New information becomes available every day, and it’s important to have those in the field of study help you evaluate. Certainly, hormonal contraception, and hormonal estrogen therapy are no longer the only options for women, nor is it deemed as essential for the length of time we used to believe it to be effective. There are non-invasive cosmetic therapies that are emerging as the most effective therapies for conditions we used to think took only continuing medication for vaginal health, vaginal tightening, and urinary issues. We now have designer estrogens, nutritional therapies, weight loss management, bone-building drugs, and heart-healthy alternatives to traditional hormonal therapy. Medications to fight the loss of muscle mass, and other radically different therapies are coming. Genetic medicine is here and we have a personalized approach to your health.

Hormone replacement therapy (HRT), could still accurately describe a young woman’s hormone therapy. This then means that HRT is a physiological replacement of female hormones in women who are prior to the age of menopause, but have lost ovarian function and thus are menopausal. Taking hormones for relief of menopausal symptoms or to prevent a disease is a treatment, or a pharmacologic dosing of medication. Replacement, in contrary, is that hormonal therapy that is given in the dosages that mimic a non-menopausal woman of that age who is still cycling. A fine point, but this is why the term HRT was separated from HT. The term hormone therapy (Hl) could refer to different hormones, alone or in combination e.g., estrogen, progesterone, or testosterone, with other hormones as well.varying dosages, and different forms of medication (pills, patches, injections, inserts, rings, or creams).

When considering hormone therapy, the first goal is to establish your health objectives: do you have a treatable symptom, a group of symptoms, or a have a personal or family genetic predisposition that would predispose you to a disease that requires preventative treatment now. Then weigh the risks and benefits of the therapy, and the risks and benefits of not taking the therapy. We want to discuss with you treatment alternatives including changes in diet, nutrition, herbal therapies, vitamins, or other prescription medications to treat your individual symptoms. There is no magic pill that can relieve all menopausal symptoms for all women. Nor can duration of therapy be realistically recommended until you have embarked on therapy, as so many factors affect whether you will need medication additions, changes, dosage adjustments, and hormone monitoring.. There are now procedural therapies to help vaginal, genital, and urological health including laser therapies such as MonaLisa Touch.

Many women can be treated effectively with minimal hormonal testing. Others may need some basic blood tests, others need more complex salivary testing, and in some cases, both hormones and their metabolites can be detected from urinary testing. Blood and salivary tests may not even reflect your symptoms. No one number or test should be evaluated out of context. We offer all those alternatives and welcome the chance to discuss which testing is best for you.

Estrogen is our female biologic hormone. Virtually every organ and almost every cell in our body can respond to estrogen in some way. Estrogen is responsible for physiologic female development and appearance, and the ovaries make estrogen, until after menopause when they make none. Estrogen was once taken by women not to "be natural" but to "beat nature". Not just a treatment for the 98% of women who get hot flashes and sleep disturbances caused by night sweats and their accompanying hot flashes as they transition through menopause, estrogen can be taken as preventative as well as curative medication. Well timed estrogen probably can prevent heart disease, and it definitely prevents osteoporosis, mood changes, and colon cancer. The effects of estrogen are so ubiquitous it can afecct mood and your thinking, improve your sex life, give you better skin with fewer wrinkles, improve joint health, and improve your eyesight. There are potential serious side effects including cardiovascular disease and breast cancer, so you need to be properly evaluated and monitored when being treated with estrogen or any hormones. It is also important that hormones be given in a balanced way. The most common minor side effects are menstrual bleeding and spotting, weight change and breast pain.

The only natural progesterone is the hormone by this name. Before natural progesterone tablets became available, the only progestins were synthetic preparations, made in the laboratory, many which resembled the male hormone testosterone. Synthetically derived progesterone may be made from wild yams, soybeans and Chinese cactus, all of which contain diosgenin. Diosgenin is a natural hormone, but it cannot be processed in our bodies to active natural progesterone, and must be chemically processed to become a useful progesterone. It is not possible to derive significant quantities of useable progesterone from dietary consumption of wild yams or soybeans. There is no enzyme in the human body that can convert the diosgenin into progesterone—this must be done in the laboratory. About 1 in 5 women are extremely intolerant to progesterone treatments. For these women, the best strategy is to use the lowest possible effective dose, for the shortest duration, and for some topical progesterone.. Some women may find the progesterone gels and creams effective. Natural progesterone is much less potent than the synthetic progestins which are designed to be metabolized less quickly, and may be necessary for some women.

Progesterone is an ovarian hormone made by the corpus luteum, and by the placenta during pregnancy. Its uterine function is to change the endometrium (the lining of the uterus) in preparation for pregnancy. If no pregnancy occurs the progesterone drops causing the uterine lining to break down and sheds as the menstrual period. Estrogen and progesterone have opposite effects on the uterine lining. Estrogen thickens the lining, whereas progesterone ultimately thins it, making it an ideal treatment to balance the hormones of the uterus and help control menstrual irregularities. Young women who do not regularly ovulate are often lacking in progesterone. If you do not ovulate because you have transitioned into menopause, your ovary does not form a corpus luteum, and hence progesterone is not produced. The transition to menopause involves more and more cycles in which a woman does not ovulate, which results in months of excess estrogen exposure to the endometrium. This can lead to the overgrowth of endometrial tissue. The hormone progesterone has effects on other parts of the body and can be used in literally dozens of hormonal treatment plans including:

Combination therapy in hormonal contraception, in combination with other hormones for menopausal hormone therapy, in the treatment of missed menstrual periods, in managing PMS, PMDD, and abnormal menstrual periods, the prevention of miscarriage and of endometrial overgrowth (hyperplasia) and endometrial polyps and in some cases the treatment of uterine cancers.

It is female hormone paradox that for a woman to make her female hormone estrogen, a woman must first have adequate production of testosterone which is made by the ovaries and converted into estrogen. To have proper hormone balance we need to have sufficient levels of the various important hormones. To be healthy we need to keep the secretion and intake of hormones (even those we encounter via foods, plastic bottles and pesticides) in check by being able to properly metabolize and excrete the byproducts of hormone metabolism. It’s a complicated female paradox that we are just beginning to be able to monitor and modify for our patients.

We have just begun to realize that the optimal hormonal health includes compounds, once thought of as lesser androgens, like androstendione actually can bind to the same places in a cell as testosterone with equal potency, and to be in testosterone hormonal balance we have to balance all the androgens.. DHEA, (Dihydroepiandosterone) an androgen from the adrenal gland is one of these potent androgens we need for sustaining health, muscle mass and energy levels, as well as sexual function. Many of the steroids in our body have receptor of their own that they bind to affect their physiologic treatment, others are actually metabolized to release the active hormone. Dihydroepiandosterone (DHEA) is one of the newest menopausal treatments, prescribed as a vaginal cream, that probably works in part by conversion to estrogen as well, as to testosterone conversion. DHEA has been prescribed as an antiaging therapy. It can improve sex drive and muscle mass and energy level, adrenal support, to boost the immune system, and it can even to treat hot flashes.

Androgen hormones levels in the female body peak between 18 and 24 and by age 35 the levels begin to drop in fairly quickly, years before natural menopause. We have not worked out why this is. We know that the levels of androgens that are circulating in the blood stream are affected by the binding proteins. Lower levels of androgens, accompanied by lower levels of the binding protein can have an effective androgen level that is actually fairly stable. Dietary, stress, or hormone imbalances and through these levels off significantly. Factors that can change your male hormone levels that you may want to come in to discuss with your WHP provider include: Fructose consumption, Exercise, Body fat, particularly deep body fat, other Steroid use, Insulin resistance or sugar control disorders including diabetes and Stress.

Treatment of hormonal imbalance and deficiencies as we age can be done with preset prescription hormonal doses, or compounded for you with individually dosed hormones. Individually dosed hormones are also called BHRT or Bioidentical Hormone Replacement Therapy. The concept from Bioidentical Hormones is that it is a compound that your own body made or still makes. There are still risks of these therapies and it’s important to understand that there is no evidence that Bioidentical therapy is actually safer than some of the standard therapies. We welcome the chance to discuss which is going to be right for you, with the best odds of treatment success and side effect minimization.

The word natural when applied to hormones has many meanings. Natural most often refers to the fact that the hormones prescribed have their base component, before any further processing, from plant or animal sources. There are hormones that are FDA-approved products which contain these natural estrogens, and an alternative that contains a natural progesterone also made from plants. The goal of therapy at Women’s Health Practice is to make sure that you get evaluated, treated, monitored, and therapy adjusted according to your needs and philosophies.

The vagina has estrogen receptors, and testosterone receptors as well, and testosterone can bring blood flow to the vaginal and vulvar tissues. That blood flow to the vaginal tissues is responsible for getting aroused with foreplay, and then lubricating with arousal. It is now being thought to be the reason that some menopausal women, with little estrogen, actually have not yet developed the issue, as their ovarian testosterone may be quite good. On the other hand some women with the condition who use estrogen without response may need the stimulation of testosterone or other androgenic hormones such as DHEA on those tissues. The laser therapies seem to work regardless of levels of estrogen and testosterone. When vaginal estrogen is used there is a 2-5 fold increase in blood estradiol after a week of vaginal treatment of estrogen. Using laser therapy doesn’t have that systemic effect.

Non-hormonal management of hormonal symptoms can mean many things, and depending upon your condition, your philosophy, and your treatment goals, virtually any hormonal condition from fibroids, PMS, to menopause, and painful sex, can be modulated by non-hormonal treatments. It may mean dilator pelvic floor therapy, biopsies, reconstructive surgery, medicines for hot flashes. We go into much more depth on particular topics in our blog section. But more importantly we encourage you to come in, letting us get to know you, having conversations about what is available, and what evaluation you need before planning a treatment plan.

Treatment of many aspects of hormonal health including vaginal dryness, menopausal bone loss, prevention of breast cancer, fertility, and other female conditions, can be done with SERMS. Selective Estrogen Receptor Modulators, or SERMS are not of the same chemical family as the steroid molecules that make up our sex hormones so they have acquired many nick names such as designer estrogens, or even ‘non-hormonal’ estrogens. They can be as pharmacologically active in some tissues as estrogens, and are an alternative to the use of estrogen in menopause, but as we will discuss they should not be considered as a ‘safe’ estrogens as they have their own side effects and risks. The infertility medicine clomid, the painful sex treatment Osphena, the bone health treatment Evista, and the anti-breast cancer treatment tamoxifen are all in this family. Actually there are now some SPRMs which are progesterone receptor modulators, so there are many available treatments. SERMS all work by binding to the estrogen receptors on various cells in our body, effectively blocking them so that estrogen cannot bind. In this way it stops estrogen-stimulated cancer cell multiplication. In addition to this anti-estrogenic effect in the breasts, tamoxifen has normal estrogenic effects in other tissues. It acts like estrogen in the liver, lowering blood levels of cholesterol. It stimulates the endometrial cells as estrogen does, causing a buildup of the uterine lining, which slightly increases the risk of endometrial cancer. And like estrogen, it stimulates bone cells, increasing bone density and strength. The effects of tamoxifen can thus be used to treat or prevent breast cancer. All the compounds mentioned have complex interactions, and their own profile of risks and side effects possible, and we can help you navigate to find the right treatment for women who are not able to be managed with bioidentical or synthetic hormones.