Menopause Q&A
Since Menopause is Natural, Why should Women Replace their Estrogen?
The human lifespan has been dramatically extended. Women rarely lived long beyond the age
of 40 in the past. Now they often live for 30 or 40 years in a hormone-deficient state causing
problems never seen before. Menopause is just one consequence of the universal disease we
call aging--and aging is definitely not good for us. So menopause is both natural and bad for a
woman's health and quality of life. Interestingly, the brain knows that menopause is not a good
thing. After menopause or the surgical removal of the ovaries, and for as long as a woman
remains alive, the pituitary gland continues to secrete super-high amounts of follicle
stimulating hormone (FSH), trying to stimulate eggs in the ovaries to produce estrogen. So
apparently nobody told the brain that menopause is natural. Menopause is caused by the loss
of functional eggs in the woman's ovaries leading to an almost complete loss of estrogen. After
menopause, women have lower estrogen levels than men! The consequences of losing
estrogen include hot flashes, insomnia, poor memory and concentration, depression,
increased thinning and wrinkling of the skin, vaginal dryness and the weakening of vaginal and
pelvic tissues, elevated cholesterol, and increased blood pressure and blood sugar. Sexual
interest is often lost and intercourse can become difficult if not impossible. The risk of several
serious diseases is increased: heart attacks, strokes, and Alzheimer’s disease. A woman
loses 25% of her bone mass in the first 5 years after menopause. The bulk of the evidence
shows that bioidentical estradiol restoration helps prevent these problems and improves
overall health and well-being.
What is Perimenopause? Why do Women need Progesterone?
Menopause is the end stage of ovarian failure. The years leading up to menopause are called
perimenopause. This is when ovarian function is altered but has not ceased. When women are
in the 40s, the ovaries start making less progesterone. Often women don't ovulate at all and the
ovaries make no progesterone. Perimenopause can be a time of very high estrogen levels with
low progesterone; causing fatigue, insomnia, bloating, heavy bleeding, allergies, and
headaches. These symptoms can all be well-controlled by adequate progesterone
supplementation--and many hysterectomies prevented. Progesterone has a sedative quality--
reducing anxiety and mood swings. Progesterone balances estrogen in the female
reproductive cycle. Estradiol promotes proliferation in the uterus and breasts, whereas
progesterone promotes maturation and differentiation of these tissues in preparation for
pregnancy. Differentiated cells are less likely to be cancer cells. Progesterone also deactivates
estradiol in these organs. (Provera® instead increases breast stimulation and the risk of
breast cancer.) The loss of progesterone increases the risk of uterine and breast cancers. After
menopause the female breasts actually make their own estradiol but cannot make
progesterone, further increasing the risk of breast cancer which continues to RISE after
menopause. Due to its ability to prevent uterine and breast cancer, (see powerpoint) it is
essential that all women replace their progesterone to adequate levels in both perimenopause
and menopause, whether or they are on estrogen replacement therapy or not, and whether they
still have a uterus or not.
How are Bioidentical Estradiol and Progesterone Produced? What about Compounding
Pharmacies?
“Bioidentical” is the term that signifies that the molecule is exactly the same as the one in our
bodies. Yams, soy, and other plants contain a molecule called diosgenin that has no hormonal
effects, but it is similar to cholesterol and is easily converted by chemical processes into
bioidentical estradiol, progesterone, testosterone, cortisol, and DHEA. However, all the alien
steroid substitutes are also made from diosgenin. The issue is not whether the molecule is
natural or synthetic--the source does not matter--it's the chemical structure that makes a
hormone right or not. Also, the route of delivery is very important as bioidentical estradiol can
cause problems if swallowed. The body accepts and metabolizes bioidentical hormones as if it
made them. There are FDA-approved bioidentical estradiol and progesterone products, but
they are often expensive and hard to indiividualize. They are often not in the best form for
delivery. There isn't any FDA-approved testosterone for women (The drug companies are trying
to fix that!) Therefore many physicians prefer to prescribe compounded estradiol, progesterone,
and testosterone. A compounding pharmacy uses USP-certified bioidentical hormones (the
same raw products used in FDA-approved products). They simply combine carefully measured
amounts of the hormone powder into a delivery vehicle--a cream, gel, tablet, or capsule.
Nothing could be simpler. Pharmacists are certified experts. They take their responsibilities
seriously. Any slight batch to-batch differences in concentration or delivery that may occur are
insignificant to hormone replacement. Compounded hormones work perfectly well, are very
convenient, and are less expensive in most cases. The scare-mongering lies about
compounded hormones that you are hearing are just drug-company propaganda passed on
through drug company-funded organizations like ACOG and NAMS straight to your local
OB/GYN. (ACOG=American College of Obstetrics and Gynecology, NAMS=North American
Menopause Society)
What of the Recent Studies proving that "HRT" is Dangerous?
Replacement implies the use of the same molecules. “Hormone replacement therapy” was
never hormone replacement at all; it was hormone substitution. The Women’s Health Initiative
study (WHI) reported in 2002 looked only at the effects of pregnant mare's urine estrogens
(Premarin®, yes, from horses) and a test-tube progestin (Provera®). A progestin is not
progesterone, it is an alien molecule with a different chemical structure. It has some
progesterone-like effects, but progestins do not raise serum progesterone levels nor support
pregnancy. Likewise, any molecule with estradiol-like effects is called “estrogen”. The arm of
the WHI study using combined Premarin® and Provera® (PremPro®) was discontinued early
because an increased risk of breast cancer was detected. This risk was attributed to ProveraÒ.
Provera® also caused a large increase in heart attacks and strokes. There is no evidence that
bioidentical progesterone increases the risk of heart disease or strokes! Prior and subsequent
reviews and clinical studies indicate that natural progesterone does not increase the risk of
breast cancer (Campagnoli, 2005), and that bioidentical estradiol and progesterone
supplementation actually lowers a woman's risk of breast cancer. (Fournier, 2005, E3N-EPIC).
The arm of the WHI study using Premarin®-only was discontinued because of an increased
incidence of blood clots and strokes in older women--a complication that we know is caused by
taking any estrogens by mouth. Oral estrogens affect the liver in an unnatural way and increase
the production of clotting factors and the risk of blood clots. However, estradiol delivered
transdermally ( through the skin) does not increase a woman's risk of blood clots, heart
attacks, or strokes at all. Unfortunately, the pharmaceutically-funded media and professional
organizations have misrepresented this and other studies and are implying that all “hormones”
are equally dangerous. This is an understandable legal strategy given the thousands of
pending lawsuits over the diseases and deaths caused by PremPro®. Many women can’t even
tolerate alien hormones; suffering side effects such as bloating, bleeding, breast tenderness,
weight gain, and mood swings. Women do tolerate the correct hormones when given by the
correct route, since this is just the restoration of their youthful hormonal state.
What About Birth Control Pills?
Ethinyl estradiol (EE) is the estrogen in birth control pills (BCPs). It is an acetylene molecule
attached to estradiol, making it almost impossible for the body to metabolize and eliminate. It is
a super-potent estrogen. EE increases the risk of blood clots and does not even affect one of
the female estrogen receptors. BCPs combine EE with one of the 30+ progestins that drug
companies have created. BCPs shut down a woman's ovaries so that they do not produce any
estradiol, progesterone, or testosterone. These three natural hormones are replaced by two
alien molecules. The woman's testosterone level declines reducing her libido, sexual function,
and muscle strength. (Female athletes should avoid BCPs!) BCPs increase blood pressure
and blood sugar. Women on BCPs should get off them and use an alternative contraceptive
method. If BCPs are being used to control irregular or painful periods, then the cause of the
hormonal problem should be found and corrected. For birth control, the current copper intra-
uterine devices (IUDs) are very safe and rarely cause the problems seen with earlier IUDs.
Avoid IUDs that dispense artificial hormones.
So Why doesn’t my Gynecologist Prescribe Bioidentical Hormones?
Naturally-occuring molecules such as vitamins and hormones are protected by federal
regulation and may not be patented. Pharmaceutical corporations are interested only in
patentable drugs that are exclusive and profitable. If it’s natural, drug companies aren’t
interested. Drug companies now control most medical information that reaches your doctor,
deciding what gets studied, what is published in journals, and what your doctor's professional
organizations tell him about hormones. Drug companies are promoting their own products and
attempting to suppress compounding pharmacies and the growing compounded bioidentical
hormone industry. So your doctor is told to use alien/synthetic hormone substitutes and to
avoid bioidentical hormones--believe it or not! Doctors are unaware of the benefits and safety of
hormone restoration, and simply don't know how to do it. For a physician to get at the truth,
he/she must take the time to educate him/herself. Most likely, he/she has just never thought
much about bioidenticals, doesn't have the time for independent study, and has no desire to
stray from the drug-company promoted “standard of care” and thus endanger his/her career.
What about Evista® and Fosamax®?
Evista® (raloxifene) is in a class of non-bioidentical hormone-like drugs known as selective
estrogen receptor modifiers or designer estrogens. Studies show that these compounds are
somewhat effective in increasing bone mass although nowhere near as effective as estrogen,
progesterone, and testosterone. They are given to postmenopausal women because doctors
are afraid to replace the lost natural hormones, and because they are more profitable for drug
companies. Designer estrogens do not relieve the other negative effects of menopause and
sometimes increase them. Fosamax® is a one of a number of biphosphonate drugs given to
reduce bone mineral loss in menopause. Biphosphonates are soap-like molecules that
poison osteoclasts, thus interfering with normal bone resorption. This does cause a short-term
increase in bone strength and mineral density. However, bone formation is eventually inhibited
also. Bisphosphonates stop the natural process of bone turnover, producing bone that is
essentially dead. Reports are arriving now of unusual fractures in persons on long-term
biphosphonates (Odvina, 2005). Biphosphonates have also been associated with a number of
side effects including gastrointestinal problems, severe muscle and joint pain, and eye
inflammation. They reduce normal bone remodeling after long-bone fractures and tooth
extractions. Orthodontists have noticed that teeth will not move if the person is on a
biphosphonate. It’s really very simple: postmenopausal osteoporosis is a hormone-deficiency
disease. The proper way to prevent and treat osteoporosis is hormone restoration (including
the hormone we call Vit. D). Doctors are simply afraid to restore a woman's hormones for the
reasons given above.
How Long should I Stay on Hormones?
Women are being told that they should take hormones for menopause only if they have
unbearable symptoms and for only 5 years. However, this recommendation is based on the
known dangers of Prempro® and other hormone substitutes as revealed in the WHI and other
studies. Doctors remain unaware that combined bioidentical transdermal estradiol and
oral/sublingual progesterone have never been show to increase the risk of breast cancer or
heart disease. Indeed, these diseases are rare in premenopausal women who have high
levels of both hormones. More studies of bioidientical hormone restoration are in progress,
and more are needed to define what doses and delivery methods are ideal. However, many
women can't wait. They need to decide now whether they will replace their hormones or not.
Do I Need to have Periods the Rest of my Life?
There is no health requirement for periods. Menstrual cycles are not for a woman's health, they
are for making babies. The complex of female organs and hormones exists to make babies
and breastfeed them. The fact that women have this complex reproductive hormonal system is
why they have so many more hormonal problems than men do. If women want to menstruate,
they can be made to bleed regularly with cyclical use of estradiol and progesterone, but this is
just a building up and the sloughing off of the uterine lining, it is not a true menstrual cycle. It is
an imitation of a menstrual cycle. The goal of menopausal hormone replacement is to provide
adequate amounts of estradiol and progesterone for health needs. When estradiol and
progesterone are taken together daily and in proper balance, there is no build-up of the uterine
lining, so there is no need to have a period to shed the lining.
What about Over-The-Counter Creams and Saliva Tests?
Over-the-counter non-prescription progesterone cream is beneficial to women in
perimenopause and menopause, but it has a low concentration and its absorption is variable.
In the usual doses, it does not provide adequate progesterone supplementation for women if
they still have significant amounts of estrogen or are on estrogen replacement. A cream with a
higher progesterone concentration requires a prescription. For many women, sublingual
progesterone tablets made by a compounding pharmacy are the best choice. Saliva tests are
generally good for assessing sex hormone levels before supplementation, but they grossly
overreact to even minimal amounts of hormones applied to the skin. In general, hormone test
results require careful interpretation when the hormone is being restored. The delivery method
and the time from the last dose greatly effect the result. For instance, practitioners who dose
transdermal hormones to produce normal saliva levels are underdosing their patients. On the
other hand, serum blood tests (with the red cells removed) can underestimate the actual blood
delivery of transdermal progesterone and estradiol, causing the practitioner to overdose the
patient. Studies have shown that 80mg/day of progesterone in a cream produces significant
whole-blood progesterone levels, equal to 200mg of Prometrium, but dose not produce much
increase in serum progesterone levels (Hermann, 2005). Most labs test only serum
progesterone and this has caused doctors to erroneously conclude that progesterone creams
have no effect. The Wiley Protocol for bioidentical hormone replacement used serum levels to
guide transdermal hormone replacement and ended up grossly overdosing women with
progesterone and estradiol creams. The prescribing physician needs to be aware of all these
issues surrounding hormone delivery and testing.
Are there other Hormones that a Woman Needs?
Other bioidentical hormones that should be a part of an optimal menopausal hormone
restoration program are testosterone and DHEA. These usually decline with age and are
essential for overall health and particularly for mood, muscle strength, and sexual desire and
response. In women with fatigue, fibromyalgia, or depression, there is often a need to optimize
thyroid and/or cortisol levels as well. The female hormonal system produces lower cortisol
levels and effects in many women, causing aches and pains, fatigue, insomnia, hypoglycemia,
PMS, anxiety, irritable bowel syndrome, and other problems. Many women cannot even tolerate
estradiol and progesterone replacement after menopause without cortisol supplementation
because these hormones antagonize cortisol's effects. Hormone restoration requires balance
among all the significant hormones.
Since Menopause is Natural, Why should Women Replace their Estrogen?
The human lifespan has been dramatically extended. Women rarely lived long beyond the age
of 40 in the past. Now they often live for 30 or 40 years in a hormone-deficient state causing
problems never seen before. Menopause is just one consequence of the universal disease we
call aging--and aging is definitely not good for us. So menopause is both natural and bad for a
woman's health and quality of life. Interestingly, the brain knows that menopause is not a good
thing. After menopause or the surgical removal of the ovaries, and for as long as a woman
remains alive, the pituitary gland continues to secrete super-high amounts of follicle
stimulating hormone (FSH), trying to stimulate eggs in the ovaries to produce estrogen. So
apparently nobody told the brain that menopause is natural. Menopause is caused by the loss
of functional eggs in the woman's ovaries leading to an almost complete loss of estrogen. After
menopause, women have lower estrogen levels than men! The consequences of losing
estrogen include hot flashes, insomnia, poor memory and concentration, depression,
increased thinning and wrinkling of the skin, vaginal dryness and the weakening of vaginal and
pelvic tissues, elevated cholesterol, and increased blood pressure and blood sugar. Sexual
interest is often lost and intercourse can become difficult if not impossible. The risk of several
serious diseases is increased: heart attacks, strokes, and Alzheimer’s disease. A woman
loses 25% of her bone mass in the first 5 years after menopause. The bulk of the evidence
shows that bioidentical estradiol restoration helps prevent these problems and improves
overall health and well-being.
What is Perimenopause? Why do Women need Progesterone?
Menopause is the end stage of ovarian failure. The years leading up to menopause are called
perimenopause. This is when ovarian function is altered but has not ceased. When women are
in the 40s, the ovaries start making less progesterone. Often women don't ovulate at all and the
ovaries make no progesterone. Perimenopause can be a time of very high estrogen levels with
low progesterone; causing fatigue, insomnia, bloating, heavy bleeding, allergies, and
headaches. These symptoms can all be well-controlled by adequate progesterone
supplementation--and many hysterectomies prevented. Progesterone has a sedative quality--
reducing anxiety and mood swings. Progesterone balances estrogen in the female
reproductive cycle. Estradiol promotes proliferation in the uterus and breasts, whereas
progesterone promotes maturation and differentiation of these tissues in preparation for
pregnancy. Differentiated cells are less likely to be cancer cells. Progesterone also deactivates
estradiol in these organs. (Provera® instead increases breast stimulation and the risk of
breast cancer.) The loss of progesterone increases the risk of uterine and breast cancers. After
menopause the female breasts actually make their own estradiol but cannot make
progesterone, further increasing the risk of breast cancer which continues to RISE after
menopause. Due to its ability to prevent uterine and breast cancer, (see powerpoint) it is
essential that all women replace their progesterone to adequate levels in both perimenopause
and menopause, whether or they are on estrogen replacement therapy or not, and whether they
still have a uterus or not.
How are Bioidentical Estradiol and Progesterone Produced? What about Compounding
Pharmacies?
“Bioidentical” is the term that signifies that the molecule is exactly the same as the one in our
bodies. Yams, soy, and other plants contain a molecule called diosgenin that has no hormonal
effects, but it is similar to cholesterol and is easily converted by chemical processes into
bioidentical estradiol, progesterone, testosterone, cortisol, and DHEA. However, all the alien
steroid substitutes are also made from diosgenin. The issue is not whether the molecule is
natural or synthetic--the source does not matter--it's the chemical structure that makes a
hormone right or not. Also, the route of delivery is very important as bioidentical estradiol can
cause problems if swallowed. The body accepts and metabolizes bioidentical hormones as if it
made them. There are FDA-approved bioidentical estradiol and progesterone products, but
they are often expensive and hard to indiividualize. They are often not in the best form for
delivery. There isn't any FDA-approved testosterone for women (The drug companies are trying
to fix that!) Therefore many physicians prefer to prescribe compounded estradiol, progesterone,
and testosterone. A compounding pharmacy uses USP-certified bioidentical hormones (the
same raw products used in FDA-approved products). They simply combine carefully measured
amounts of the hormone powder into a delivery vehicle--a cream, gel, tablet, or capsule.
Nothing could be simpler. Pharmacists are certified experts. They take their responsibilities
seriously. Any slight batch to-batch differences in concentration or delivery that may occur are
insignificant to hormone replacement. Compounded hormones work perfectly well, are very
convenient, and are less expensive in most cases. The scare-mongering lies about
compounded hormones that you are hearing are just drug-company propaganda passed on
through drug company-funded organizations like ACOG and NAMS straight to your local
OB/GYN. (ACOG=American College of Obstetrics and Gynecology, NAMS=North American
Menopause Society)
What of the Recent Studies proving that "HRT" is Dangerous?
Replacement implies the use of the same molecules. “Hormone replacement therapy” was
never hormone replacement at all; it was hormone substitution. The Women’s Health Initiative
study (WHI) reported in 2002 looked only at the effects of pregnant mare's urine estrogens
(Premarin®, yes, from horses) and a test-tube progestin (Provera®). A progestin is not
progesterone, it is an alien molecule with a different chemical structure. It has some
progesterone-like effects, but progestins do not raise serum progesterone levels nor support
pregnancy. Likewise, any molecule with estradiol-like effects is called “estrogen”. The arm of
the WHI study using combined Premarin® and Provera® (PremPro®) was discontinued early
because an increased risk of breast cancer was detected. This risk was attributed to ProveraÒ.
Provera® also caused a large increase in heart attacks and strokes. There is no evidence that
bioidentical progesterone increases the risk of heart disease or strokes! Prior and subsequent
reviews and clinical studies indicate that natural progesterone does not increase the risk of
breast cancer (Campagnoli, 2005), and that bioidentical estradiol and progesterone
supplementation actually lowers a woman's risk of breast cancer. (Fournier, 2005, E3N-EPIC).
The arm of the WHI study using Premarin®-only was discontinued because of an increased
incidence of blood clots and strokes in older women--a complication that we know is caused by
taking any estrogens by mouth. Oral estrogens affect the liver in an unnatural way and increase
the production of clotting factors and the risk of blood clots. However, estradiol delivered
transdermally ( through the skin) does not increase a woman's risk of blood clots, heart
attacks, or strokes at all. Unfortunately, the pharmaceutically-funded media and professional
organizations have misrepresented this and other studies and are implying that all “hormones”
are equally dangerous. This is an understandable legal strategy given the thousands of
pending lawsuits over the diseases and deaths caused by PremPro®. Many women can’t even
tolerate alien hormones; suffering side effects such as bloating, bleeding, breast tenderness,
weight gain, and mood swings. Women do tolerate the correct hormones when given by the
correct route, since this is just the restoration of their youthful hormonal state.
What About Birth Control Pills?
Ethinyl estradiol (EE) is the estrogen in birth control pills (BCPs). It is an acetylene molecule
attached to estradiol, making it almost impossible for the body to metabolize and eliminate. It is
a super-potent estrogen. EE increases the risk of blood clots and does not even affect one of
the female estrogen receptors. BCPs combine EE with one of the 30+ progestins that drug
companies have created. BCPs shut down a woman's ovaries so that they do not produce any
estradiol, progesterone, or testosterone. These three natural hormones are replaced by two
alien molecules. The woman's testosterone level declines reducing her libido, sexual function,
and muscle strength. (Female athletes should avoid BCPs!) BCPs increase blood pressure
and blood sugar. Women on BCPs should get off them and use an alternative contraceptive
method. If BCPs are being used to control irregular or painful periods, then the cause of the
hormonal problem should be found and corrected. For birth control, the current copper intra-
uterine devices (IUDs) are very safe and rarely cause the problems seen with earlier IUDs.
Avoid IUDs that dispense artificial hormones.
So Why doesn’t my Gynecologist Prescribe Bioidentical Hormones?
Naturally-occuring molecules such as vitamins and hormones are protected by federal
regulation and may not be patented. Pharmaceutical corporations are interested only in
patentable drugs that are exclusive and profitable. If it’s natural, drug companies aren’t
interested. Drug companies now control most medical information that reaches your doctor,
deciding what gets studied, what is published in journals, and what your doctor's professional
organizations tell him about hormones. Drug companies are promoting their own products and
attempting to suppress compounding pharmacies and the growing compounded bioidentical
hormone industry. So your doctor is told to use alien/synthetic hormone substitutes and to
avoid bioidentical hormones--believe it or not! Doctors are unaware of the benefits and safety of
hormone restoration, and simply don't know how to do it. For a physician to get at the truth,
he/she must take the time to educate him/herself. Most likely, he/she has just never thought
much about bioidenticals, doesn't have the time for independent study, and has no desire to
stray from the drug-company promoted “standard of care” and thus endanger his/her career.
What about Evista® and Fosamax®?
Evista® (raloxifene) is in a class of non-bioidentical hormone-like drugs known as selective
estrogen receptor modifiers or designer estrogens. Studies show that these compounds are
somewhat effective in increasing bone mass although nowhere near as effective as estrogen,
progesterone, and testosterone. They are given to postmenopausal women because doctors
are afraid to replace the lost natural hormones, and because they are more profitable for drug
companies. Designer estrogens do not relieve the other negative effects of menopause and
sometimes increase them. Fosamax® is a one of a number of biphosphonate drugs given to
reduce bone mineral loss in menopause. Biphosphonates are soap-like molecules that
poison osteoclasts, thus interfering with normal bone resorption. This does cause a short-term
increase in bone strength and mineral density. However, bone formation is eventually inhibited
also. Bisphosphonates stop the natural process of bone turnover, producing bone that is
essentially dead. Reports are arriving now of unusual fractures in persons on long-term
biphosphonates (Odvina, 2005). Biphosphonates have also been associated with a number of
side effects including gastrointestinal problems, severe muscle and joint pain, and eye
inflammation. They reduce normal bone remodeling after long-bone fractures and tooth
extractions. Orthodontists have noticed that teeth will not move if the person is on a
biphosphonate. It’s really very simple: postmenopausal osteoporosis is a hormone-deficiency
disease. The proper way to prevent and treat osteoporosis is hormone restoration (including
the hormone we call Vit. D). Doctors are simply afraid to restore a woman's hormones for the
reasons given above.
How Long should I Stay on Hormones?
Women are being told that they should take hormones for menopause only if they have
unbearable symptoms and for only 5 years. However, this recommendation is based on the
known dangers of Prempro® and other hormone substitutes as revealed in the WHI and other
studies. Doctors remain unaware that combined bioidentical transdermal estradiol and
oral/sublingual progesterone have never been show to increase the risk of breast cancer or
heart disease. Indeed, these diseases are rare in premenopausal women who have high
levels of both hormones. More studies of bioidientical hormone restoration are in progress,
and more are needed to define what doses and delivery methods are ideal. However, many
women can't wait. They need to decide now whether they will replace their hormones or not.
Do I Need to have Periods the Rest of my Life?
There is no health requirement for periods. Menstrual cycles are not for a woman's health, they
are for making babies. The complex of female organs and hormones exists to make babies
and breastfeed them. The fact that women have this complex reproductive hormonal system is
why they have so many more hormonal problems than men do. If women want to menstruate,
they can be made to bleed regularly with cyclical use of estradiol and progesterone, but this is
just a building up and the sloughing off of the uterine lining, it is not a true menstrual cycle. It is
an imitation of a menstrual cycle. The goal of menopausal hormone replacement is to provide
adequate amounts of estradiol and progesterone for health needs. When estradiol and
progesterone are taken together daily and in proper balance, there is no build-up of the uterine
lining, so there is no need to have a period to shed the lining.
What about Over-The-Counter Creams and Saliva Tests?
Over-the-counter non-prescription progesterone cream is beneficial to women in
perimenopause and menopause, but it has a low concentration and its absorption is variable.
In the usual doses, it does not provide adequate progesterone supplementation for women if
they still have significant amounts of estrogen or are on estrogen replacement. A cream with a
higher progesterone concentration requires a prescription. For many women, sublingual
progesterone tablets made by a compounding pharmacy are the best choice. Saliva tests are
generally good for assessing sex hormone levels before supplementation, but they grossly
overreact to even minimal amounts of hormones applied to the skin. In general, hormone test
results require careful interpretation when the hormone is being restored. The delivery method
and the time from the last dose greatly effect the result. For instance, practitioners who dose
transdermal hormones to produce normal saliva levels are underdosing their patients. On the
other hand, serum blood tests (with the red cells removed) can underestimate the actual blood
delivery of transdermal progesterone and estradiol, causing the practitioner to overdose the
patient. Studies have shown that 80mg/day of progesterone in a cream produces significant
whole-blood progesterone levels, equal to 200mg of Prometrium, but dose not produce much
increase in serum progesterone levels (Hermann, 2005). Most labs test only serum
progesterone and this has caused doctors to erroneously conclude that progesterone creams
have no effect. The Wiley Protocol for bioidentical hormone replacement used serum levels to
guide transdermal hormone replacement and ended up grossly overdosing women with
progesterone and estradiol creams. The prescribing physician needs to be aware of all these
issues surrounding hormone delivery and testing.
Are there other Hormones that a Woman Needs?
Other bioidentical hormones that should be a part of an optimal menopausal hormone
restoration program are testosterone and DHEA. These usually decline with age and are
essential for overall health and particularly for mood, muscle strength, and sexual desire and
response. In women with fatigue, fibromyalgia, or depression, there is often a need to optimize
thyroid and/or cortisol levels as well. The female hormonal system produces lower cortisol
levels and effects in many women, causing aches and pains, fatigue, insomnia, hypoglycemia,
PMS, anxiety, irritable bowel syndrome, and other problems. Many women cannot even tolerate
estradiol and progesterone replacement after menopause without cortisol supplementation
because these hormones antagonize cortisol's effects. Hormone restoration requires balance
among all the significant hormones.
For Health and Quality of Life
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