk of osteoporosis. It helps to increase bone density
  • Several studies have found that it is effective in treating depression. One study in particular found it effective in treating depression during menopause years
  • It enables weight loss. A study published in the Journal Of The American Medical Association (JAMA) found that participants given DHEA supplements experienced a significant decrease in abdominal fat

There have also been studies that have found that DHEA can be effective in treating lupus, heart disease and diabetes. However other studies have not found this to be conclusive.

The Mayo clinic says that there is strong scientific evidence that DHEA helps to prevent osteoporosis, that it is effective in treating major depression, and that it helps to bring about weight loss and fat loss.

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Expect Your GYN To Encourage You To Take HRT In 2014

HRT

But....what about the health risks associated with taking HRT?

It is likely that your GYN will encourage you to take HRT for your menopause symptoms.

The American College of Obstetricians and Gynecologists (ACOG) has just updated its Practice Bulletin for treating hot flashes and vaginal atrophy. The ACOG 2014 Practice Bulletin will go to all GYNs and perhaps all GPs.

The recommendations are listed in 3 tiers:

Level A (“good or consistent scientific evidence”):

Systemic HT, with just estrogen or estrogen plus progestin, is the most effective approach for treating vasomotor symptoms.

Low-dose and ultra-low systemic doses of estrogen have a more favorable adverse effect profile than standard doses.

Healthcare providers should individualize care and use the lowest effective dose for the shortest duration.

Thromboembolic disease and breast cancer are risks for combined systemic HT.

Selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, clonidine, and gabapentin relieve vasomotor symptoms and are alternatives to HT.

Local estrogen therapy is advised for isolated atrophic vaginal symptoms.

The only nonhormonal therapy approved to treat vasomotor symptoms is paroxetine, and to treat dyspareunia is ospemifene.

Level B conclusions ():

Data do not support use of progestin alone, testosterone, compounded bioidentical hormones, phytoestrogens, herbal supplements, and lifestyle modifications.

“Common sense lifestyle solutions” are layering clothing, lowering room temperature, and consuming cool drinks.

Nonestrogen water-based or silicone-based lubricants and moisturizers may alleviate pain.

Level C recommendation (“based primarily on consensus and expert opinion”):

Individualize the decision to continue HT.

In essence the ACOG is telling gyns that the only treatments for hot flashes and vaginal atrophy that have “good or consistent scientific evidence” are HRT and anti-depressants.

It does not surprise me that the ACOG has chosen to push HRT and anti-depreesants and to classify other treatments …. that have been proven by medical studies to be effective, …. as having “limited or inconsistent scientific evidence”. I will leave it to you to hazard a guess about why they may have done so.

Other treatments that studies have found to be effective

  • A new study published this month in the Journal of the American College of Nutrition showed that HMRlignan, an extract from the Norwegian spruce, can dramatically reduce hot flashes in postmenopausal women. The study showed that 72mg/day effectively reduced hot flashes by 55% over four weeks. When factoring in women with more severe hot flashes, the results showed an 80% decrease in the severity of hot flashes over eight weeks. This study was conducted by MDs in conjunction with the UCLA School Of Medicine
  • A clinical trial published in The Journal of Reproductive Medicine found that natural supplement Pycnogenol (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, is most effective for lowering hot flashes and nighttime sweating. This trial was performed by medical doctors
  • A clinical trial found that menopausal women who took a Chinese herbal formula called EXD (Er-xian decoction) experienced a 62% reduction in the number of hot flashes and night sweats that they experienced. This trial was conducted by doctors
  • Relaxation Therapy significantly reduces hot flashes. A study conducted by Baylor University researchers, and reported by the International Federation of Gynecology and Obstetrics, found that relaxation therapy reduced hot flashes by 80%. This study was not conducted by MDs
  • Estriol, one of the 3 estrogens, is effective at relieving vaginal dryness according to Dr. Robert Greenblatt, who was an MD and one of the foremost researchers in hormone therapy. Estriol does not have the health risks associated with estradiol, which is the main form of estrogen used in conventional hormone replacement therapy.

    In a review of estriol in the 1980s, Dr. Greenblatt, commented that “the ability of estriol to relieve vasomotor symptoms (hot flashes) and to improve vaginal maturation (prevent vaginal atrophy) without inducing notable side effects, is sufficient reason for it to be included in the management of the postmenopausal syndrome.”

    In other words, he felt that estriol should be considered as an effective and safe form of hormone therapy because it prevents menopausal symptoms like hot flashes without causing side effects so common to conventional HRT. Estriol therapy is only available via bio-identical hormone therapy

There is no question that HRT is effective in treating hot flashes and vaginal atrophy. However, there is also no question that there are health risks associated with taking it. 18 months ago, a review study of HRT was conducted in behalf of the U.S. Preventive Services Task Force (USPSTF), in preparation for its updated statement about HRT. It concluded that HRT increased the risk for stroke, thrombosis, and breast cancer.

These health risks are not associated with the other treatments discussed above.

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How To Evaluate The Risks Of Taking HRT

HRT

Should I or shouldnt I take it?

HRT is such an emotive topic. Just the mention of it in the title of this post, will result in some women not reading this post.

I understand this kind of response. Some women view it as a life saver; others view it as a killer.

Almost every menopausal woman is aware that there are health risks associated with taking hormone replacement therapy. Studies have found that taking it, increases the risk of breast cancer, heart disease and stroke.

Most women elect not to take it, because of those health risks.

However, 7% of menopausal women report that their symptoms have a very negative effect on their lives. It is estimated that there are 50 million menopausal women in America today. 7% of them = 3.5 million women.

For many of these women, their symptoms can be so debilitating that they are unable to function in life adequately. Their symptoms can have a devastating affect on their roles as a mother, wife, carer for elderly parents, and earner of income for the family. Their symptoms, if untreated, can also lead to conditions that can be damaging to their health and well being ….ie – depression.

For these women, there are risks in not treating their severe symptoms.

Conventional HRT and bioidentical HRT are effective at relieving menopause symptoms.

You will read and hear many competing claims and statistics about hormone replacement therapy. Some doctors say that the benefits outweigh the risks; others say the reverse. Authority sites will tell you to discuss it with your doctor, but in so doing, the answer that you get will be an opinion….that may not even be based on medical fact, but rather the promotional marketing of HRT by a pharma.

What should you do?

The best and safest thing for you to do is to research the facts yourself. You need to learn how to interpret the research that has been conducted into hormone replacement therapy.

How to evaluate HRT, if you are experiencing debilitating symptoms

To view this matter objectively, you have to look closely at statistics, rather than listen to authors of articles that say “HRT increases the risk of….” or “HRT decreases the risk of….”

We get most of the information about hormone replacement therapy from the media, who report the findings of medical studies. The headlines and stories will often talk about a “25% increase in risk” of a “25% decrease in risk” etc. But what does this actually mean?

“Risk” in the health and medical fields have special meanings. Knowing the basic types of risk can help you understand your risks in taking HRT.

As you probably know, the big study that first identified the health risks associated with HRT was the 2002 Women’s’ Health Initiative (WHI). It followed 16,000 women for approximately 5 years. Some of the women took HRT and some did not.

Researchers reported that HRT increased the risk of breast cancer by 26 per cent. That sounds terrifyingly high. But on further inspection this statistic is not quite what it appears to be.

There are different ways of presenting a health risk. For example, if the risk of having a stroke is 2 in 100, and a medication increases it to 3 in 100, then it could be said that the treatment has increased the risk of a stroke by 1 per cent. This method of presenting data is called the absolute risk.

However, it could equally be said that it has increased the risk of a stroke by 50 per cent. While this sounds far more alarming, it is the same data, just presented in a different way. This is called relative risk. It compares the risk between 2 groups. The WHI study reported findings based on relative risk. It compared the findings of women who took hormone replacement therapy and women who did not.

The relative risk doesn’t help you assess the actual risk of a woman on HRT developing breast cancer – because it doesn’t tell you how many women would develop breast cancer, who were not on HRT. In the case of breast cancer and hormone replacement therapy, while the relative risk is 26 per cent, the absolute risk is 0.4 per cent. This means that, according to the WHI study, there are four extra cases of breast cancer per 1,000 women taking it over a five-year period. While this is still significant, it’s a clear example of how the same data can be expressed in different ways.

The way that risk information is presented can influence your decision to take HRT or not.

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80% Reduction Of Hot Flashes From A Natural Product

Hot Flashes

When will this end?

A new study, just published in the Journal of the American College of Nutrition, has found that HMRlignan has produced 80 percent fewer severe hot flashes in postmenopausal women.

HMRlignan is one of the predominant plant lignans of dietary importance. Lignans are phytoestrogens. Phytoestrogens are plant-based compounds structurally similar to estradiol, which is the primary estrogen hormone.

Lignans are one of three main groups of plant compounds classified as phytoestrogen – the other two being isoflavonoids and coumestans. Lignans are a normal part of a healthy diet and widely distributed in foods and plants in small amounts. The most common dietary sources of lignans are whole grains, seeds, nuts, legumes, fruits, and vegetables. Flaxseed is by far the richest dietary source of plant lignans.

How lignans reduce hot flashes

Previous research has associated lignans in the diet with reduced hot flashes. The author of a Mayo Clinic study says that lignans provide a more natural estrogen treatment for menopause and hot flashes than synthetic hormone therapy and therefore are a potentially healthier treatment for both.

During perimenopause, hot flashes are caused by too much estrogen in the body relative to progesterone. During postmenopause, they are caused by permanently low levels of estrogen. Lignans can help to re-balance the ratio between estrogen and progesterone during perimenopause and increase the level of estrogen during postmenopause

Lignans can help women in this stage of life due to their ability to balance hormones and raise natural estrogen levels by competing with progesterone. When too much estrogen is present, lignans, which mimic estrogen, bind to estrogen receptors and excess endogenous levels of estrogen are then excreted from the body either though urine or the bowels. When not enough estrogen is present, the lignans also bind to estrogen receptors and exert their weak estrogenic effects, augmenting a woman’s low level of estrogen. Lignans (phytoestrogens) can be used as a natural hormone replacement treatment and are much safer than conventional hormone replacement treatments.

Lignans have other health benefits

A study by the University of California at Davis found that lignans helps to prevent cardiovascular disease.

Several other studies have found that lignans helps to reduce the risk of breast cancer, and several other cancers, by reducing the risk of tumors. It has also been found to improve the recovery rate of breast cancer patients.

How to increase your intake of lignans

You can increase your intake of lignans, by including foods in your diet that are rich in them, and by taking it in supplement form.

Apart from flaxseed, which is the richest source of lignans, other specific sources include (richest sources first)

  • Nuts and seeds – particularly chestnuts and pistachio nuts and sesame and sunflower seeds
  • berries
  • rye
  • apples and prunes
  • wine
  • leafy vegetables
  • cabbage
  • rice
  • wheat
  • onion vegetables
  • oats and barley
  • root vegetables
  • citrus fruits

HMRlingan, the natural product used in the the most recent hot flashes study, is available in supplement form. It is made from knots in the Norwegian Spruce tree. It is available from many sources, including Amazon.

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Do You Want To Be In “The Mood”?

Loss Of Libido

Sexual enjoyment is important to my husband and I

Two new studies published in the journal Menopause offer hope to menopausal women who want to restore their libido.

An ongoing survey being conducted by the North American Menopause Society is showing that 79% of menopausal women have experienced a significant loss of sex drive during menopause.

Many women experience a decrease of libido during perimenopause. That decrease intensifies after menopause. One survey of 580 postmenopausal women, conducted by Siecus – the Sexuality Information and Education Council of the United States, found that 45 percent of the women reported a decrease in sexual desire after menopause, 37 percent reported no change and 10 percent reported an increase.

A study that examined the changes in sexual function, as women progress from early perimenopause to postmenopause, found that

  1. Women experienced a significant decrease in sexual desire during the late perimenopause
  2. Women using hormone therapy also reported higher sexual desire
  3. Those reporting higher perceived stress reported lower sexual desire
  4. Those most troubled by symptoms of hot flashes, fatigue, depressed mood, anxiety, difficulty getting to sleep, early morning awakening, and awakening during the night also reported significantly lower sexual desire
  5. Women with better perceived health reported higher sexual desire and those reporting more exercise and more alcohol intake also reported greater sexual desire
  6. Having a partner was associated with lower sexual desire

For some women loss of libido is frustrating and they want to do something to improve it. For other women, it is a natural occurrence that leads to a pleasant transition in their relationship with their partners.

One study found that testosterone treatment increases libido

Recent research on loss of libido found that testosterone plays a role in a woman’s sex drive. Though present in only small amounts, some researchers believe that it has a significant impact on your sex life. While decreased levels of estrogen contribute to loss of sex drive during menopause, one of the leading researchers of testosterone treatment thinks that a decreased level of testosterone may be the main reason for it.

Women at the age of 40 produce approximately half of the testosterone they did when they were in their 20s. Testosterone levels continue to decline with the onset of menopause or in women who have had their ovaries removed.

To date, the FDA has not approved a testosterone treatment for women. However, an important step toward developing a successful and safe treatment for women, after natural or surgical menopause, is to find out how much testosterone is really needed to bring desire back. Now a study has provided that and has confirmed that testosterone treatment increases libido.

The study found that women who took a 25mg dose of testosterone weekly, experienced a significant increase in their libido. They had nearly three more sexual encounters per week after the treatment compared to before the study.

It is important to note that taking 25 milligrams weekly boosted the subject’s testosterone levels to five or six times what’s considered a healthy level. This suggests that simply raising low testosterone levels to what’s normal won’t improve sexual function and these other measures.

The researchers said there were no serious negative side effects from taking this dosage. However, high doses of testosterone previously have been linked to negative heart effects. The researchers caution that cardiovascular and metabolic risks need to be investigated in long-term trials.

Margery Gass, MD and Executive Director of The North American Menopause Society said

Keeping hormone levels within the normal range for your gender and age is the safest approach. Hormones affect many systems in the body, and it takes a large and long-term study to identify side effects. One recent well-designed study in men reported that mortality was greater among older men taking testosterone. More is not necessarily better when it comes to hormones

The other study found that flibanserin, a nonhormonal drug, increased libido

This new study looked at 949 postmenopausal women with very low sexual drives. A little less than half of them were given 100 milligrams a day of flibanserin for six months. The others were given a placebo pill.

Those taking flibanserin reported increases in the number of satisfying sexual encounters and a higher score on a sexual desire scale, compared to those on placebo. About 38 percent of women on flibanserin said they experienced benefits to their sex lives after they took the treatment, compared to only 20 percent of the women on the placebo.

Thirty percent of the women on the treatment experienced side effects including dizziness, sleepiness, nausea, and headaches, but ultimately only 8 percent stopped the treatment because of them.

Both studies were published Dec. 4 in Menopause, the journal of the North American Menopause Society.

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What Every Perimenopausal Woman Really Wants To Know

End Of Menopause Symptoms

When will it end?

For many perimenopausal women, the pre-eminent menopause symptom is irregular periods. It is the first symptom they become aware of, that tells them that they have entered perimenopause.

They may have experienced other symptoms prior to the change in their period cycle…. like mood swings, anxiety, irregular heartbeat, and perhaps some hot flashes….but they may not have associated these symptoms with the onset of perimenopause.

In the early phase of the perimenopause, periods typically become more frequent. The most common early menstrual irregularity noticed in the perimenopause is a shortening of cycle length. Women with prior 28 day cycles will commonly describe 24 to 26 day cycles during the early perimenopause.

It is common for perimenopausal women to experience

  • an increased quantity of menstrual flow and premenstrual spotting
  • “flooding”, wherein they experience a very heavy flow that can last for up to 2 weeks
  • a widening of the length of the menstrual cycle
  • skipping periods entirely

Ninety percent of women experience four to eight years of irregular periods before their final menstrual period.

This combination of shorter cycles, spotting, and heavier bleeding periods …. which is then followed by a widening of cycle length and skipping periods …. can keep a woman’s attention firmly riveted on her periods. She may come to look forward to menopause …. that point in time when she has not had a period for 12 consecutive months.

Many perimenopausal women expect their symptoms to cease, or at least diminish, when menopause is reached. Unfortunately this is not the case.

During the early postmenopause stage, you can expect to continue to experience most of the symptoms you experienced in perimenopause. Towards the end of early postmenopause, your hormone levels will begin to stabilize and many of the symptoms you had been experiencing will reduce or even stop.

While some menopause symptoms do cease after menopause, others diminish. However, some symptoms intensify after menopause

  1. Hot flashes and night sweats tend to become more frequent as a woman approaches menopause, but they are most intense for the first 2 years after menopause
  2. 50% of postmenopausal women experience vaginal atrophy. The symptoms include vaginal dryness, burning and itching, and painful intercourse or urination
  3. While 41% of women approaching menopause complain about joint pains and aches, 57% of women 2 years past menopause, report that they experience significant joint pain

What menopausal women really want to know

Perimenopausal women really want to know when they can expect their menopause symptoms to end. It is the question most asked by postmenopausal women.

It is not possible to know exactly when the end of menopause symptoms will occur, given the current level of research into menopause. It varies from woman to woman. However research exists that provides some indication of what to expect.

Just as in perimenopause, the prevalence, frequency, severity and duration of postmenopause hot flashes vary considerably.

One study of more than 10,000 postmenopausal women was conducted to learn more about postmenopause hot flashes. The study collected information from these women for 3.5 years. The researchers found the following

  • 89% of the women experienced hot flashes/night sweats during the 3.5 years
  • more women had hot flushes (86%) than night sweats (78%)
  • the frequency of hot flashes/night sweats was 33.5 per week

Another study that followed 436 menopausal women from 1995 – 2009 (thirteen years) shed more light on postmenopause hot flashes. All of the women were between the ages of 35-47 in 1995. The findings of this study were as follows

  1. the median duration of moderate to severe hot flushes was 10.2 years
  2. women whose moderate to severe hot flashes commenced in the early menopause transition stage had a median duration of 7.35 years
  3. women whose moderate to severe hot flashes commenced in the late menopause transition to early postmenopause stage had a median duration of 3.84 years
  4. The most common ages at onset of moderate to severe hot flashes were 45–49 years. For this group, the median duration was 8.1 years

Bottom line: The earlier you begin to have hot flashes during the menopause transition stages, the longer you can expect them to continue during postmenopause.

Vaginal atrophy progressively worsens as you age, unless you treat it with some form of estrogen therapy. The cause of vaginal atrophy is the low levels of estrogen in your body after menopause.

Joint pain is caused by inflammation in and around the joint. Low levels of estrogen, during postmenopause, exacerbates joint pain because estrogen fights inflammation. Estrogen therapy helps to reduce joint pain.

While it is not possible to tell exactly when your menopause symptoms will end, this post provides you with some parameters, as a guide. Know that they WILL end….you just dont know when.

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Is Menopause Never-Ending?

End Of Menopause

I am almost there

As you have probably noticed, many women seem to breeze through menopause with mild symptoms that last for just a short period of time. Others suffer with debilitating symptoms that seem to go on forever. And….there seems to be no rhyme or reason for either.

I have helped thousands of women during their menopause journeys. I cannot think of a single patient who didnt ask me, at some point during their meno-journey, how long menopause would last.

It is not possible to know when the end of menopause will occur, given the current level of research into menopause. When I am asked about the end of menopause symptoms, my response is to

  • provide them with information about the stages of the entire menopause process. Those stages are early menopause transition, late menopause transition, early postmenopause and late postmenopause
  • help them manage their expectations as they progress through the menopause stages

Stages of menopause and menopause symptoms

During the early and late menopause transition stages (perimenopause), you can expect to experience any of the symptoms of menopause.

During the early postmenopause stage, you can expect to continue to experience most of the symptoms you experienced in the two earlier stages. Towards the end of early postmenopause, your hormone levels will begin to stabilize and many of the symptoms you had been experiencing will reduce or even stop.

During late postmenopause, the predominant symptoms experienced by many women are hot flashes/night sweats, vaginal atrophy, and joint pain.

The cause of vaginal atrophy is low levels of estrogen. Vaginal atrophy progressively worsens as you age, unless you treat it with some form of estrogen therapy. Joint pain is caused by inflammation in and around the joint. Low levels of estrogen, during postmenopause, exacerbates joint pain because estrogen fights inflammation. Estrogen therapy helps to reduce joint pain.

The cause of hot flashes is not certain, but it is thought to be related to falling levels of estrogen during early and late menopause transition and low levels of estrogen during postmenopause stages. The drop in estrogen confuses the hypothalamus — which is sometimes referred to as the body’s “thermostat” — and makes it read “too hot.” The hypothalamus apparently senses that your body is too hot, even when it is not, and tells the body to release the excess heat (hot flash).

When can you expect an end to hot flashes?

Just as in perimenopause, the prevalence, frequency, severity and duration of postmenopause hot flashes vary considerably.

One study of more than 10,000 postmenopausal women was conducted to learn more about postmenopause hot flashes. The study collected information from these women for 3.5 years. The researchers found the following

  1. 89% of the women experienced hot flashes/night sweats during the 3.5 years
  2. more women had hot flushes (86%) than night sweats (78%)
  3. the frequency of hot flashes/night sweats was 33.5 per week

Another study that followed 436 menopausal women from 1995 – 2009 (thirteen years) shed more light on postmenopause hot flashes. All of the women were between the ages of 35-47 in 1995. The findings of this study were as follows

  • the median duration of moderate to severe hot flushes was 10.2 years
  • women whose moderate to severe hot flashes commenced in the early menopause transition stage had a median duration of 7.35 years
  • women whose moderate to severe hot flashes commenced in the late menopause transition to early postmenopause stage had a median duration of 3.84 years
  • The most common ages at onset of moderate to severe hot flashes were 45–49 years. For this group, the median duration was 8.1 years

Bottom line: The earlier you begin to have hot flashes during the menopause transition stages, the longer you can expect them to continue during postmenopause.

Managing your expectations about the end of menopause symptoms

Managing your expectations, concerning the end of menopause symptoms, creates breathing room for your experiences. It allows you to live more calmly, with less stress, disappointment and upset.

I am reminded of a true story concerning American POWs, who were held captive by the North Vietnamese during the Viet Nam war.

The most senior POW was an American admiral. He noticed that many of the POWs, subordinate to him, became distraught as a result of setting specific dates by when they expected to return home to the US. When those dates passed, and they remained in captivity, he noticed that they became anguished and frantic…almost to the point of hysteria.

The admiral counselled POWS to keep the thought firmly in their minds that they WILL be returning home….but not to set a date in their minds (over which they had no control) of when it will happen.

The same applies to the end of menopause symptoms for you. Know that they WILL end….you just dont know when.

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Keep Your Ovaries……Ladies

Hysterectomy

Women without ovaries are at higher risk of heart disease, than women with their ovaries

I have been asked the following type of question frequently…..

I am having a hysterectomy because I have painful fibroids. My surgeon wants to take out my ovaries at the same time. He says that I dont need them anymore, since I am menopausal. What should I do?

When your doctor recommends that you have your ovaries removed, during a hysterectomy to correct a benign condition, think very carefully about it before proceeding.

The presence of ovarian cancer is the only legitimate medical reason to remove the ovaries.

There are more than 600,000 hysterectomies performed every year in the US. Hysterectomy, is the second most commonly performed surgical operation on women, after Cesarean delivery.

Today there is growing sentiment that many of the hysterectomies performed are unnecessary. It is argued that around 10% of the hysterectomies performed are necessary, due to the presence of cancer. That amounts to around 60,000 hysterectomies. The remaining 540,000 hysterectomies are performed for benign conditions, which either resolve themselves over time or which have alternative treatments that are less invasive.

In the United States, 78% of women 45 to 64 years old …. and 55% of women overall …. undergo bilateral oophorectomy (removal of both ovaries) at the time of hysterectomy. These percentages mean that almost 300,000 women undergo bilateral oophorectomy each year.

Why doctors encourage you to have your ovaries removed

It has been common practice to counsel women who were in their mid-40s or older and who were planning to have a hysterectomy for benign conditions, to undergo bilateral oophorectomy at the time of the hysterectomy. The rationale for this approach has been that oophorectomy greatly decreases the risk of ovarian cancer. However, according to the American Cancer Society, the risk of ovarian cancer is extremely low.

A woman’s risk of getting invasive ovarian cancer in her lifetime is about 1 in 72. Her lifetime chance of dying from invasive ovarian cancer is about 1 in 100.

Dr. Mitchell Levine, a prominent ob-gyn who teaches at the Tufts and Harvard Schools of Medicine, says that doctors are taught that once a woman is done having children her ovaries are a ticking time bomb…..and they should be removed to prevent ovarian cancer.

Why you should not allow your ovaries to be removed unnecessarily

There is a common misconception that when you reach menopause, your ovaries no longer produce estrogen and other hormones. This is incorrect. The production of estrogen by your ovaries does not go to zero at menopause. Your ovaries continue to produce estrogen, for the rest of your life, but much less of it. They also continue to produce testosterone and androstenedione, which is converted by your body into estrogen.

What is the significance of having estrogen in your body? Estrogen protects your heart from heart disease. Whats more….studies show that estrogen also protects you from stroke, hip fracture, Parkinson’s Disease, dementia, cognitive impairment, depression, and anxiety.

If your ovaries are removed, your body will be deficient in estrogen. A major study was conducted in 2008 to determine the affect of hysterectomy on women’s health. It was led by Dr William H. Parker, a noted gynecological surgeon. The study reviewed the health of 29,000 women who had hysterectomies for non cancerous conditions. 16,000 of these women had their ovaries removed. 13,000 of these women retained their ovaries. The findings of the study, which was reported in 2009 were as follows

  • women whose ovaries were removed had a higher risk of death from any cause, and had a significantly higher risk of heart disease, stroke and lung cancer
  • While breast cancer and ovarian cancer were less frequent in women who had their ovaries removed, the overall risk of death from all types of cancer was higher among women who had their ovaries removed

To put these findings into context, ovarian cancer accounts for 14,700 female deaths per year in the U.S., heart disease causes 326,900 female deaths, and stroke causes 86,900 female deaths each year. The risk of death from heart disease is 23 times greater than the risk of death from ovarian cancer. The risk of death from stroke is 6 times greater than the risk of death from ovarian cancer.

If a woman is at such a low risk for ovarian cancer with her ovaries intact, and at such a high risk for heart disease and stoke as a result of her ovaries having been removed, does it make sense to you to have your ovaries removed?

The truth is that by consenting to have your ovaries removed, your risk of ovarian cancer is reduced somewhat….but in so doing your risk of heart disease increases by 500% (that’s by 5 times).

So if you’re looking at odds, you would be wise to keep your ovaries.

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Is Bioidentical HRT Safer Than Conventional HRT?

Bioidentical HRT

Is it or isnt it safe?

Many women toil over whether or not to pursue hormone therapy, as they experience menopause symptoms that are affecting the quality of their lives. It can be a difficult decision, especially with all the media headlines and fears instilled from previous studies, like the WHI.

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 these health risks.

According to the National Cancer Institute, there can be no doubt that taking conventional HRT, in the form of synthetic estrogen plus progestin or synthetic estrogen only, increases the risks of these health conditions.

But…..does taking bioidentical HRT (BHRT) carry these same risks?

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.

What advocates of bioidentical HRT say about BHRT safety

  • The International Hormone Society

    There currently is sufficient evidence confirming the greater safety of bioidentical sex hormones compared to the nonbioidentical ones, in particular when the transdermal, nasal or intramuscular routes are used instead of the oral route.

  • Virginia Hopkins, medical writer, discusses the findings of the E3N study that examined the association between HRT and breast cancer

    The study involved 54,548 postmenopausal women who had not been on any kind of HRT for at least a year before entering the study. The average age was 53, and the study lasted for almost 6 years.

    Compared to women who had never used HRT, those using estrogen plus synthetic progestins had a 40% increased risk of breast cancer, while those using estradiol plus progesterone (e.g. bioidenticals) had a 10% decreased risk of breast cancer.

    In January 2008, with eight years of follow-up, data was released from E3N showing that women using synthetic HRT had a 60% higher risk of cancer, while women using bioidenticals still had the same risk as women using no HRT of any kind.

  • Dr. Kent Holtorf, MD, a specialist in bioidentical hormone therapy and anti-aging medicine

    A thorough review of the medical literature clearly supports the claim that bioidentical hormones have some distinctly different, often opposite, physiological effects to those of their synthetic [non-bioidentical counterpart] hormones.

    With respect to the risk for breast cancer, heart disease, heart attack, and stroke, substantial scientific and medical evidence demonstrates that bioidentical hormones are safer and more efficacious forms of HRT than commonly used synthetic versions.

What conventional medicine authorities say about bioidentical hormone therapy

  • Dr. Adriane Fugh-Berman, MD and associate professor of pharmacology and physiology at Georgetown University Medical Center

    A 2008 study of more than 80,000 French women found that while combining estrogens (including bioidentical estradiol) with conventional synthetic progesterone significantly increased breast cancer risk, combining them with bioidentical progesterone did not.

  • Dr. Alan Garber, MD, PhD, chief medical editor of Endocrine Today

    Bioidentical hormone replacement is a clever marketing concept devoid of scientific underpinnings, and preys upon the patient’s desire for better hormonal replacement therapies that are both safe and effective, properties totally unproven by the proponents of such agents.

  • Dr. Robert W. Rebar, MD, and Executive Director of the American Society for Reproductive Medicine

    It is difficult to understand why women continue to request bioidentical hormones despite a lack of data. Why would anyone put something into her body that no one has ever tested?

My take on bioidentical HRT and conventional HRT safety

Bioidentical HRT has yet to conclusively demonstrate safety and efficacy by means of well-designed, head-to-head clinical trials in which bioidentical hormones are compared against synthetic hormones.

Such trials may be a very long time in coming. Almost all clinical trials are funded by pharma companies. Pharma companies view the providers of BHRT as competitors. Pharma companies have billions of dollars invested their conventional HRT products. It would not be in their interests to fund such trials.

To borrow from the theme of Dr. Rebar’s message above

Why would a woman put synthetic HRT products into her body …. when they have been found to increase her risk of breast cancer, heart attack and stroke …. when an alternative is available that appears to be at least as effective and which does not appear to carry the same health risks?

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A Way To Take HRT …. That Reduces Health Risks

HRT

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

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