Hormones for Healthy Menopause: Part OneDr. Carolyn DeMarco, MD October 1, 2002
Menopause and pre-menopause are two very different but interconnected subjects. The pre-menopause or peri-menopause is that time leading up to menopause, when your hormones are fluctuating in a kind of a hormonal chaos. You don’t feel like yourself; you may feel different than ever before, with mood swings, irritability and brain fog. Your estrogen levels overall are higher than they have ever been in your life, but they are fluctuating up and down, and your progesterone levels are low. This is a clear case of progesterone deficiency. The worst thing you can do is go to your doctor and get an estrogen patch, and this is exactly what many people do. That will make all your symptoms worse.
The modern medical model supports a full-scale menopause industry that is profit-driven, and that is the key to understanding the push for Hormone Replacement Therapy (HRT). Much continuing education on this topic to doctors is sponsored by hormone companies or their competitors. The industry identifies menopause as a “disease” in order to induce a whole population of women over 50 to take hormones for the rest of their lives. At present only 11 to 15% of Canadian women are taking hormones, compared to about 40 to 50% of American women.
The basic dilemma in menopause is whether all women should take hormones, or only women with high risk of bone loss or heart disease. Only 25% of women will develop osteoporosis. Fifty per cent will develop heart disease, but of course, heart disease is preventable through diet, lifestyle, anti-oxidant vitamins and even the use of chelation therapy.
Although the medical model of menopause is depressing — focussing on deterioration, crumbling bones, sagging skin and estrogen deficiency — there are other traditions in which post-menopausal women are considered to be the wise women of the tribe who have extra privileges. In our society, when you reach your 50th and 60th birthdays, you certainly don’t get extra privileges. Usually the opposite is true; there are fewer job opportunities and more discrimination. Menopause is a radical transition which occurs on the physical, mental, emotional and spiritual planes; a transition from the childbearing years to the non-childbearing years and also a transition in which women can be truer to themselves and contribute to their larger community.
TESTING YOUR HORMONE LEVELS
• THE SALIVA TEST The blood test for hormones can be used to determine the level of your hormones when you go into menopause, and whether or not you are extremely estrogen or progesterone deficient. The saliva test, however, is more accurate in its measurement of hormones, and you can do it yourself. For information, call ZRT Labs (Dr. Zava) or Google saliva tests in your area. You send a sample of spit, and they will measure your estrogen, progesterone, free testosterone and DHEA.
• DHEA is one screening test to give an indication of your adrenal function. If your DHEA is rock bottom, then you know that your adrenal glands are functioning very low. DHEA is low in most women who are approaching menopause. DHEA is a mother hormone and can convert either to estrogen or testosterone. It is a useful supplement and women can take anywhere from 10 to 20 mg a day. Unfortunately, you need to obtain special permission from the government to take it. Your physician has to make the application to the government. I do not recommend DHEA for women who have breast cancer, or men who have prostate cancer because it can increase estrogen and testosterone levels.
• If you are going into menopause and you don’t know your bone density, you can ask your doctor for a bone density test. I highly recommend it if you are trying to decide whether or not you need hormones. You can be having irregular or normal cycles and yet may not be ovulating, therefore possibly losing bone. Natural progesterone is a very bone-specific hormone. Testosterone is often the missing key. Sometimes women have very low testosterone. Testosterone and DHEA are also very important for bones. Weight training is essential because it actually builds bone mass as well as muscle mass. The program in the book Strong Women Stay Young by M. Wilson is easy to follow and highly recommended.
THE ABCs OF HORMONE THERAPY
Progesterone is usually lower than estrogen at menopause. Premarin, a natural estrogen derived from pregnant mare’s urine, is one of the most widely used billion dollar drugs. But most research done on menopause hasn’t even included progesterone. Progesterone declines far more than estrogen at menopause and that is a very key factor. Progesterone is the mother hormone which is used in the body to make other hormones. Progesterone, through a series of steps, leads to estrone and estradiol (two different types of estrogen) and testosterone. So it is a precursor hormone which can convert into either estrogen or testosterone. By the way, you need cholesterol to make progesterone; if your cholesterol is too low it can have an adverse effect on your hormone levels.
• Natural Vs. Synthetic Hormones — All hormones, even synthetic ones, are derived from natural ingredients: but this does not make them natural. And all hormones, even natural hormones, are made in the lab. Natural progesterone is made in the lab from a natural source. Hormones are natural only if they are identical to the hormones in your own body: that is if they have identical structures or are bioidentical. If the progesterone is natural, you have something which the body can recognize.
• Synthetic Progesterone — Provera is one of the synthetic progesterones. It looks completely different from natural progesterone and doesn’t have the same kind of action. Provera causes bloating, mood swings, depression, PMS-like symptoms, and also bleeding. It causes more bleeding than natural progesterone, which can also cause a little bit of spotting, which will disappear after a few months.
• Natural Progesterone — Right now in Canada, natural progesterone is not available except by prescription. An oral form is now available called Prometrium. It has been available in Europe for 40 years. European women just wouldn’t put up with a synthetic progesterone like Provera and its side effects. Natural progesterone is broken down in the stomach. It causes drowsiness and sleepiness, which is very handy if you are menopausal, because most menopausal and peri-menopausal women have sleep problems. It may cause vaginal bleeding or spotting, which disappears over time. Natural progesterone comes in oral, vaginal and trans-dermal form (skin cream).
• Progesterone Creams — Progesterone may come from wild yam or soy bean, but it has to be converted in the lab from its precursor, diosgenin. This process requires three chemical steps and cannot be converted in your body.
Beware the wild yam scam — there are many wild yam creams on the Canadian market today which contain no natural progesterone or only insignificant amounts that have no hormonal action whatsoever. They are being marketed as containing natural progesterone or as being equivalent to natural progesterone creams, but natural progesterone creams have been taken off the market. Their sale is against the law right now in Canada.
• Methods of Applying Natural Progesterone Cream — When you are applying progesterone cream to the skin, it is best to rotate the area where you apply the cream. Day One — face, Day Two— neck, Day Three — inner arms or back of thighs, Day Four — hands, and Day Five apply to the soles of feet. And then on day one, repeat the cycle. You have to rotate the sites because otherwise the fatty tissue will become saturated with natural progesterone, and may not absorb as much. As a result you won’t get a constant dosage. For menstruating women, the usual dose is 1/4 to 1/2 tsp. twice a day from day 12 or 14 to 26; for menopausal women, use it for 21 days out of every month. According to Dr. John Lee – and I think he is right – receptors become over-stimulated; so you must stop to give them a rest at least 5 to 7 days a month. You want to try and mimic the natural cycle as much as you can. I don’t think any hormone should be taken continuously, unless you are having very severe symptoms (and only for a short period of time).
• Pharmacies That Compound Natural Hormones — Many doctors are prescribing natural hormones, and Canada does have pharmacies that compound natural hormones. They have to actually grind them up as pharmacists used to do when their preparations were made from scratch. In Vancouver, try Kripp’s Pharmacy; in Toronto, visit Hooper’s Pharmacy, Smith’s Pharmacy, York Downs Pharmacy, Markie’s Pharmacy, The Medicine Shoppe at 2917 Bloor W., and many others. All these pharmacies will make up a formula with natural progesterone, natural estrogen, natural testosterone, or whatever you need. Kripp’s Pharmacy also has DHEA, which you can get by obtaining permission from the government through your doctor. The government will have Kripp’s ship it to your doctor. The red tape to obtain DHEA has increased recently, however.
• Oral Progesterone — Prometrium oral progesterone is available by prescription from any pharmacy. Oral micronized progesterone does bypass the liver, according to some researchers. The suggested dose of the oral form, oral micronized progesterone, is 25 to 50 mg to 100 to 200 mg at bedtime every night for 21 days of the month. If you are menstruating, only take it 10 to 14 days a month. After you stop menstruating, take it 21 to 25 days a month. It is possible to overdose on natural progesterone. To determine your hormone levels, ask your doctor to get a blood level of estrogen, progesterone, free testosterone, DHEA sulphate.
• Effects of Natural Progesterone — Natural progesterone has quite a few advantages for both peri-menopause and the menopause, and studies have indicated it protects from breast and uterine cancer. One study demonstrated that oral progesterone alone provided relief from all menopausal symptoms. It appears to prevent, and even reverse, bone loss. Most bone loss occurs in the first five years of menopause, and after that bone loss slows down. Research on oral progesterone demonstrates it also has a very favourable effect on blood lipids. It actually increases high density HDL cholesterol, which is the good cholesterol (unlike the synthetic Provera which actually has a negative effect on blood cholesterol).
References: Recommended Books
Carolyn DeMarco — Take Charge of Your Body
Alan Gaby — Preventing and Reversing Osteoporosis
Susan Love — Hormone Book
John Lee — What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About PreMenopause
Miriam Nelson — Strong Women Stay Young (weight-training)
Rina Nissam — Natural Healing in Gynecology
Leslie Kenton — Passage to Power
Jensen and Lorna Vanderhaeghe — No More HRT: Menopause, Treat the Cause
(This is Part One of a Two-Part Series on Hormone Replacement Therapy by Dr. DeMarco, MD)