Can I avoid Menopause altogether?
Women who struggle with perimenopause and menopausal symptoms often feel like it’s a burden they have to carry. These symptoms most frequently include: hot flashes/night sweats, mood, depression, cognitive issues, fog-brain, cloudy thinking, can’t come up with a name, a word, or a number, can’t go to sleep or wake up, and can’t go back to sleep, hair, skin, vaginal, lack of sexual desire, fatigue, and weight gain. These symptoms can make a woman feel as though life is slipping away.
However, several safe solutions can help women feel energized and confident 365 days a year! All of these symptoms can be resolved, and this blog post is dedicated to answering some frequently asked questions in depth.
Today’s Covered Questions:
Is there a way to simply avoid altogether the symptoms that women associate with Perimenopause and Menopause?
Do the regimens used as HRT (Hormone Replacement Therapy) have side-effects or risks that can predispose to cancer?
Do I need to get my hormone levels checked and, if so, when and how often?
How would it be determined what specific kind of HRT I need, and how would it be dosed?
After starting HRT, how long should women stay on it?
Where does simply “having a hysterectomy and being ‘done with it’” fit into this discussion?
Answers:
Can a woman altogether avoid the symptoms that characterize menopause and perimenopause?
The answer to this question is, for 99% of women, YES, absolutely! The problematic and irregular bleeding of perimenopause — YES — can be stopped! The enhanced premenstrual symptomatology around this time – YES – can be eliminated! All of the associated symptoms can be done away with by helping women turn the clock back and feel, both mentally and physically, like you did 10 years ago. Again, all these symptoms can be avoided in nearly all women; you don’t need to put up with any of them. Furthermore, it’s not “age-related”; it is GYN-related, and you can get back to feeling 100% normal all the time.
If I were to start on HRT (Hormone Replacement Therapy), are there significant side effects or risks, and, specifically, is it true that Hormone Replacement Therapy predisposes to cancer?
The answer to this question is that there is ZERO increased risk of cancer with Hormone Replacement Therapy, when given in the right way and in the right doses. In fact, the exact opposite is true. Not only does HRT not cause cancer, but people on HRT generally live longer and have fewer cancers. Let me ask a somewhat rhetorical question: If a woman has a declining output of certain hormone molecules in her body, how would restoring the identical hormone molecules cause cancer, or any other problem, for that matter? From a logical and theoretical point of view, simply restoring what was already there would not cause any negative side effects. This fact has also been demonstrated in real-world clinical data countless times. So, again, there is NO increased risk of cancer or negative side effects when given in the right way and in the right doses.
Should I get my hormone levels checked and, if so, how often? Would such hormone tests have any bearing on whether I should start Hormone Replacement Therapy?
The short answer to this question is that you may not need to get your hormone levels checked at all. That’s the short answer, however, now let me give you the longer answer. Beginning around age 40 there is a gradual decline in hormone output from the ovaries, and this decline continues until a woman is between 60-70. It is a very long time from a woman’s normal level in her 20s and 30s to a very low level in the later stages of life. Some women drop suddenly around age 40 and then decline more gradually after that. Others tend to maintain regular premenopausal blood-hormone levels until much later, and then later on experience a decline.
However, in either case, ALL women’s ovarian output eventually declines, and they all will go through a certain threshold, and most—but not all— will then have some of the symptoms of hormone deficiency. The most common symptoms associated with this decline are hot flashes and night sweats, but they can also have mood problems, cognitive issues, sleep dysfunction, lack of sexual desire, and others. So, if a woman says, “Okay, I’m in this age group, and a few months ago I started having some hot flashes or night sweats,” it’s a pretty good bet that she has dropped through that threshold. Therefore, it’s highly likely that were she to take the appropriate bioidentical supplement, these symptoms would completely disappear.
If at the same time, she says she also has begun having some of the other symptoms listed, it will likely all go away with a bioidentical supplement. This is why your provider needs to ask the right questions and have a healthy dialogue about when symptoms started and what would be the right course of treatment.
If you took a survey of all women, about 70% would have some of these symptoms at some point in the declining phase. Whereas 30% would have no symptoms whatsoever. Those are the older ladies you may know who would say, “I have other problems in my life—I just never had any of these problems.” That’s wonderful! However, that still leaves the 70% of women who do have symptoms, and that’s everything from hardly any to terrible (“I can’t think, I can’t sleep, I’m a ‘basket case.’”)
To summarize, women who do not have complaints, or only minimal ones, probably do not need HRT. Those at the other end of the spectrum certainly do benefit tremendously. For them, it’s not only a life-changer, but they’ll live longer and have fewer overall health problems, including a significantly lower likelihood of later on developing cognitive problems such as dementia.
To find out whether a woman would need treatment, should she have her hormones checked?
To properly understand this issue, you first need to understand that there is a very wide range of normal for all these hormones in question. By way of example, let’s use a scale of 20 to 80. So, if a woman is in the sub-basement (10), but she feels fine, then she doesn’t need anything. On the other hand, if she’s in the middle of the normal range (40), but she describes having hot flashes and night sweats along with other symptoms, she needs to be a little higher.
The point is that whether to begin HRT in the first place is mainly based on symptoms, not on blood levels. We’re certainly not against checking hormone levels if somebody wants to have them checked, but as a general rule, these tests are not usually necessary and generally are unhelpful.
How do you know the proper dose of HRT (Hormone Replacement Therapy) that a woman should take, and what are the differences in the way it’s given?
Again, dosing is largely determined based on symptomatology. Typically, we try to figure out what the lowest dose is to eliminate symptoms. Hormone-wise, there are three outputs from the ovaries: Estrogen, Progesterone, and Testosterone.
The Estrogen component (the formal name, “Estradiol”), will get rid of the hot flashes and night sweats—that’s known and proven. It will also get rid of certain other symptoms including mood swings, depression, cognition problems including “fog-brain”, cloudy thinking, can’t come up with a name/word/number, etc. When a woman has a subset of these complaints, and she’s in the 35-55 age group, the Estradiol supplement restores that woman to normal. It’s a wonderful solution for most women and it can be life-changing.
Importantly, when women have a uterus in place (in other words, they have not had a hysterectomy) it’s required to also give a Progesterone component to balance the Estrogen. Generally, it’s the Estrogen that’s the workhorse, but we also give the Progesterone to not cause an imbalance.
Testosterone also is produced in the ovaries which surprises some people. Many would think Testosterone is a male hormone and Estrogen is a woman’s. One indeed does dominate in each sex, but Testosterone has 2-3 key roles in women. Specifically, in some women Testosterone seems to have a positive impact in three categories:
It can restore libido in many cases
In some women it seems to have a positive effect on mood, mainly “enthusiasm” and “zest for life”
Lastly, it helps maintain a woman’s muscle mass and strength.
There’s rarely a downside to giving women Testosterone, so if any of these issues are present, we generally recommend it.
What is the best way for HRT to be taken?
Bioidentical Human Estrogen (Estradiol) can be formulated and given in many ways. It can be given orally, through the skin with patches and creams, injected by shot, or placed under the skin with a special kind of needle in the form of a pellet. Of course, many people might prefer to take a pill, but the problem with taking a pill is that it’s degraded in the stomach acid and further changed in the liver. Therefore, the form of Estrogen that eventually gets into a woman’s bloodstream is not the bioidentical form. Therefore, in our practice we usually prefer to start with the “through-the-skin method,” the transdermal Estradiol patch. We also give oral bioidentical Progesterone when warranted, as mentioned previously.
We also highly recommend pellets. Many women indeed respond to these better than anything else. We usually don’t start with Pellets, but if a woman is not optimized, Pellets as an important option.
I want to circle back to the Libido question briefly. If a woman specifically says that her libido is diminished, we will frequently give her a Testosterone shot. About 2/3 of women will say that this Testosterone injection restored their Libido. Based on a woman’s response to that shot, we may repeat it a few times and sometimes we’ll consider the Pellets. The Libido issue is a longer story and we will dive into this in subsequent blogs. Alternatively, please feel free to call our office and speak with one of our nurses, if have specific questions about the libido issue.
Once started, how long am I supposed to stay on HRT?
Once a woman is situated on the proper dose of HRT, the question usually comes up, “How long should I stay on it?” The answer to that question is, as long as it’s helping! The average time would be about 5-7 years, but it varies based on whether the symptoms persist. For example, suppose a woman goes out of town and forgets to take the supplement with her. If she gradually realizes she is not having the symptoms she once had, she can probably discontinue it altogether. The reverse is also true. If symptoms are persisting, she needs to stay on it. We have quite a few patients who seem to benefit from HRT well into their 70s, and we’ve also had a few in their 80s.
Where does a Hysterectomy fit into all of this?
To start with, a hysterectomy is a major surgical procedure that removes the uterus; many doctors at the time of a hysterectomy will also remove the ovaries, technically called, “hysterectomy with a bilateral salpingo-oophorectomy.” Hysterectomies usually involve women being out of work for 4-6 weeks, and there can be significant complications—not common, but possible. Needless to say, I am not against hysterectomies at all, and I’ve done thousands of them, but you need to realize that these are major surgeries.
With that said, are there too many hysterectomies being done? Well, let’s put it this way. ~70% of hysterectomies in the US are not done for cancer or large tumors—they’re done for problem periods. To be specific, a “problem period” is when a woman is struggling with anemia as well as other problems, generally what we refer to as Premenstrual Syndrome—headache, mood, fatigue, etc. It is precisely these kinds of situations, i.e., the anatomy is normal but the period is very disruptive to her life, in which the Endometrial Ablation procedure serves the same purpose as a hysterectomy but at a tiny fraction of the invasiveness and down-time.
Again, when it’s mainly the problem periods or PMS symptomatology that is bothering a woman, Endometrial Ablation is the better choice for most women. It’s 1% as invasive, and women are back at work the next day. No cutting, no stitches, and nothing structural. I’ve personally performed thousands of hysterectomies and they need to be done if they’re necessary. But the minimally invasive approach that accomplishes the same purpose and has women back at work the next day should be considered first in most cases. Our medical practice now specializes in Endometrial Ablation. We’ve done 6,000 of these procedures and have the best success rate in the Southeast.
I hope by reading this you have found the answers you are looking for. Our office specializes in the forms of treatment I’ve discussed, and we’ve seen excellent results. If you would like help with HRT, Endometrial Ablation, and Perimenopausal care, fill out a contact form and we’ll be in touch.
Dr. Clint Ashford
