New Menopause/Osteoporosis Medicine Coming 2014. Horsing Around With Your Hormones

Good Morning Blog Circle!

I wanted to make good on my promise to present the facts about a FDA approved therapy coming to the shelves of your local pharmacy and soon to be highlighted on your physician's script pads in the Spring of 2014.  I'm just sharing what I'm reading on the healthcare professionals side of the scene so that you can do your own homework, and make an educated decision about treatment if you are struggling with the issues of menopause.  

Pfizer recently announced that the FDA gave it's 'APPROVED' stamp on a new treatment (Brand Name-Duavee) for moderate-to-severe symptoms associated with menopause and for prevention of osteoporosis in post-menopausal women.  

http://press.pfizer.com/press-release/pfizer-inc-announces-fda-approval-duavee-conjugated-estrogens-bazedoxifene-treatment

The magazine article that I read and will talk about in this blog today, states that the manufacturer anticipates the treatment will be available in the first quarter of 2014.  Sounds fantastic right?!?!  Eliminate the hot flashes and build bone all at the same time.  WOW!  It certainly must be a win-win and physicians will be seeing pharmaceutical representatives in their offices soon (I would imagine) to bring attention to this novel therapy.  I must share that I was impressed……at first….but thankfully, I did my own homework.

Yes, I was intrigued by a new therapy for menopause since I basically practice in the realm of hormonal balance 85% of my time in customizing therapies for patients.  It's no wonder that men and women are coming in to seek bio-identical hormones as a treatment option for their Andropause and Menopause problems.  The headline in an endocrine magazine caught my attention first and then I began to read certain words in the article that stood out as bright as a neon sign in my mind.  I'll explain in a minute, but let me first share some of the details of the article that physicians and prescribers are gaining their information from.  Much of those practicing medicine in any form, and if honest, would tell you that a majority of their prescribing trends and habits come from pharmaceutical representatives and from short articles in magazines such as what I am highlighting today in this blog.  That's not just an opinion, but it has been studied if you want to rabbit trail on that for awhile.  Example: 

Pharmaceutical representatives do influence physician behaviour

It is a not a truth universally acknowledged that pharmaceutical representatives influence physician behaviour. However, the pharmaceutical industry clearly believes they do. In fact so sure are they of this that in 2000, $4.8 billion dollars were spent in the USA on ‘detailing’, the one-on-one promotion of drugs by a representative of the company1

I read a lot of articles such as this endocrinology magazine to stay current on research, products, and medical industry news, but I truly realize that the nuts and bolts of the information is not always presented on the front lines of the reference material.  

Quoted from the article I was reading: 

"The agency (FDA) based its approval on the phase 3 clinical trails in the Selective Estrogens, Menopause, and Response to Therapy (SMART) program evaluating the safety and efficacy of the drug in healthy, postmenopausal women with a uterus for the approved indications.  In one (just one?) trial, the number of moderate to severe hot flashes was reduced by 74% after 12 weeks of treatment vs. 47% with placebo."  Data from other trials also demonstrated a significant increase from baseline in bone mineral density in the total hip and lumbar spine."  ~Again, sounds great right? 

Here's why the hair on my neck stood up when reading about this new therapy because I make my living treating patients with hot flashes, night sweats, osteoporosis, etc.  I just hate when patients don't know the details of what they are taking.  If you know what you're taking, ok.  If you don't, not ok. 

So here you go, and now you know...  

"It combines "conjugated estrogens" with a selective estrogen receptor modulator in a once-daily tablet designed to be taken orally." (as stated in the article)  Bingo!!!  I found the magic words I was looking for.  Conjugated estrogens?  Just like Premarin (pregnant-mares-urine) maybe? 

I then went to the manufacturers website and to the section for healthcare professionals.  I simply wanted to know what the source of the estrogens was in this hot flash busting, bone building, once daily,  magical menopausal medicine.   I thought, please tell me no, but could it possibly be...???  And there it was like a NEON sign.  ( I told you I would get to this point.  It's the most important of all...The meat and potatoes….The brass tacks….The read between the lines…..The need-to-know infO'!)

From the drug package insert:  "Conjugated estrogens are purified from PREGNANT MARES' URINE and consist of the sodium salts of water-soluble estrogen sulfates blinded to represent the average composition of material derived from pregnant mares' urine."  Eeeesh….Huh?   Horse urine? Really?   Found it!!!   Thumbs down!!!!    Didn't the FDA learn anything from the WHI study?  (BTW, I wrote a blog on this if you want to educate yourself more).  Why didn't they highlight that in this article to the physicians and practitioners?  Do all prescribers know what 'conjugated estrogens' means?  I'm not sure they do especially if the pharmaceutical reps are not highlighting this little known fact in their marketing moments with prescribers as they capture those 4.8 billion dollars at stake in the pharmaceutical industry business. The article I was reading certainly didn't come right out and state that.  Sad!

So, that's enough information for me to not want to take it, but what about the adverse reactions associated with Duavee?  

 Nausea, Diarrhea, Dyspepsia Abdominal Pain, Muscle Spasms, Neck Pain, Dizziness, Oropharyngeal pain.  (stated in the news release and package insert)

  I simply don't understand how taking hormones from horse urine and putting them into humans is considered a safe thing to do.  Some have even gone so far as to think it's a 'natural' source of hormones.  Horse urine is natural I suppose, but not when we're talking about making it into a medicine? From patient interviews throughout the years, and from clinical studies, it's not a good thing at all.  The adverse effects of those using horse urine derived estrogens tend not to sit well with patients and after reading the above, I think anyone could understand why.  How many of the side effects are due to taking a non-human hormone and putting it into humans?  Want to venture a guess?    

 Please, if you are struggling with hot flashes, night sweats, foggy thinking, anxiety, fatigue, loss of hair, poor mood, etc. then do your own research on the available treatment options out there.  I, and my team, are more than happy to send you a packet of information and some things to read about before making your choice in hormone therapy.  You do have options and I think knowing certain information is important in making your decision.  Some of the options are very good for you and for your health and longevity.  We are here to help. 

To your good hormone health,

Dr. Sonja

Prepare Now For the New Year's Resolution to Lose Weight

Hormonal imbalance is tied to more than just hot flashes, night sweats, and the other tsunami of symptoms that come with aging.   Did you know that weight problems are very much associated with hormonal imbalance as well?  Today, I'll share just a few things that you might want to get checked out before you make that New Years Resolution.  Why set yourself up for failure, when you could start now on the road to success, once and for all.  If I were wanting to lose weight, I would have these things evaluated so that I could be completely ready to put my feet in the starting blocks come January 1st.

Sex hormones:  Estradiol, Progesterone, and Testosterone

Too much estrogen and you will tend to pack the Holiday turkey and dressing on the side of your hips and in your butt.   Also, normal estrogen, but too little progesterone, and the fat distribution elves will send the fruit cake to the wrong storage areas of the body.  Ya know, the places you don't want them to be, right?  It's the same for men too.  Guys, I'm not letting you off the hook.  In overweight men, testosterone levels drop and estrogen levels rise leading to, you guessed it, weight gain in the hips, thighs, and even breasts.  Progesterone can help balance that estrogen, but also provides support to the thyroid in helping to eliminate fats, and rid the body of excess fluid.  Low Testosterone is associated with decreased lean muscle, low metabolic rate, and belly fat.  Not only that, but men and women who have low T usually aren't the first to sign up for exercise or strength training because of lost vitality and stamina.  On the other side of the spectrum are those with high testosterone.  This group of people tends to have insulin resistance and weight gain in the belly as well.  Do you see why it's important to know your hormone levels?

Adrenal Hormones:  Cortisol and DHEA
Imbalances of these two hormones can cause poor blood sugar control, poor sleep, increased appetite, food cravings, and poor exercise tolerance.  If you are super stressed, your cortisol levels will skyrocket causing fat to be sent to areas around your internal organs (visceral fat) and to your hiney. Not good!  If your adrenals are exhausted from juggling too much for too long, then you will feel it.  Exhaustion, fatigue, achy joints, poor immunity, and pitiful endurance usually are associated with low cortisol.

Vitamin D (D2,D3):
Those who are overweight tend to have low vitamin D levels.  I personally take a vitamin D supplement daily because I just don't get enough sunlight and because it has such great benefits to the body.  I'm trapped in an office like nearly everyone else in America and a boost of vitamin D is a part of my daily 'healthcare' regimen.

Insulin: If your insulin is high, and consistently high, then other problems can arise.  (i.e. polycystic ovaries, type 2 diabetes, belly fat, increased inflammation throughout the body,  increased heart disease risks, thyroid gland problems, ovulation problems, etc.)

HgA1c:  This important blood test value indicates what your blood sugar has been running over the previous 3 months.  If the number is above 6%, it can be predictive of diabetes and heart disease risk. Often, correlating a high insulin with a high Hemoglobin A1c show signs of problems in the future.  It's worth knowing and addressing.

Thyroid:  A high TSH and a low T3 and T4 will likely contribute to sluggish metabolism, weight gain, and fatigue.  I will interject here that transdermal (through skin) hormone therapy is better than oral therapy because oral estrogens can reduce thyroid hormone bioavailability.  When asked what form of hormone therapy I recommend in patients, I will probably say transdermal >90% of the time and this is one reason why.

So, what do you do with all of this information?  Well, I have an all-in-one/DIY kit that can be shipped to you.  Just call  and we'll get one in the mail ($20 kit/packet fee).  This is a great value because 12 different profile parameters can be tested right from your very own home (cost $295 to lab for analysis of sample).  That's a great discount off of the testing for each individual lab parameter (normally $45 each).  If there's diabetes, thyroid disease, cardiovascular disease, female/menstrual problems, weight gain, or anything else, then this is the test to do.  Your health is your wealth so invest in yourself, starting today!  

Creative Medicine for Your Individual Needs!  That's what I'm all about.  Get tested! Get treated!

To your good health,
Dr. Sonja

From The Experts: Could Balancing Hormones Help Save Your Life? Call & Get Tested ASAP!!

Could Balancing Your Hormones Help Save Your Life?

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During National Breast Cancer Awareness month, we should all take a pause to consider our health.
When was the last time you thought about your risk for breast cancer? Is there anything you can do about lowering those risks?
Yes. Absolutely. You can start by losing weight and balancing your hormones.
As it turns out, these may be two of the most important actions we can take to reduce breast cancer risks in our lifetime. And the science is on our side here. There are numerous studies in the medical literature linking hormones and lifestyle to cancers.
A recent study published in Cancer, a peer-reviewed journal of the American Cancer Society (Dec 2012, vol. 118) found that extra pounds - even within the overweight but not obese range - are linked to a 30 percent higher risk of breast cancer recurrence and a nearly 50 percent higher risk of death despite optimal treatment. Given that the most common type of breast tumors are fueled by excess estrogen, and that fat cells (via aromatase conversion) are mini estrogen-producing factories, pinpointing the hormonal links to weight gain is a key to preventing breast cancers.
Dr. John Lee and David Zava, PhD, reiterate that point in their groundbreaking book, What Your Doctor May Not Tell You About Breast Cancer: How Hormone Balance Can Help Save Your Life: "Experts agree that environmental risk factors, such as diet and exposure to toxins, account for about 80% of breast cancers, and genetic factors account for about 20 percent. Even those who happen to have a genetic predisposition can improve their chances of dodging a breast cancer diagnosis with hormone balance and a healthy diet."
So, let's talk about best ways to improve your odds of dodging a breast cancer diagnosis in the first place:
1. First test your hormone levels to detect hidden imbalances. Examples such as estrogen dominance or high cortisol stress hormones are associated with weight gain, as well as higher risks for breast cancer. In case you haven't heard, ZRT Laboratory just launched a Weight Management Profile that can detect and help correct such imbalances.
2. If estrogen dominance is identified through testing, take steps to correct it ASAP. An estimated 97% of breast cancers are linked with excess estrogens unbalanced by adequate progesterone. If hormone therapy is indicated, bioidentical hormone approaches are preferable with a better safety profile and fewer side effects than synthetic hormone replacement (HRT).
3. Fill up on high fiber, cruciferous vegetables like cabbage, broccoli, cauliflower and brussel sprouts that help promote proper estrogen metabolism.
4. Get your "good fats" in avocados, olive/coconut oils, nuts and seeds to help inhibit tumor growth, boost immunities, and reduce inflammation.
5. A daily dose of 64 oz of water can flush out free radicals and toxins that invite cancers.
6. Avoid bad "xeno" hormones with hormone-free meat/dairy/poultry. Also make sure to microwave in glass or ceramic versus plastic containers, drink from non-plastic water bottles, and choose "green" household, garden, and personal care products.
7. Minimize stress to stabilize cortisol, blood sugars and insulin levels. When those levels are elevated, they provide raw fuel for tumors. Prioritizing time to de-stress, eat right and exercise can boost your immunities against cancer.
Those are ZRT's top suggestions for balancing your hormones to reduce your breast cancer risk - and ultimately help save your life.

 

The "M" word!

"M"??  Ya know……(strike up the fan), Menopause!  Years ago women didn't talk about it openly.   Today, women are flooding the offices of physicians and practitioners to find help in combatting their symptoms, in turning back the hands of the ticking biological clock, and in transitioning through those years as gracefully as possible.

So what is Menopause all about?  What can be expected?  What is normal?


Menopause is the time of life when menstruation ceases.  It's a process and transition that usually occurs over several years and the average age in the U.S. is 51 years old.  This gradual change (sometimes 10 years) can be fairly unnoticeable for some, but can cause others significant disruptions. Did I mention10 years???  Absolutely!  If you start paying attention, you will notice slight changes from how you felt in years gone by, and if left untreated, WHAM!, the mirror will make you aware,…. if the scale doesn't rat you out first.



Menopause can happen these ways.
1) Natural: normal cessation of menstrual cycles often between 45-55 years old.
2) Surgical: total hysterectomy or hysterectomy but leaving the ovaries intact
3) Premature: (chemotherapy, stress, trauma, functional disorders, ovarian failure, unknown etiology)

Indications of Possible Menopause:
Irregular periods (shorter or longer cycles, lighter or heavier flow, intermittent starts and stops)
Hot flashes and feeling hot inside
Atrophy of genital tissue, dryness, painful intercourse
Being more forgetful
Mood changes
Breast tenderness
Being emotional
Loss of libido
Poor sleep
Weight gain

Now, before you just rush out to the health food store and get your friends favorite hormone remedy, STOP just one second, and realize this!  Hormonal Balancing is a science and that guesswork approach is not the best medicine.  Here's why!

Stress and weak adrenals can also contribute to Menopausal symptoms.  Hot flashes, night sweats, insomnia, mood swings, anxiety, sugar cravings, and more, can be connected to adrenal fatigue as much as to sex hormone imbalances.  It often takes a professional to help in determining whether hormones, or adrenal support products are the best approach for an individual.  This can easily be tested!  And it won't break the bank!

Now if you're 'right there' in dealing with problems or symptoms that you are connecting to menopause, please ask for help!!!  We can mail an @ home hormone/saliva testing kit, informational packet, and answer all of your questions over the phone.  Our professional staff has been providing this specialty care for nearly 15 years and we have had a positive impact in the lives of countless patients.   This is what we do all day, everyday.  So, don't go through "M" alone!  We are the professionals that can help guide your decisions based on your individual hormonal values, needs, and medical history.

***I can also read your hormone values through serum assays.  If your doctor or practitioner prefers to draw blood lab work, then call ahead to determine what hormones need to be evaluated while you are in your providers office.  Or, I can send them a lab requisition request by fax or email.  Partnering with your personal provider is an excellent approach to your care and health.

We look forward to your call.

Dr. Sonja

WEIGHT MANAGEMENT PROFILE TESTING. It's HERE!!

Hormones and Obesity

an article provided from ZRT laboratory

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As the incidence of obesity climbs ever higher in the United States and other industrialized countries around the world, so does the number of theories on what are the causes and solutions to the problem. The science becomes ever more specialized as researchers debate the possibility of a genetic predisposition, a lifestyle effect, a socioeconomic effect, or an ethnic component. People struggling to lose weight receive a plethora of dietary advice – eat low carb, eat more whole grains, eat low fat, eat less meat, eat more protein, etc., and no-one seems to agree on the best diet for weight loss. But are we becoming too focused on the details and losing sight of the big picture about how our bodies really work?

Let’s think of the human body. It takes in foods and digests them to supply itself with what it needs to function. A normally regulated body knows when it is hungry and when it has eaten enough. So how does it “know” these things? The whole panoply of bodily functions related to hunger and satiation is orchestrated by chemical messengers that are produced in response to messages from the brain as well as external stimuli that affect us all the time. These chemical messengers are known (and defined) as hormones.
So can it be argued that “my hormones are making me fat”? This blog looks at one family of hormones, the steroid hormones, that have been closely linked with how your body manages to control your weight, and when “out of balance” may result in weight gain. This family of steroid hormones can be grouped into the sex-hormones and adrenal hormones. The sex hormones include the estrogens (estradiol, estrone, and estriol), progesterone, and testosterone. The adrenal hormones include DHEA and cortisol.
Estrogen and testosterone
Estrogens are known as the female sex hormones and testosterone as the male sex hormone. While both estradiol and testosterone in fact have a wide variety of functions in both sexes, women in their youth have about ten times more estrogen than men, and men have about 10 times more testosterone than women. These stark differences in estrogen and testosterone levels in women and men define many of the characteristics that make men and women look and behave differently, including the way our body fat is distributed.
Women tend to have fat stores under the skin (subcutaneous fat), around the hips, and in the breasts. This results in the characteristic female curves that contribute to the characteristic hour-glass figure. When estrogen levels are high, excessive fat deposition occurs primarily around the hips and thighs leading to the typical pear-shaped body type, referred to as “gynoid obesity” or female type obesity.
Normally, healthy men have very little estrogen and subcutaneous fat. When they start gaining weight, it tends to be in the belly, in the intestinal space, and is known as “visceral fat” or “central weight gain”. This results in the characteristic apple-shaped body type, known as “android” (male type) obesity, when weight gain becomes excessive. However, this is also the type of fat that is the most metabolically active and therefore easiest to lose – men generally lose weight more easily than women for this reason. Visceral fat is very easily mobilized in response to adrenalin (the “fight or flight” hormone) and strenuous activity. Think of the hunter-gatherers from which we are descended – the males would store visceral fat preferentially when food was plentiful so that it could be easily used as fuel for the muscles when hunting for the next meal.
The picture is a little more complicated in postmenopausal women, when estrogen levels become very low while testosterone continues to be produced from the ovaries and adrenals. Normally estrogen rules over testosterone at the tissue/cellular level, but when estrogen levels drop at menopause and testosterone levels remain the same this estrogen/testosterone ratio shifts in favor of testosterone dominance. The presence of testosterone that is not counteracted by estrogen, a relative “androgen excess”, tends to promote the male type body fat distribution, and women who tend to gain weight during and after menopause often find that their waistline thickens and they become rather more apple-shaped than pear-shaped. The same effect is seen in women with polycystic ovarian syndrome (PCOS), who over-produce androgens. Studies of estrogen replacement therapy in postmenopausal women consistently show that this can prevent central weight gain, by maintaining a relatively higher level of estrogens than testosterone.
Fat tissue itself is an endocrine (hormone-producing) organ. It contains the enzyme aromatase, which converts testosterone to estradiol and androstenedione to estrone. In obese postmenopausal women, estrone can become the predominant circulating estrogen, rather than estradiol. Estrone is about ten times less potent than estradiol and its presence in the absence of estradiol is a hallmark of menopause.
DHEA
DHEA (dehydroepiandrosterone) is the precursor for the production of estrogens and testosterone in tissues where they are needed, and it therefore circulates in the body in significantly greater quantities than the other steroid hormones. Studies of DHEA supplementation have found no significant effect on body weight, but one of its natural metabolites, 7-keto DHEA, is known to increase the metabolic rate and has been found to help with weight loss.
Progesterone
Progesterone is well known for its ability to balance and optimize the effects of estrogens. With each monthly cycle, estradiol stimulates the proliferation of the breast epithelial cells and those of the reproductive tissues. Progesterone produced in the second half of the menstrual cycle then slows the estrogen-stimulated proliferation, allowing for tissue specialization and differentiation. For the same reason, progesterone is needed to balance estrogen replacement therapy to prevent excessive growth and proliferation of the uterine lining to reduce the risk of endometrial cancer. We know that synthetic progestins are also used for this purpose, but while they effectively suppress endometrial proliferation they have been found to have adverse effects in other areas, notably the cardiovascular system and the breast. Natural progesterone is without these adverse effects, and indeed has many beneficial effects in the body. But some women find that it can contribute to weight gain or bloating. Studies have found that women tend to have an increase in appetite and food intake in the latter half of the menstrual cycle, and during pregnancy, when progesterone levels are higher than usual. An encouragement to eat more in preparation for a pregnancy and during gestation would make sense physiologically, but we don’t need excessively elevated progesterone levels otherwise. Some forms of progesterone replacement therapy may lead to excessive progesterone levels that can increase the risk of insulin resistance, which will promote fat storage rather than utilization for energy. It is important to monitor progesterone levels, as with all hormones, during supplementation to ensure that levels are not out of physiological range and well balanced with estradiol and testosterone. Bloating or weight gain could mean you are using too much progesterone.
Cortisol
Cortisol is an adrenal hormone essential for blood glucose regulation, fat storage and utilization, and control of other body functions like the immune system. Cortisol acts in synergy with many other hormones to help regulate their actions. Cortisol is released from the adrenal glands in response to stressors sensed by the brain. These stressors come in many different forms and include low glucose levels, emotional or physical stress, or invasion of the body by pathogens. Cortisol mobilizes glucose from the glycogen stores in the liver to be used as short-term energy for the muscle. While normal physiological levels of cortisol are essential to survival, excessive levels caused by chronic stressors shut down non-essential body functions, such as the immune system, and by suppressing the production of other hormones, such as sex hormones, growth hormone, and thyroid hormones. When stressors are present for extended periods the system goes awry and we develop a chronic stress condition and persistently elevated cortisol levels. When this happens, the effects of cortisol on blood sugar result in an increased appetite, particularly for carbohydrates (“stress eating”) and storage of more glucose as fat, especially in the visceral area, which has more cortisol receptors than other types of fat tissue. Stress-related weight gain can be treated by finding and reducing sources of stress, as well as relaxation techniques to reduce the harmful effects of stress on the body.
Conclusions
When you understand more about your body and how it is hormonally regulated, it is easier to see that hormones, when in balance, are friends rather than foes. The entire endocrine system includes many more hormones than are mentioned above, which are involved in metabolic processes and other bodily functions that can affect our weight and our overall health. But even taking just the reproductive hormones and cortisol, and a little common sense, we can conclude that:

1. We have changing reproductive hormone levels as we age. In our attempts to replenish hormone levels back to youthful levels, we sometimes upset the balance as we replace hormones to levels outside an ideal range, and we don’t recognize the effects this hormonal imbalance has on weight gain.
2. Weight gain itself affects hormone balance.
3. Our bodies have highly efficient stress responses, but the extreme, prolonged stresses of modern life have created an unhealthy hormonal imbalance (excessive cortisol) that has contributed to weight gain.

It is important not to ignore the elephant in the room, the highly palatable and refined foods that dominate the “Western” diet, which are clearly associated with the obesity epidemic. These are not the foods our ancestors ate.Our bodies have not adapted hormonally to the challenges of regulating fat stores when presented with these foods in excess.
Keeping our hormones in balance while maintaining a healthy diet, following an exercise program, and aiming for a stress-reduced lifestyle is key to optimal wellness and longevity.

References

1. Björntorp P. The regulation of adipose tissue distribution in humans. Int J Obes Relat Metab Disord. 1996;20(4):291-302.
2. McTiernan A, Wu L, Chen C, Chlebowski R, Mossavar-Rahmani Y, Modugno F, Perri MG, Stanczyk FZ, Van Horn L, Wang CY; Women's Health Initiative Investigators. Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring). 2006;14(9):1662-77.
3. Pasquali R, Vicennati V, Gambineri A, Pagotto U. Sex-dependent role of glucocorticoids and androgens in the pathophysiology of human obesity. Int J Obes (Lond). 2008;32(12):1764-79.
4. Shi H, Seeley RJ, Clegg DJ. Sexual differences in the control of energy homeostasis. Front Neuroendocrinol. 2009;30(3):396-404.
5. Torréns JI, Sutton-Tyrrell K, Zhao X, Matthews K, Brockwell S, Sowers M, Santoro N. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: study of Women's Health Across the Nation. Menopause. 2009;16(2):257-64.
6. www.endotext.org; Endocrine changes in obesity. (Free registration required)

It's Not Just About the Ovaries

Women are driving the ship of Bio-identical hormone therapy more than ever before.  Honk Honk!!  Let me just pause there for a HIGH FIVE!!  The momentum is gaining to the point that pharmaceutical companies are beginning to strong arm insurance companies in efforts to combat the abandonment of the synthetic regimens of years gone by.  Their wallets are getting thinner because of individualized and customized medicine, that WORKS!! I had a call yesterday from a long standing patient who received a letter in the mail that her custom therapy would no longer be covered by her private insurance plan.  Boo-Hiss!!  Those are fighting words I tell you and there's nothing like telling a peri-menopausal woman that she can't have something anymore that she loves and that makes her feel better.  She simply wanted answers and I don't blame her.  I had my hand up saying the "Amens" right there with her. Remember, I'm a bio-identical hormone user MYSELF.  Truth!  I immediately directed her to call her insurance company and ask them to explain why.  I absolutely love that the new force to be reckoned with in this hormonal balancing field of medicine are a brigade of believers with ranks including stay-at-home moms, executives, laborers, physicians and practitioners (believe me, I have many), stage performers, menopausers, peri-menopausers, and young women who just want some good options in treating their symptoms and needs.  Years ago, I had to do a lot of the fighting myself for people.  Uh, not so much anymore and I love that.   Turn the women loose!!

Hormones are where it's at, my blog friends.  I have never seen so many clear cut studies coming out supporting the role of hormonal balance in overall health, improved mortality, cognitive function, bone health, reduction of other disease risks, and in longevity.  A staff member recently brought in a popular magazine article with the title,  "I knew I shouldn't feel this tired."  The article focused on adrenal fatigue, low DHEA and cortisol, and the impact that it had on this woman's life.  I excitedly read it for myself and proclaimed, "That's what I'm talkin' 'bout!"  (My team is used to me and they know I love that kind of stuff)  I'm especially excited because this is hitting the media and press in every form.  I still have Oprah's magazine in my office from 2009 where she shares her personal story about hormonal imbalance.  From about that time forward, I have seen a tremendous amount of growth and attention to this area of health and wellness.  And, I didn't go back to school because I didn't think this would happen.  I'm now buckling my seat beat and enjoying the new drivers at the wheel of their (and their families) healthcare.  Drive on, ladies!

Today, as an example of the importance of this, I want to highlight one key hormone that can't be ignored for the aging woman.  Progesterone is a BIG player in the female scheme of things, and typically the first hormone to go down, down, down with aging.  Although the ovaries are the powerhouse of production for sex hormones, that decline of progesterone and other hormones can have a significant impact on HEART health.  We can live without ovaries ladies, but we cannot live without our heart.....and we can't deny what the studies are showing us.  It's time to talk hormones and heart disease like never before.

At menopause (avg age of 51), the levels of estrogens, progesterone, and testosterone, secreted by the ovaries, decrease considerably.  In a woman's third decade of life and up to about 50 years old, progesterone can drop by up to 75%.  Whoa!  That should get your attention.  And, if you have had a hysterectomy with ovaries removed, just consider yourself right there on the quick hill of decline with those who are going through menopause naturally.  Here's something you need to know.  Progesterone is not the same as the 'synthetic and pharmaceutical company version' called medroxyprogesterone.  There's an added prefix to that name for a reason and it's because it's not a true replica of what the body produces on it's own.  Add a methyl, get a patent!! Although they sound similar, their similarity ends there.  The methyl group addition at C-6 in the structure (pardon me for the organic chemistry lesson but I think it's important) is ABSENT with progesterone.  Studies show us that this little switcheroo does not provide the benefit that progesterone does to our body. 

Remember that progesterone is a pro-gestational hormone.  It is KEY in sustaining a pregnancy, impacting fertility, regulating menstrual cycles and the list goes on and on.  Conversely, medroxy-progesterone is teratogenic and contraindicated in pregnancy.  Say what??? Are you seeing this picture???  I hope so!  One cannot reasonably be substituted for the other in pregnancy, but also as a general rule in providing hormone replacement therapy (in my professional opinion).  I'll take progesterone, hold the methyl please!!   You must also know that Progesterone is essential in the production of other hormones.  (ie. cortisol, aldosterone, estrogens, testosterone, etc. etc.)  We need ALL of these hormones working on our behalf and progesterone is the necessary start of the steroid production pathway.  Take a look at a hormone synthesis chart and you'll see progesterone near the top.  You will quickly realize (hopefully) that you don't want to use a synthetic substitute!! 

Remember the title of this blog.  It's not just about the ovaries.  It's not!  Heart Disease is the number ONE cause of death in women.  Not cancer!  And, I repeat, not cancer!  In many studies to date, we are seeing evidence that progesterone (NOT medroxy-PG) added to estrogen can have a complimentary role in protecting the heart and other health improving markers.  Cholesterol profiles improve, treadmill exercise times improve, a natural diuretic effect occurs, and blood pressure profiles improve.  Conversely, medroxyprogesterone consistently shows negative effects when tracked in studies.  Now that's getting down to the "heart" of the hormone matter if you ask me. In other matters, progesterone can help re-establish menstrual cycles, provide sedation for those suffering from insomnia, and acts as a anti-anxiety agent to most everyone I talk to in my care.  I can verify that during my days on cycle progesterone therapy, I feel more at ease, less bloated, and sleep without those crummy sweats that tend to creep up in those golden peri-menopausal years.   I don't mind sharing my own experiences because I know that it will help others feel comfortable in getting the help that they need.  But, I'm sure you don't have any aging symptoms going on for yourself, right?  (wink wink)

Hormonal balance is one of the areas of my expertise that I love working in the most.  If you could sit in this office and hear the benefits that women share back, you would easily understand why it's so rewarding.  I'm convinced that it's the right thing to do.  From the young woman struggling with PMS, PCOS, or irregular cycles, to the post-menopausal woman noticing that she's foggy in mind, gaining tremendous weight, and has no energy to perform daily tasks, our team can help give insight to all ages and all stages of aging and guide you through testing.  It's easy and affordable to see how well you are doing on the hormone measuring scales.  I'm not sure why you would wait to be checked if you are suspicious that your problems are a direct result of hormonal imbalance.  Perhaps it's time for YOU to get back to normal. 

To your good hormone health,
Dr. Sonja

Young Women and Hormones

I can't help but use some real patient situations to teach others who might be struggling with some of the same things you will read about in this blog.  In the last 6 months or so, I have noticed a growing patient population of young women connecting to our office for help with their suspected hormonal imbalances.  I love it!!  Why do I love that so much?  Because I feel that many women have suffered for a very long time with endometriosis, missed menstrual cycles, horrible menstrual cramping, infertility, ovarian cysts, premenstrual syndromes, depression, and anxiety, and many other hormonally driven problems.  Menopause is one thing that we link to hormones, but young women also need to know that they don't have to be middle age to experience significant imbalances as well.  Addressing them early in life is critical in health for the long haul.  And birth control pills are not the magic cure-all for the things that ail young women.  Just being honest and the reason customized therapies with bio-identical hormones and natural treatments continues to grow. 

Here's a few brief scenarios of what young women are struggling with out there and I can promise that in a majority of these type cases, hormones are to blame.

Maybe YOU can relate to one of these women???

1.  A young 25 year old woman who had already been diagnosed with Polycystic Ovary Syndrome (PCOS).  She is growing hair in certain places of the body and losing it on her scalp.  She is also struggling with intense weight gain (despite eating very little), experiencing extreme mood swings, missing menstrual cycles, suffering from acne breakouts, and experiencing vaginal dryness.  She sought me out and asked if I would be willing to help her check her hormone levels and to create a regimen of therapy so that she can try for a pregnancy in a few months.  "ABSOLUTELY!!", was my answer.   Get this!  She was diagnosed in her late teens and felt as if her case was hopeless.  Well, it's not! I just shared the lab reports with her yesterday and she now has a plan that is outside of everything else she has ever tried.  We clearly identified reasons!!!  I FULLY expect that she will be successful in starting a family after we get some of these 'reasons' reset for her.  She also needs to be encouraged to address this, because PCOS can cause diabetes and other endocrine diseases if left untreated.  Oh, and BTW, she is in nursing school and just couldn't shake the teachings she was made privy to in her studies. She acted on her knowledge and suspicion that more could be done.  And, yes, more can be done! Yeah for her!!

2.  A 28 year old with depression and anxiety, missed menstrual cycles, weight gain, extreme fatigue, exaggerated stress, and PMS symptoms.  Again, this young women needs to have her hormones evaluated.  Her case wreaks of hormonal deficiencies and a stress syndrome.  Just doing some lifestyle teaching and creating a supplement regimen for her can be incredibly life changing for her.

3.  A 30'ish woman with fatigue, painful intercourse, irritability, endometriosis, low libido, vaginal dryness, stress and lifestyle demands, depression, anxiety, and emotional instability.   This young women has a long life ahead of her and using band-aid coping medicines is not what's best for the long haul.   Again, testing her sex hormones along with her adrenal status, and treating her unique physical needs, can turn her around 180 degrees. 

4.  A young woman with menstrual migraines.  Hormones can be a reason for headaches and noticing their onset and severity near menstrual cycle time, can be a good clue that things need to be checked.  I have plenty of patients in my care who use hormone therapy to minimize or eradicate menstrual headaches.  I also advise on elimination of certain known environmental and food triggers linked to headaches.

If you are a young woman reading this, and if you are "dealing with" any of these problems, you should get tested.  I will be happy to guide you on the process of finding reasons and answers. If you are a mom or grandmother reading this for your young female family members, then please share this information to them.  It's so affordable and so critical to health. 

I'm proud to say that I've been doing customized and creative medicine for nearly 20 years.  I now take care of entire families, circles of friends, and now many physicians and practitioners are joining our patient pool.   Word of mouth is our teams greatest advertisement.  That means a GREAT deal to us !!  It really, really, really does.

To health and happy hormonal balance,
Dr. Sonja