The most common reason women choose to engage in bio-identical hormone replacement therapy (BHRT) is for the relief of symptoms related to menopause, perimenopause and premenstrual syndrome (PMS), all also known as ‘hormonal imbalance.’
Menopause is defined as the permanent cessation of the primary functions of the ovaries for one year. This transition from a potentially reproductive to a non-reproductive state is the result of a reduction in the female hormonal production in the ovaries. This transition is not sudden or abrupt but tends to occur over a period of years and is a consequence of biological aging.
For some women, the accompanying signs and effects that can occur during the menopause transition years can significantly disrupt their daily activities and sense of well-being. Menopause is based on the natural or surgical cessation of estradiol and progesterone production by the ovaries. Estrogen continues to be produced in other tissues, notably the ovaries, but also in bone, blood vessels and even in the brain. However, the dramatic fall in circulating estradiol levels at menopause impacts many tissues, from brain to skin.
In contrast to the sudden fall in estradiol during menopause, the levels of total and free testosterone, as well as dehydroepiandrosterone sulfate (DHEAS) and androstenedione appear to decline more or less steadily with age.
Perimenopause is defined as the menopausal transition years. According to the North American Menopause Society, this transition can last for four to eight years. Signs and effects of perimenopause can begin as early as age 35, although most women become aware of the transition in their mid to late 40’s. During perimenopause, estrogen levels average about 20-30% higher than during premenopause, often with a wide fluctuation in levels. These fluctuations cause many of the physical changes that occur during perimenopause as well as in menopause, including but not limited to hot flashes, palpitations, night sweats, sleeplessness, vaginal dryness or atrophy, mood swings, anxiety, fatigue, memory problems, lack of energy, dry skin, incontinence, osteoporosis and heart disease.
What’s not normal is for these fluctuations to become so extreme or erratic that they make a woman’s life miserable. That’s hormonal imbalance!
Premenstrual Syndrome (PMS) is a collection of emotional symptoms, with or without physical symptoms, related to a woman’s menstrual cycle, specifically the luteal phase (10 days prior to onset of menses) that are of “sufficient severity to interfere with some aspects of life.” The three most prominent symptoms of PMS are irritability, tension and dysphoria (unhappiness). Common emotional and nonspecific symptoms include stress, anxiety, difficulty falling asleep, headache, fatigue, mood swings, increased emotional sensitivity and changes in libido. Each woman’s pattern, although different from what other women with PMS may experience, will be relatively predictable and stable for the woman who experiences it.
The Female Hormone Evaluation
At Balanced Life and Health, the Female Hormone Balancing Program begins, like all our programs, with an initial in-depth consultation and physical evaluation by a licensed practitioner. Until a practitioner has had the opportunity to hear from the patient as to when and where stressful events adversely impacted her life, it is often hard to diagnosis and treat the underlying cause of symptoms. A partial list of our pre-screening includes:
- DHEA Sulfate
- Estradiol, Estrone
- FSH (Follicle Stimulating Hormone)
Some conventional doctors tend to treat menopause rather than the woman experiencing menopausal symptoms. Every woman is different, and each woman will experience this time of her life in a different way. Therefore, it is important to take measurements before beginning any hormone program. This allows us to design a program specifically to fit each woman individually.
A decrease in vision, mental activity and/or mobility are the three main effects of aging that make us less independent and more dependent on others. We all want to be as functional, independent and able to contribute up to the day we leave this world. It’s very important to understand that while BHRT works well for some, others need more support – or different kinds of support – to get the same relief.
Cognitive decline is scary to anyone. It has been predicted that by the 2050’s, approximately 50% of the adult population will be affected to some degree. Having the proper amount of estrogen in the body can decrease the incidence of Alzeheimer’s disease. Estrogen has a vasodilatory effect on the blood vessels allowing more blood flow to the brain, resulting in better cognition. Estrogen also aids in the formation of neurotransmitters in the brain, resulting in:
- A decrease in the likelihood of depression
- Less irritability
- Less pain
As we age, we become more prone to fall and fracture our bones. It is now estimated that one out of every two post-menopausal women will suffer some degree of osteoporosis, a manifestation of estrogen insufficiency. Building up bone density prior to menopause is the best strategy for osteoporosis prevention, but once menopause has occurred, the most effective therapy is hormone modulation. In addition to replacing estrogen to aid your bones, testosterone provides bone strength and progesterone facilitates the production of new bone. Together, these hormones provide the framework for healthy bones. There are many nutrients that assist in optimizing bone staying power, including magnesium, Vitamin D and even strontium, to name a few.
Osteopenia (the early breakdown in bone tissue) can be addressed and sometimes reversed with the proper use of hormones and supplements.
While a woman’s estrogen levels are gradually declining throughout the years of perimenopause and menopause, the skin is also declining, losing strength and flexibility. By causing the vascular system to dilate, estrogen allows more blood flow to the skin. Estrogen also maintains collagen, a part of the connective tissue that in the skin helps with firmness, suppleness and constant renewal of skin cells while also playing a vital role in skin elasticity.
How does a woman’s temperature increase about five degrees in only several seconds? Any woman who has experienced the sudden sensations of intense heat, become drenched with perspiration and has searched frantically for some type of relief, be it a fan or cold rag, more likely than not has decreased estrogen levels in her body. Often, replenishing the essential hormones in the proper ratio can dramatically improve these symptoms.
Vaginal/Urinary Tract Changes
As hormone levels decline over time, the vaginal lining gets thinner, drier and more easily irritated. The pH of the vaginal area also changes, resulting in an increased likelihood of a urinary tract infection and/or incontinence (urine leakage). This condition can also make intercourse uncomfortable. Restoring the hormones to optimal levels will often increase the thickness of the vaginal mucosa, in addition to moisture and elasticity. Sexual function can be dramatically improved with replacement of these essential hormones to levels one had earlier in life.
Testosterone is essential for a beating heart to function properly and has been found to strengthen the contraction of the heart muscle, which in turn assists in lowering the triglycerides and the LDL component of the fat found in blood. While estrogen improves the arterial flexibility, both testosterone and estrogen increase blood flow. It has been found that estrogen decreases the amount of atherosclerosis in the vessel walls. By decreasing the “stickiness” of the platelets, estrogen lowers the risk of a stroke. Bottom line, early recognition, lifestyle changes, and hormone replenishment have been shown to be effective in reducing the incidence and severity of cardiovascular disease in post-menopausal women.
Hormone replacement therapy has been refined considerably over the past sixty years. While there are still contraindications for some women (e.g., those with history of breast disease and uterine cancer), many physicians feel that the benefits of BHRT far outweigh the risks. Much of the medical field agrees that hormone therapy:
- Improves mental acuity, mood and psychological well-being;
- Reduces the risk of osteoporosis;
- Assists in maintaining skin firmness and elasticity;