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In the United States, there are more than 45 million women in some stage of menopause, and close to 4 million more women will experience menopausal symptoms this year. Menopause is defined as ovarian shutdown - no more estrogen or progesterone production by the ovaries.

Once a year goes by without menstrual bleeding, menopause is said to be present. In menopause, estrogen and progesterone levels are dramatically decreased (but are not completely gone). Incredibly, the peri-menopausal period can start up to 15 years before actual menopause is seen.

It is clear that hormones play a crucial role in physiologic processes that maintain health and wellness (homeostasis). Hormones are proteins that are produced by endocrine organs such as the pituitary, adrenal, thyroid, testes, and ovary.

Imbalances in the true end-organ sex hormones - estrogen, progesterone and testosterone very often leads to rather distressing symptoms and disease.

These symptoms may include hot flashes, mood swings, anxiety, depression, insomnia, bloating, hair loss, memory problems, sexual indifference and many more. Diseases include osteoporosis, cardiovascular disease, and dementia. As an example, it has been shown that susceptibility to cardiovascular disease, which dramatically increases with menopause, is significantly reduced with proper hormonal balancing.

Estrogen is made in the ovaries, but is also made in the corpus luteum, adrenal glands, and fat cells. Once the ovaries stop producing estrogen on a regular basis, the adrenal glands become the main source of estrogen (primarily as E1). Estrogen is actually available in 3 forms - estrone (E1), estradiol (E2), and estriol (E3). The production of the various forms of estrogen, and estrogen metabolism depends on patient age, cycle, genetics, and other factors. Suffice it to say that the various estrogens have different potencies and effects.

While the absolute levels of estrogen and progesterone are affected, it is also important to consider the relative levels of estrogen as it relates to progesterone (i.e. estrogen dominance vs estrogen deficiency). Failure to attend to the proper balance of estrogen to progesterone can lead to worsening symptoms.

Finally, estrogen, progesterone, and testosterone do not act in a vacuum, but intimately interact with other hormone systems such as the thyroid and adrenals (cortisol). Hormones must be considered a web with rather complex interconnections that must be properly monitored and adjusted as needed.

To that end, proper monitoring and management of hormone therapy is paramount. Estrogen is metabolized into substances that, if not properly monitored and managed, are known carcinogens (i.e. greatly increase the chance of breast cancer). If you are currently on hormone therapy (or even if you are not) you should be aware if your metabolic products of estrogen metabolism are within a safe range (easily measured with a urine test).

It is important to appreciate that BHRT (bioidentical hormone replacement therapy) needs to be properly integrated into a comprehensive approach. There are multiple metabolic systems that interrelate with female hormones and influence their levels, potential toxicities and effects. Focusing solely on hormone creams is not recommended - the reader is strongly advised to make sure you are being treated and monitored by a properly trained physician. Hormones are powerful and potentially dangerous and need to be treated as such.

Not all hormones are alike. Bioidentical hormones are, well…. identical to the hormones your body produces. This seems to be an appropriate approach (and it is the one that we adhere to - using only bioidentical hormones) but many are still being treated with hormones that are not bioidentical (such as Premarin - derived from horse urine, and medroxyprogesterone - Provera). The Womens Health Initiative study showed the risks involved with artificial progesterone (provera), and there are definite risks with oral estrogens as well.

It is our contention that symptomatic improvement without the excess risk (seen with non-bioidentical hormone treatment) is attainable but is complex and requires proper monitoring.

Our patients feel better, age more gracefully, and have more control of their lives when their hormones are appropriately balanced and managed.

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