Are You Perimenopausal (Approaching Menopause) Or Menopausal?

If you are Menopausal you may wish to consider Hormone Replacement.
Women have a difficult time deciding whether or not to start hormone replacement therapy (HRT) around the time of menopause. The most common reason for recommending estrogen replacement therapy (ERT) is for relief of hot flashes, vaginal dryness poor sleeping pattern and other discomforts associated with diminishing estrogen production.

Estrogens are part of the family of compounds called steroids that are synthesized from the cholesterol molecule. The predominant sex hormone in human females, estrogens exist in several forms: estrone (E1), a weak estrogen; estradiol (E2), the strongest form of natural estrogen; and estriol (E3), a weak estrogen that is made during pregnancy only. Estrogens are synthesized primarily in the ovary beginning around the time of puberty; and their production follows a pattern corresponding to the phase of the menstrual cycle, gradually falling off around the time of the menopause. Estrogens are responsible for the physical characteristics associated with being a female such as breast development and the female figure. Among women who start ERT around menopause, about 80% discontinue the medication after one year due to side effects or concern about possible negative effects of therapy. Prescribed estrogens may be derived from either natural or synthetic sources. Natural hormones are bio-identical in both structure and function to the hormones that they are intended to replace. Synthetic hormones are not found in humans and are not identical to the forms that they are replacing. If a woman possesses her uterus, her physician will likely recommend that she also take progesterone along with estrogen. The combination of the two steroids (hormones) will protect the uterus from chronic estrogen stimulation and thereby decrease her risk of developing uterine cancer.

Progesterone, which is also derived from cholesterol, may be obtained from synthetic or natural sources. In the human female, the ovary synthesizes progesterone during the second half of each menstrual cycle throughout a woman's reproductive years. Current available medical data suggests that women experience a slightly increased risk of breast cancer taking estrogen even if they take progesterone concomitantly. Unfortunately the published data are from studies that have used synthetic progesterone combined with estrogen. Studies that evaluate the risk of developing breast cancer while on ERT while using natural progesterone have not been published. Although definitive studies are yet to be published the trend of the data suggests that estrogens provide a protective effect against heart disease. It is unfortunate that the mass media has given an inordinate amount of press to the more negative reports associated with HRT in the medical literature. There are philosophical, emotional, and medical reasons why someone may choose to take a natural form of estrogen or progesterone over the synthetic varieties. The overwhelming majority of estrogen prescribed to women in North America is derived from the urine of pregnant mares. This product is called Premarin - you can see the derivation of the name! It is a mixture of perfectly natural hormones for mares, and it contains a whole family of estrogens. Some of them can be recognized and utilized by humans and some cannot. Many natural estrogens, which are prone to deterioration as a result of the digestive process, are taken as in the pill forms as micronized particles, which resist digestive acids. Synthetic estrogens resist degradation. Their structure is similar enough to their natural equivalents to allow them to bind to estrogen receptors in the body and cause an estrogen-type effect. They may have a stronger or weaker effect than natural hormones and they may exert a prolonged effect on the body due to slower metabolic deactivation. In any case, all estrogens are compared to Premarin, which has remained the gold standard because so many articles have been published about it. Progesterone may be prescribed in a natural, micronized form or it may have a synthetic residue attached to the progesterone molecule. Both forms are protected from degradation during digestion. In the synthetic form the synthetic residue is removed from the active molecule after digestion. Provera is an example of the synthetic form of progesterone. To make matters even more confusing progesterone compounds are sometimes called progestins or gestogens.

The route of administration of hormones varies considerably. Oral, skin patches, vaginal creams, sub dermal pellets and injectible forms. The therapeutic benefit and side effects may vary with the form of the hormone as well as with the route of administration. It is generally recognized that ERT relieves the most common symptoms associated with menopause: hot flashes and night sweats that many women find both debilitating and embarrassing. Furthermore, it has been shown that estrogen augments the "good" cholesterol (HDL) while diminishing the "bad" cholesterol (LDL), and therefore should decrease the risk of heart attack. Unfortunately, progesterone somewhat weakens estrogens beneficial effect on the body's production of cholesterol. Another of estrogen's positive effects is its ability to promote calcium absorption, and augment the formation of new bone thus increasing bone density. Stabilizing bone density or at least reducing the precipitous bone loss that occurs within the first two years after the onset of menopause will diminish osteoporosis and the associated increase in fracture risk. It appears that progesterone also influences bone metabolism and may also play a role in building new bone in concert with estrogen. More recent data suggests that estrogen may confer protection against senile dementia and Alzheimer's disease. Since the population is living longer, this benefit is significant.

An often overlooked form of estrogen, estriol (E3), may even be more beneficial than the other forms of estrogen commonly recommended. Published data of urinary estriol levels from women from a population with a lower incidence of breast cancer indicate that higher levels of estriol are protective against breast cancer. Laboratory studies confirm that rats given carcinogens to induce breast cancer show a reduced risk of cancer if they are concomitantly given estriol. Although clinical trials of estriol have not been undertaken in this country, there is evidence to suggest that women take this particular estrogen as part of ERT. Clearly, this would be ideal because it would both reduce the complaints of menopause and hopefully lower the risk of developing breast cancer while on ERT.

Many products are available to women at health food stores or natural pharmacies including progesterone cream, wild yam cream, a multitude of foods containing soy and combinations of herbs specifically for the perimenopausal female. Manufactures may make claims about the effectiveness of their products for various symptoms and conditions related to menopause. Unfortunately, the FDA does not allow the labels on these products to state exactly the nature or amount of active hormone that they contain. The FDA doesn't regulate these products because it regards them as food supplements. It is impossible to make a comparison between one product and another, nor to compare one batch of the same preparation from month to month! Since it is impossible to know the amount of active hormone in any of these products (or whether they even contain active hormone) it is impossible to know how much of the product to use. If you are taking any such preparations please advise your physician.

Foods that are therapeutically active (neutraceuticals) such as soy powder or soy milk or herbs such as black cohosh or licorice can have an additive effect on prescription hormones that may result in side effects or make it impossible to adjust the dose properly. Recent studies indicate that a phytonutrient called indole-3-carbinol (I3C) and its metabolite diindolymethane (DIM), which are derived from cruciferous vegetables as cabbage, cauliflower and broccoli tend to shift estrogen metabolism toward a safer balance of estrogen metabolites. This effect reduces the cancer risk associated with ERT. The deciding which forms of hormones to use and how to administer them is very complex. Any health professional is most likely biased about both the routes of administration and the forms that they recommend for HRT based upon both training and experience. Nevertheless, any experienced clinician should be able to address your concerns and be able to intelligently discuss the available options, their side effects and potential complications.

By carefully choosing the forms of both estrogen and progesterone and adding certain phytonutrients to your diet you can derive maximum benefits from hormone replacement while minimizing your risk of developing cancer.

Click on the name of each product for more information.

Herbal Preparations That Help Fight The Effects Of Menopause:
1. Estrogen enhancing formula (Black Cohosh-Licorice Compound) augments estrogen in perimenopausal or menopausal women. It helps reduce the risk of heart disease and increased bone loss. Take 30 to 40 drops in a little water 3 times a day. Use in cycles of three weeks on and one week off.
 

2. Tonic for Menopausal Women (Pulsatilla-Vitex Compound) restores the optimal balance of estrogen/progesterone alleviating mood disturbance. Take 30 to 40 drops in a little water 2 to 4 times a day. Positive results can take from several days to several weeks.
 

3. Kava (60 mg of kavalactones) alleviates stress. Take 1 to 2 capsules with water 2 to 3 times a day.
 

4. Valerian-Passionflower Compound is a gentle sedative for the nervous system. For general sedation take 30 to 40 drops in a little water 2 to 5 timer per day. For insomnia mix 15 to 30 drops in a little water and take 1 hour before bedtime and again just before you go to sleep.
 

Support For Perimenopausal Or Menopausal Women:
Nutritional support, neutraceuticals and hormone replacement for women at this stage of life need to be indivualized. To individualize a program for youself please schedule a consultation. You can reach our offices by calling (914)722-9300.
 

The U.S. Food and Drug Administration has not evaluated these statements. These products are not intended to diagnose, treat, cure or prevent any disease.