family practice 15 years of practice bellevue specializing in natural medicine : nutrition,...
TRANSCRIPT
Trina Seligman, N.D., L.Acwww.DrTrinaSeligman.com
Bio-identical Hormones:
The Treatment of Menopause
Naturopathic Medicine
Family practice 15 years of practice Bellevue Specializing in natural medicine : nutrition,
herbs, bio-identicals, lifestyle, Acupuncture My approach is Integrative: integrating the
best of conventional and natural medicines and integrating care with your other physicians.
Covered by all insurance companies
Why Use Hormones ?
The symptoms of menopause can start as early as the late-30’s, with most significant symptoms in the late 40’s
Symptoms include: hot flashes, nightsweats, sleep disturbance, depression, anxiety, weight gain, arrhythmia, vaginal dryness, low libido, cognitive changes, changes in pelvic floor/urethral tissue, menstrual cycle changes, headaches/migraines, fatigue etc……
What are Bio-identical Hormones
“Bio-identical” is a term that was coined to mean ‘biologically identical’.
Prior to menopause, a woman produces 3 different estrogens:
•Estrone
•Estradiol
•Estriol
A woman also produces Progesterone
DH
EA
Testo
stero
ne
Synthetic Hormones
Examples of Estrogen:Ethinyl EstradiolConjugated Equine Estrogens (Premarin)Estradiol Acetate
“Progesterone” actually, should be called a Progestin:MedroxyprogesteroneNorethindroneDrospirenoneLevonorgestrel
Methyl-testosteroneAlthough DHEA declines with age and can impact the symptoms of menopause, it is not usually treated by OBGyn’s
Bio-identical vs Synthetic Estrone Estradiol Estriol
Progesterone
Testosterone
DHEA
Ethinyl Estradiol Conjugated Equine
Estrogens Esterified estrogens Estradiol acetate
Medroxyprogesterone Norethindrone Drospirenone Levonorgestrel
Methyltestosterone
Bio-Identical VS Synthetic
PEPI study 1995
Postmenopausal Estrogen/Progestin Interventions Trial
Premarin + bio-identical progesterone, Premarin alone, Premarin +medroxyprogesterone
Increased HDL cholesterol was seen to the greatest benefit with the bio-identical progesterone group.
Women’s Health Initiative(WHI), 2002
Study of Premarin (conjugated equine estrogens) or Prempro (Premarin + medroxyprogesterone)
Over 16,000 women Study was halted due to increased risk
of breast cancer, stroke, and blood clots.
Bio-Identical Research
Estradiol is assoc. with increased risk of breast cancer when used for >5 years, but not <5 years.
French E3N-EPIC study of over 54,000 women found greater risk of breast cancer with synthetic progestins. 2005
Natural Progesterone has an anti-proliferative effect on breast tissue
Prometrium when compared to Progestin did not adversely effect HDL
Preliminary research shows E2 +Prometrium protect against coronary vasospasm (contrary to Progestin)
Estriol –preliminary research suggests it may be protective to breast tissue
More Bio-identicals….
Estrogen alone has a beneficial effect on bone density; estrogen + progesterone the results are mixed.
Progesterone has a calming effect on the nervous system, Progestins actually increased risk of dementia.
Reasons to Consider or Decline Treatment
Menopause is NOT a disease, it is a stage of life:
Treat based on Quality of Life symptoms
Genetics Personal Philosophy Treat with the lowest possible dose to
alleviate side effects, for the shortest duration (usually 5 years)
Lab Testing
Salivary testing Blood testing Urine testing
Testing of estrogen & progesterone is not necessary, unless needed to monitor efficacy & safety of treatment
Testing of DHEA-S and testosterone can be helpful
Benefits of Blood testing
Where are they from ?
Originally derived from soy or wild yam (dioscorea), chemically modified
Compounding pharmacies-benefits of individual dosing, different delivery systems, lack of additives/chemicals to formulations
“Bi-est” meaning two estrogens; estradiol and estriol (80/20)
Progesterone
Using the Hormones
Creams (transdermal) Sublingual drops Pills suppositories
Bio-identicals:Compounding vs Pharmacy Bi-est
Progesterone
Testosterone DHEA
Estradiol tablet (Estrace, Gynodiol)
-Vivelle, Climara, Estraderm, Menostar
Estring, Estrace, Vagifem
Prometrium
No testosterone or DHEA alternative from conventional pharmacies.
Bio-identicals from a Pharmacy: are they Natural ?!
Estrace: includes corn starch, lactose, blue 1, red 27, yellow 5 (tartrazine)
Estrace Cream: includes propylene glycol, sodium lauryl sulfate, methylparaben, EDTA (an organic pollutant), tertiary-butylhydroquinone (an organic phenol)
Prometrium : contains peanut oil, yellow 10 and red 40
What is “anti-aging” ?
Suzanne Somers What does “anti-aging” mean ? Dose of hormones Menstrual cycles Continued use of hormones > 5 years Long term safety is not known
Other Natural Treatments
Herbal medicine: Phytoestrogens: dang quai, black
cohosh, soy, cimicifuga, Phytoprogesterones: dioscorea, vitex, glycyrrhiza
No plant-based DHEA or testosterone Other libido-assisting herbs: maca,
damiana leaf, black cohosh, dioscorea, ashwaghanda, muira puama, ginko biloba
Other Herbs
Herbal medicine can also help with sleep issues, depression, anxiety, cholesterol
Nutritional Supplements: evening primrose oil, hesperidin, flax seed, ipriflavone
Vitamin D,calcium,magnesium strontium, boron, minerals Acupuncture: Lifestyle : Diet –alcohol, sugar, sleep, Decreasing processed foods exercise
Other Preventive Measures
Bloodwork: chemistry, CBC, TSH, lipid panel, 25-OH-vitamin D, CRP, homocysteine
Consider VAP testing Bone Density: 1 year post-menopause Colonscopy: age 50 Mammogram Annual pap/physical Consider advanced nutrition testing
In Closing…..
Hormone Replacement is an individual decision, based on quality of life issues, genetics and personal philosophy
Bio-identical hormones are “biologically identical”
Compounding pharmacies specialize in manufacturing natural products including hormones
Research is limited Safety is a balance Testing is not necessary, unless to
assess treatment efficacy & Safety Anti-aging has not been studied long-
term Acupuncture, herbal medicine, lifestyle
Trina Seligman425-646-4747
www.eimed.comwww.DrTrinaSeligman.com
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Additional Reading
Natural Progesterone: The Multiple Roles of a Remarkable Hormone. Dr. John Lee
The Wisdom of Menopause. Christiane Northrup
What your doctor may not tell you about menopause.
Dr. John Lee
Natural Hormone Replacement. Jonathan Wright
Smart Medicine for Menopause. Sandra Cabot
Screaming to be heard. Elizabeth Vliet
The Hormone of Desire. Susan Rako