Hormone Therapy for Menopause: A Guide to Doses, Levels, and Delivery Methods

Many people have strong opinions about compounding pharmacies, although few people know what they really are, how they are regulated and what the difference is between one type of compounding pharmacy and another. There is a perception that compounded drugs are not FDA approved, not regulated or somehow not safe or reliable. Today I'm going to explain what these pharmacies are, why we might choose to use them (or not) and why the perception that compounding is inferior or not safe is quite inaccurate.

This past two decades has brought so much confusion about menopausal hormone replacement and breast cancer risk, but we now are entering a modern time with a much better understanding of how all this works. Today I'm going to review how this controversy ever started and what the modern understanding is regarding estrogen and breast cancer. You may be surprised that we are now flipping the script and realizing that estrogen not only has no effect on increasing breast cancer risk, but actually reduces the risk of dying from breast cancer if it's started early. Not only that, but estrogen also undeniably reduces the risk of colon cancer, osteoporosis, and particularly cardiovascular disease when it is started shortly after menopause. We no longer recommend taking hormone replacement only for treatment of hot flashes and night sweats, or stopping it after any defined time period. The health benefits of starting it as soon as possible after menopause and taking it for life outweigh any risks for most women. ~ Dr. Susan

While the safety and benefits of menopausal hormone therapy (MHT) are becoming widely accepted, hot debate continues around dosing, delivery methods and how to monitor levels. Advisory boards including the American College of Ob/Gyn and the Menopause Society support the use of (MHT), but much confusion continues regarding ideal blood levels, whether to check blood levels at all, and optimal route of delivery. The dosing of both estradiol and testosterone varies 5-10 fold between methods such as patches, gels, sublingual methods or pellets. Both doctors and patients need to understand the dose that they are prescribing to make an educated decision. Today I will help to shed light on the differences between these options, and why my strong opinion is that blood levels are critical to ensure that levels are not too high or low for your optimal health.

Sometimes we have to be our own advocate and ask for the tests that we need since many doctors don't offer very high-level labs that can be critical to maximizing your healthspan and helping you to feel great. Today I'm going to go through a real patient's lab panel and show you what we look for in our office during a hormone consultation. I'll be discussing the difference between "reference ranges" and "optimal ranges" so that you can interpret your own lab values with a critical eye and make sure that you're not missing any opportunities for wellness. I'll include an actual copy of this patient's labs so that you can ask for exactly the same thing when you go to your doctor and you'll be empowered with everything you need to start on your wellness journey! LINK - https://completemidlifewellnesscenter.com/private-practice/womens-fasting-panel/ If you do get these labs done, we can also discuss them with you virtually -or in person if you find your way to Houston!

So much has changed in our understanding of cholesterol and how it affects our risk for heart disease since I was in med school! Until recently we talked about "good cholesterol" and "bad cholesterol" with very little understanding of what those words actually meant. Today I'll attempt to unwind a little bit about what cholesterol does in our body, how to test for the particular lipoproteins that put us at highest risk for heart disease, the importance of ApoB, and most importantly what we can do to reduce our risk of heart disease based on this information. While this is often a largely forgotten subject for women, it's important to remember that the number one killer of both men and women is cardiovascular disease, and it is critical that we understand our own heart health, and how to optimize it!

Have you been as confused as me about all the controversy that you hear about which fats are the healthiest? Which ones we should avoid and which we should consume more of? What does MUFA, PUFA, trans fat or saturated fat mean? Is a low-fat diet healthy or should we aim for 30% fat or higher? Today I'll go through a basic introduction to the types of fat that are available in foods, which ones appear scientifically to be the most healthy, and which ones we should avoid.

Last month my video with Dr. Antoniewicz (@drleahatoz) started the discussion about the importance of diagnosing and treating insulin resistance, not only for weight management but for lifelong health and disease reduction. Today we are digging more into this really important and complex topic, and highlighting some more details about what IR is, why it’s important, how we diagnose it and how we can treat it with simple concepts surrounding Nutrition, Movement, Rest and Stress (emotional and physical) management. If you didn’t catch Part 1, you can find here! If you struggle with your weight, sugar addiction or just feel stuck, as Dr. Leah says, "you are not a bad person trying to get good, you are a sick person trying to get well”. While up to 40% of American women suffer with IR (largely undiagnosed) only a small fraction are getting the help that they need. My hope is that the information you will hear today will inspire you on your wellness journey, and we are here to help you. The recipe for success in healing IR is clear, it works for our patients, and it can work for you too!

Today I'm discussing a fantastic option for dealing with one of the most difficult problems that we experience in menopause, which is vaginal dryness and pain, as well as decreased sexual sensation. While hormone therapy is the mainstay for restoring vaginal health, vaginal laser therapy is another tool in the toolbox that is safe for patients who cannot take estrogen due to current or recent breast cancer, or even for patients like myself who just want a little extra boost! This week was time for my annual laser treatment and I will be taking you to the office to watch my laser treatment done live by Dr. Leah. Along with the Juliet vaginal laser, I am having an o-shot with umbilical-derived growth factors, and I will walk you through the pros and cons of all of the options and show you what the experience is like for a real-life patient!

I am delighted to see more attention paid every month to issues regarding menopause and perimenopause, with articles popping up in every magazine and newspaper, often with celebrities talking about their experiences. We're finally starting to have a voice in the world about this critical time in life. While this is a fantastic development, one of the dark sides is that it has opened up a market for companies to sell products that claim to help with menopause symptoms, but have no scientific backing. This is particularly worrisome because it preys on women in a very vulnerable time in life who may be experiencing truly devastating symptoms that have serious future health ramifications. Marketing products that are not proven to be helpful, is not only unethical, but is harming women. Today I'm talking about the business of supplements sold to improve menopause symptoms, and discussing the fact that not one single supplement has any scientific backing to support the claims that menopause symptoms are reduced. In the meantime, bioidentical hormone replacement has been rigorously studied and shown not only to be safe, but to have very important health benefits that should not be ignored because of unfounded fears. Each of us can make her own decision but today I'm inviting you to think and be smart, and not let people pray on our vulnerability, or assume that we are not smart enough to understand scientific studies. While the ingredients in many menopause symptoms products are very good for numerous things, none of them has been shown to help with the symptoms of menopause. This is an invitation to be very careful and not to believe everything that you are told by celebrities who are being paid to deliver a message that is potentially harmful.

Every day I am asked several times if the HORMONE REPLACEMENT causes WEIGHT LOSS, and the answer is a little bit complex - but generally YES! The important thing to know is that it is not the hormone replacement itself that causes weight loss, but the different ways in which it increases your energy, improves with sleep, improves mental outlook, muscle mass, physical strength, and all of those things that we need in order to move more and stick to our healthy nutrition plan. Apart from ovarian hormones, it's also critical to optimize thyroid and cortisol, which are both hormones that dramatically affect our ability to lose weight. Overall, it's absolutely true that optimizing hormones can help with weight loss - by helping us to stick to our healthy nutrition, exercise, and sleep protocols ....which ultimately are the cause of weight optimization.