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 after menopause--in a hormone-
deficient state that causes problems not 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 natural menopause or surgical removal of the
ovaries, 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. 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 are in a state of severe steroid hormone deprivation--they
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 atrophy, incontinence, increased blood pressure,
and increased 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 is safe at any level.
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 continue to 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 individualize. 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 professional 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 only
some progesterone-like effects. 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
Provera. Provera® also caused a large increase in heart attacks and strokes. There is no
evidence that bioidentical progesterone increases the risk of breast cancer, 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), nor does
bioidentical estradiol and progesterone supplementation increase 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 and potential 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. It 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. IUD's can be used by young women who have not been pregnant. (Speroff) It's
best to avoid IUDs that dispense artificial hormones, but they are better than BCPs.
So Why doesn’t my Gynecologist Prescribe Bioidentical Hormones?
Naturally-occuring molecules such as vitamins and hormones cannot be patented.
Pharmaceutical corporations are interested only in patentable drugs (new, alien molecules)
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/her 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,
disrupting the natural process of bone turnover and producing bone that is essentially dead.
There are increasing reports of unusual fractures in persons on long-term biphosphonates
(Odvina, 2005). They 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).
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. 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. Estradiol-
progesterone restoration brings many known health benefits. Therefore women should
replace these hormones for the rest of their lives in order to maintain their health and
vitality.
Do I Need to have Periods the Rest of my Life?
The complex female organs and hormonal system exists to make babies and breastfeed them.
Menstrual cycles are not for a woman's health, they are for making babies. The fact that
women have this complex reproductive hormonal system is why they have so many more
hormonal problems than men do. There is no health requirement for periods, however, if a
woman wants to menstruate, she can be made to bleed regularly with cyclical use of estradiol
and progesterone. This is not a real period though, but just the building up and the sloughing
off of the uterine lining, just as occurs with birth control pills. It is just 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.
The usual dose is not sufficient, though, for women who are on estrogen replacement. A
prescription progesterone cream with a higher progesterone concentration is more cost-
effective and convenient. 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, so they can't be used to adjust replacement doses. Practitioners
who use saliva tests to determine the dose of transdermal hormones 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, causing the practitioner to overdose the
patient. 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. A landmark study showed that 80mg/day of progesterone
in a cream produces significant whole-blood progesterone levels, equal to 200mg of
Prometrium, but the cream did not produce much increase in the usual serum progesterone
test. (Hermann 2005). Labs only test for serum progesterone and this has caused doctors to
erroneously conclude that progesterone creams have no effect. The prescribing physician
needs to be aware of all these issues surrounding hormone delivery and testing.
Are there other Hormones that a Woman Needs?
Yes, most women should also restore their testosterone and DHEA to youthful levels. These
hormones decline with age, yet 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 which in many women can lead
to a partial adrenal insufficiency 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 after menopause--in a hormone-
deficient state that causes problems not 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 natural menopause or surgical removal of the
ovaries, 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. 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 are in a state of severe steroid hormone deprivation--they
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 atrophy, incontinence, increased blood pressure,
and increased 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 is safe at any level.
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 continue to 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 individualize. 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 professional 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 only
some progesterone-like effects. 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
Provera. Provera® also caused a large increase in heart attacks and strokes. There is no
evidence that bioidentical progesterone increases the risk of breast cancer, 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), nor does
bioidentical estradiol and progesterone supplementation increase 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 and potential 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. It 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. IUD's can be used by young women who have not been pregnant. (Speroff) It's
best to avoid IUDs that dispense artificial hormones, but they are better than BCPs.
So Why doesn’t my Gynecologist Prescribe Bioidentical Hormones?
Naturally-occuring molecules such as vitamins and hormones cannot be patented.
Pharmaceutical corporations are interested only in patentable drugs (new, alien molecules)
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/her 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,
disrupting the natural process of bone turnover and producing bone that is essentially dead.
There are increasing reports of unusual fractures in persons on long-term biphosphonates
(Odvina, 2005). They 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).
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. 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. Estradiol-
progesterone restoration brings many known health benefits. Therefore women should
replace these hormones for the rest of their lives in order to maintain their health and
vitality.
Do I Need to have Periods the Rest of my Life?
The complex female organs and hormonal system exists to make babies and breastfeed them.
Menstrual cycles are not for a woman's health, they are for making babies. The fact that
women have this complex reproductive hormonal system is why they have so many more
hormonal problems than men do. There is no health requirement for periods, however, if a
woman wants to menstruate, she can be made to bleed regularly with cyclical use of estradiol
and progesterone. This is not a real period though, but just the building up and the sloughing
off of the uterine lining, just as occurs with birth control pills. It is just 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.
The usual dose is not sufficient, though, for women who are on estrogen replacement. A
prescription progesterone cream with a higher progesterone concentration is more cost-
effective and convenient. 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, so they can't be used to adjust replacement doses. Practitioners
who use saliva tests to determine the dose of transdermal hormones 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, causing the practitioner to overdose the
patient. 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. A landmark study showed that 80mg/day of progesterone
in a cream produces significant whole-blood progesterone levels, equal to 200mg of
Prometrium, but the cream did not produce much increase in the usual serum progesterone
test. (Hermann 2005). Labs only test for serum progesterone and this has caused doctors to
erroneously conclude that progesterone creams have no effect. The prescribing physician
needs to be aware of all these issues surrounding hormone delivery and testing.
Are there other Hormones that a Woman Needs?
Yes, most women should also restore their testosterone and DHEA to youthful levels. These
hormones decline with age, yet 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 which in many women can lead
to a partial adrenal insufficiency 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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