Bio-identical Hormone Therapy and Sage Advice 4 Women from

• Hormone balance is crucial to preventing illness and symptoms of disease  all during our lives. We have  a more difficult time with this in peri-menopause and menopause than at other times in our lives. Most women do not need estrogen as they age.  Our ovaries still produce approximately one third  the amount after menopause as they did before. We produce estrogen in our ovaries, our adrenal glands and we transform testosterone into estrogen in our adipose tissue.

 What we are missing is progesterone which we produce with ovulation. After ovulations ceases, progesterone is not produced in the ovaries.  Progesterone is necessary for our estrogen receptors to be sensitive. Progesterone primes the pump. It takes super -physiologic doses of estrogen to provide symptom relief in women who are progesterone deficient. Progesterone supplementation may be the only hormone needed for many women to feel good. Progesterone has receptor sites in all tissue, not just the endometrium. Women who have had total hysterectomies still need progesterone to protect hormone balance in breast and brain tissues.

     Sometimes adjusting hormones does not help women whose issues  originate from other endocrine dysfunction.  Our ovaries do not live in a vacuum. The adrenal glands, the brain, pituitary , hypothalamus and the thyroid glands interplay together to produce the hormonal environment that drives our daily lives. Hormones are needed for proper neurotransmitter function and attention must be paid to providing all the nutrients needed to make neural function the the brain and the  rest of the body as healthy as possible.

 I utilize saliva testing for measuring hormone levels in the body. If you are imbalanced in your hormones, you should replace only those you are deficient in and balance your hormones to a normal physiologic state.  One size does not fit all.

     Once you have become comfortable and symptom free on your hormones, they should be tested at least yearly to make sure that you are not being exposed to amounts that are not in balance.  Topical hormones can concentrate in tissue. Too much hormone exposure is just as dangerous as the discomfort of too little hormone exposure  or imbalanced hormones.  During  initial balancing, you may need to retest with saliva every 3-6 months to prevent over or underexposure to hormones. If your hormone therapy helps right away and then 2 or 3 months down the road it seems to not work any more, you were probably started on a dose that was too high for you. Rather than needing more of your hormone , you need less to up regulate your receptors( make them listen to the hormone that they are now ignoring). It is also a good idea to not take continuous hormones. A 5-7 day break a month or if your symptoms get ugly with a break that long, a one or two day break a week will help to minimize the amount of hormone exposure that you need to be comfortable. Dr Diana Schwartzbein found that her diabetic patients on continuous HRT  had difficulty with blood sugar regulation levels until they cycled HRT. Glucose metabolism is affected negatively in those women who are susceptible to metabolic syndrome and who take continuous HRT.

  I usually use topical or sublingual hormone preparations and rarely oral because I wish to avoid liver formation of metabolites that have greater risks. With oral progesterone, metabolites key into Gaba receptors and help with sleep. Sublingual progesterone gives both topical and oral advantages since approximately half of the dose is going through the liver. 
         Signs of not enough estrogen are: mental fogginess, forgetfulness, depression, minor anxiety, mood changes, difficulty falling asleep, hot flashes, night sweats, temperature swings, day long fatigue, reduced stamina, decreased sensuality and sexuality, decreased self image, dry eyes, skin and vagina, sagging breasts, pain with sex, weight gain, increased back and joint pain, episodes of rapid heart rate, headaches and migraines, and gastrointestinal discomfort. Neurotransmitter deficiencies are key in most of these symptoms. Acetylcholine needs estrogen, Dopamine needs progesterone, estrogen dominance affects Serotonin in the brain and Gaba disturbances are related to hypoglycemia and insulin resistance (The brain needs glucose in the cells!).

   Signs of too much estrogen are: Breast tenderness, increase in breast size, water retention (swollen rings, swollen legs), impatient, edgy behavior with a clear mind, pelvic cramps, and nausea.

    Topical Estrogen should be divided into two doses, one in the am and one in the pm, with a few exceptions.  This is because the half life on natural topical estrogen in short and once a day dosing may not help all day long. The more stressed a woman is, the faster she burns her estrogen. On a restful vacation, a woman may have symptoms of excess estrogen because she is not burning it up as fast as usual.
In very stressful days, a woman may need to increase her dosage to feel symptom free.

    Progesterone is an important part of hormone therapy for all women, not just those who have a uterus to protect. Women who have had hysterectomies have not been given progesterone as if the uterus was the only cellular body that uses this hormone. Estrogen and progesterone must be balanced to protect the breasts from cancer, the heart and vessels from stroke and heart attack and our bones are helped by both hormones. Progesterone acts as a natural diuretic, it produces a calming anti-anxiety effect, it decreases PMS symptoms and monthly flow. It enhances the body’s defenses, it improves the breakdown of fat into energy, it cuts the craving for carbohydrates, it reduces breast pain, contributes to new bone formation, and increases good HDL cholesterol. Progesterone taken at night may improve sleep. Many of these functions are related to progesterone's part in neurotransmitter activity in the body.

Signs of progesterone deficiency are: menstrual irregularities (no menses, fewer menses, heavy menses, spotting before menses) PMS type symptoms, lumpy painful breasts, cases of endometriosis, adenomyosis, and fibroids, anxiety, irritability and nervousness, and lastly water retention.
Signs of progesterone excess are: drowsiness, dizziness, sense of physical instability, feeling drunk, and heaviness of extremities. Signs of paradoxical response are: feeling antsy , anxious, can’t sleep, retain water, hot flashes, depression, appetite increases and it’s resultant weight gain.

 Here you will find  theories on hormone therapy I have learned through continuing medical education courses and how I help you decide on a course of therapy that best suits you  and your health risks.

 The basic rule for hormone therapy according to functional medicine experts is to only replace hormones in the body that are missing or deficient and with only bio-identical forms of the hormone that the body readily identifies and has experience and ease in utilizing. Replace only what the body needs never more. Monitor the levels closely to make sure you have not provided too much. Too much of a needed hormone will help symptoms only temporarily and will down regulate receptors so that symptoms will return.