Tuesday, May 18, 2010

A Standard of Care Approach To Menopause. I Propose The Wiley Protocol


Menopause is an individualized experience. Some women notice little difference in their bodies or moods, while others find the change extremely bothersome and disruptive. Estrogen and progesterone affect virtually all tissues in the body, but everyone is influenced by them differently.

Hot Flashes

Hot flashes, or flushes, are the most common symptom of menopause, affecting more than 60 percent of menopausal women in the U.S. A hot flash is a sudden sensation of intense heat in the upper part or all of the body. The face and neck may become flushed, with red blotches appearing on the chest, back, and arms. This is often followed by profuse sweating and then cold shivering as body temperature readjusts. A hot flash can last a few moments or 30 minutes or longer.

Hot flashes occur sporadically and often start several years before other signs of menopause. They gradually decline in frequency and intensity as you age. Eighty percent of all women with hot flashes have them for 2 years or less, while a small percentage have them for more than 5 years. Hot flashes can happen at any time. They can be as mild as a light blush, or severe enough to wake you from a deep sleep. Some women even develop insomnia. Others have experienced that caffeine, alcohol, hot drinks, spicy foods, and stressful or frightening events can sometimes trigger a hot flash. However, avoiding these triggers will not necessarily prevent all episodes.

Hot flashes appear to be a direct result of decreasing estrogen levels. In response to falling estrogen levels, your glands release higher amounts of other hormones that affect the brain's thermostat, causing body temperatures to fluctuate. Hormone therapy relieves the discomfort of hot flashes in most cases.

Some women claim that vitamin E offers minor relief, although there has never been a study to confirm it. Aside from hormone therapy, which is not for everyone, here are some suggestions for coping with hot flashes:
* Dress in layers so you can remove them at the first sign of a flash.
* Drink a glass of cold water or juice at the onset of a flash.
* At night keep a thermos of ice water or an ice pack by your bed.
* Use cotton sheets, lingerie and clothing to let your skin "breathe."

Vaginal/Urinary Tract Changes

With advancing age, the walls of the vagina become thinner, dryer, less elastic and more vulnerable to infection. These changes can make sexual intercourse uncomfortable or painful. Most women find it helpful to lubricate the vagina. Water-soluble lubricants are preferable, as they help reduce the chance of infection. Try to avoid petroleum jelly; many women are allergic, and it damages condoms. Be sure to see your gynecologist if problems persist.

Tissues in the urinary tract also change with age, sometimes leaving women more susceptible to involuntary loss of urine (incontinence), particularly if certain chronic illnesses or urinary infections are also present. Exercise, coughing, laughing, lifting heavy objects or similar movements that put pressure on the bladder may cause small amounts of urine to leak. Lack of regular physical exercise may contribute to this condition. It's important to know, however, that incontinence is not a normal part of aging, to be masked by using adult diapers. Rather, it is usually a treatable condition that warrants medical evaluation. Recent research has shown that bladder training is a simple and effective treatment for most cases of incontinence and is less expensive and safer than medication or surgery.

Within 4 or 5 years after the final menstrual period, there is an increased chance of vaginal and urinary tract infections. If symptoms such as painful or overly frequent urination occur, consult your doctor. Infections are easily treated with antibiotics, but often tend to recur. To help prevent these infections, urinate before and after intercourse, be sure your bladder is not full for long periods, drink plenty of fluids, and keep your genital area clean. Douching is not thought to be effective in preventing infection.

Side View of the Pelvis

The side view of the pelvis and its contents after menopause shows the slight dropping of the uterus, bladder and rectum. Also notice how the vagina becomes shorter and narrower.
Source: W.Utian and R.Jacobowitz, Managing Your Menopause, New York: Prentice Hall Press/Simon & Shuster, 1990, p.29.

Menopause and Mental Health

A popular myth pictures the menopausal woman shifting from raging, angry moods into depressive, doleful slumps with no apparent reason or warning. However, a study by psychologists at the University of Pittsburgh suggests that menopause does not cause unpredictable mood swings, depression, or even stress in most women.

In fact, it may even improve mental health for some. This gives further support to the idea that menopause is not necessarily a negative experience. The Pittsburgh study looked at three different groups of women: menstruating, menopausal with no treatment, and menopausal on hormone therapy. The study showed that the menopausal women suffered no more anxiety, depression, anger, nervousness or feelings of stress than the group of menstruating women in the same age range. In addition, although more hot flashes were reported by the menopausal women not taking hormones, surprisingly they had better overall mental health than the other two groups. The women taking hormones worried more about their bodies and were somewhat more depressed.

However, this could be caused by the hormones themselves. It's also possible that women who voluntarily take hormones tend to be more conscious of their bodies in the first place. The researchers caution that their study includes only healthy women, so results may apply only to them. Other studies show that women already taking hormones who are experiencing mood or behavioral problems sometimes respond well to a change in dosage or type of estrogen.

Studies indicate that women of childbearing age, particularly those with young children at home, tend to report more emotional problems than women of other ages.

The Pittsburgh findings are supported by a New England Research Institute study which found that menopausal women were no more depressed than the general population: about 10 percent are occasionally depressed and 5 percent are persistently depressed. The exception is women who undergo surgical menopause. Their depression rate is reportedly double that of women who have a natural menopause.

Studies also have indicated that many cases of depression relate more to life stresses or "mid-life crises" than to menopause. Such stresses include: an alteration in family roles, as when your children are grown and move out of the house, no longer "needing" mom; a changing social support network, which may happen after a divorce if you no longer socialize with friends you met through your husband; interpersonal losses, as when a parent, spouse or other close relative dies; and your own aging and the beginning of physical illness. People have very different responses to stress and crisis. Your best friend's response may be negative, leaving her open to emotional distress and depression, while yours is positive, resulting in achievement of your goals. For many women, this stage of life can actually be a period of enormous freedom.

What About Sex?

For some women, but by no means all, menopause brings a decrease in sexual activity. Reduced hormone levels cause subtle changes in the genital tissues and are thought to be linked also to a decline in sexual interest. Lower estrogen levels decrease the blood supply to the vagina and the nerves and glands surrounding it. This makes delicate tissues thinner, drier, and less able to produce secretions to comfortably lubricate before and during intercourse. Avoiding sex is not necessary, however. Estrogen creams and oral estrogen can restore secretions and tissue elasticity. Water-soluble lubricants can also help.

While changes in hormone production are cited as the major reason for changes in sexual behavior, many other interpersonal, psychological, and cultural factors can come into play. For instance, a Swedish study found that many women use menopause as an excuse to stop sex completely after years of disinterest. Many physicians, however, question if declining interest is the cause or the result of less frequent intercourse.

Some women actually feel liberated after menopause and report an increased interest in sex. They say they feel relieved that pregnancy is no longer a worry.

For women in perimenopause, birth control is a confusing issue. Doctors advise all women who have menstruated, even if irregularly, within the past year to continue using birth control. Unfortunately, contraceptive options are limited. Hormone-based oral and implantable contraceptives are risky in older women who smoke. Only a few brands of IUD are on the market. The other options are barrier methods--diaphragms, condoms, and sponges--or methods requiring surgery such as tubal ligation.

Is My Partner Still Interested?

Some men go through their own set of doubts in middle age. They, too, often report a decline in sexual activity after age 50. It may take more time to reach ejaculation, or they may not be able to reach it at all. Many fear they will fail sexually as they get older. Remember, at any age sexual problems can arise if there are doubts about performance. If both partners are well informed about normal genital changes, each can be more understanding and make allowances rather than unmeetable demands. Open, candid communication between partners is important to ensure a successful sex life well into your seventies and eighties.

For most women, natural menopause is not a major crisis and does not influence their opinion of their general health.




One of the most important health issues for middle-aged women is the threat of osteoporosis. It is a condition in which bones become thin, fragile, and highly prone to fracture. Numerous studies over the past 10 years have linked estrogen insufficiency to this gradual, yet debilitating disease. In fact, osteoporosis is more closely related to menopause than to a woman's chronological age.

Bones are not inert. They are made up of healthy, living tissue which continuously performs two processes: breakdown and formation of new bone tissue. The two are closely linked. If breakdown exceeds formation, bone tissue is lost and bones become thin and brittle. Gradually and without discomfort, bone loss leads to a weakened skeleton incapable of supporting normal daily activities.

Each year about 500,000 American women will fracture a vertebrae, the bones that make up the spine, and about 300,000 will fracture a hip. Nationwide, treatment for osteoporotic fractures costs up to $10 billion per year, with hip fractures the most expensive. Vertebral fractures lead to curvature of the spine, loss of height, and pain. A severe hip fracture is painful and recovery may involve a long period of bed rest. Between 12 and 20 percent of those who suffer a hip fracture do not survive the 6 months after the fracture. At least half of those who do survive require help in performing daily living activities, and 15 to 25 percent will need to enter a long-term care facility. Older patients are rarely given the chance for full rehabilitation after a fall. However, with adequate time and care provided in rehabilitation, many people can regain their independence and return to their previous activities.

Healthy bone Osteoporotic bone

Source: Dr. Robert Lindsay, Helen Hayes Hospital, West Haverstraw, N.Y.

For osteoporosis, researchers believe that an ounce of prevention is worth a pound of cure. The condition of an older woman's skeleton depends on two things: the peak amount of bone attained before menopause and the rate of the bone loss thereafter. Hereditary factors are important in determining peak bone mass. For instance, studies show that black women attain a greater spinal mass and therefore have fewer osteoporotic fractures than white women. Other factors that help increase bone mass include adequate intake of dietary calcium and vitamin D, particularly in young children prior to puberty; exposure to sunlight; and physical exercise. These elements also help slow the rate of bone loss. Certain other physiological stresses can quicken bone loss, such as pregnancy, nursing, and immobility. The biggest culprit in the process of bone loss is estrogen deficiency. Bone loss quickens during perimenopause, the transitional phase when estrogen levels drop significantly.

Doctors believe the best strategy for osteoporosis is prevention because currently available treatments only halt bone loss--they don't rebuild the bone. However, researchers are hopeful that in the future, bone loss will be reversible. Building up your reserves of bone before you start to lose it during perimenopause helps bank against future losses. The most effective therapy against osteoporosis available today for postmenopausal women is estrogen (see Managing Menopause). Remarkably, estrogen saves more bone tissue than even very large daily doses of calcium. Estrogen is not a panacea, however. While it is a boon for the bones, it also affects all other tissues and organs in the body, and not always positively. Its impact on the other areas of the body must be considered.

Cardiovascular Disease

Most people picture an older, overweight man when they think of a likely candidate for cardiovascular disease (CVD). But men are only half the story. Heart disease is the number one killer of American women and is responsible for half of all the deaths of women over age 50. Ironically, in past years women were rarely included in clinical heart studies, but finally physicians have realized that it is as much a woman's disease as a man's.

Influences on Bone Development
Increases bone formation Speeds bone loss
Dietary calcium Estrogen deficiency
Vitamin D Pregnancy
Exposure to sunlight Nursing
Exercise Lack of exercise

CVDs are disorders of the heart and circulatory system. They include thickening of the arteries (atherosclerosis) that serve the heart and limbs, high blood pressure, angina, and stroke. For reasons unknown, estrogen helps protect women against CVD during the childbearing years. This is true even when they have the same risk factors as men, including smoking, high blood cholesterol levels, and a family history of heart disease. But the protection is temporary. After menopause, the incidence of CVD increases, with each passing year posing a greater risk. The good news, though, is that CVD can be prevented or at least reduced by early recognition, lifestyle changes and, many physicians believe, hormone replacement therapy.

Menopause brings changes in the level of fats in a woman's blood. These fats, called lipids, are used as a source of fuel for all cells. The amount of lipids per unit of blood determines a person's cholesterol count. There are two components of cholesterol: high density lipoprotein (HDL) cholesterol, which is associated with a beneficial, cleansing effect in the bloodstream, and low density lipoprotein (LDL) cholesterol, which encourages fat to accumulate on the walls of arteries and eventually clog them. To remember the difference, think of the H in HDL as the healthy cholesterol, and the L in LDL as lethal. LDL cholesterol appears to increase while HDL decreases in postmenopausal women as a direct result of estrogen deficiency. Elevated LDL and total cholesterol can lead to stroke, heart attack, and death.

Percentage of Deaths from Specific Conditions


Hormone Replacement Therapy

To combat the symptoms associated with falling estrogen levels, doctors have turned to hormone replacement therapy (HRT). HRT is the administration of the female hormones estrogen and progesterone. Estrogen replacement therapy (ERT) refers to administration of estrogen alone. The hormones are usually given in pill form, though sometimes skin patches and vaginal creams (just estrogen) are used. ERT is thought to help prevent the devastating effects of heart disease and osteoporosis, conditions that are often difficult and expensive to treat once they appear. The cardiovascular effects of progesterone, however, are still unknown. Hormone treatment for menopause is still quite controversial. Its long-term safety and efficacy remain matters of great concern. There is not enough existing data for physicians to suggest that HRT is the right choice for all women. Several large studies are currently attempting to resolve the questions, though it will take several more years to reach any definitive answers.

In the 1940's when estrogen was first offered to menopausal women, it was given alone and in high doses. Today, after 50 years of trial and error, it is well known that estrogen stimulates growth of the inner lining of the uterus (endometrium) that sheds during menstruation. This growth may continue uncontrollably, resulting in cancer. Today, doctors typically prescribe a lower dose of estrogen. However, few doctors still prescribe estrogen alone to women who have a uterus. Most now prefer to add a synthetic form of progesterone called progestin to counteract estrogen's dangerous effect on the uterus. Progestin reduces the risk of cancer by causing monthly shedding of the endometrium. The obvious drawback to this approach is that menopausal women resume monthly bleeding. Once menopause arrives, most women enjoy the freedom of life without a period. Many are reluctant to begin their cycles again. In addition, there are other unpleasant side effects of progestin which often discourage women from continuing HRT. These include breast tenderness, bloating, abdominal cramping, anxiety, irritability, and depression.

Only about 15 percent of women who are eligible for hormone replacement therapy are now receiving it. This leaves 85 percent who either do not want or need it, or do not know about it.

The good news is that researchers are evaluating different schedules of low-dose estrogen and progestin to completely eliminate monthly bleeding. Currently most women receive what is called cyclic HRT. They may take estrogen continually and progestin for the first 12 days of each month. The use of a continuous combined dose, where estrogen and smaller amounts of progestin are taken every day, is also being studied. In theory, this use of progestin stems endometrial growth so no bleeding will occur. Unfortunately, it may take 6 months or more until bleeding finally stops. In many cases, monthly bleeding has been replaced by more bothersome irregular bleeding patterns. Obviously, further research is needed to evaluate and perfect this treatment. Various types of progestins in different dosages, preparations, and schedules are being studied in hopes of reducing its other unpleasant side effects while retaining the known advantages of estrogen.

Estrogen and Your Bones

HRT and ERT are successful methods of combatting osteoporosis. As previously discussed, estrogen halts bone loss but cannot necessarily rebuild bone. Long-term estrogen use (10 or more years) may be required to prevent postmenopausal bone loss. Why estrogen helps protect the skeleton is still unclear. We do know that estrogen helps bones absorb the calcium they need to stay strong. It also helps conserve the calcium stored in the bones by encouraging other cells to use dietary calcium more efficiently. For instance, muscles require calcium to contract. If there is not enough calcium circulating in the blood for muscles to use, calcium is "borrowed" from the bone. Calcium is also needed for blood clotting, sending nerve impulses, and secreting various hormones. Prolonged borrowing from bone calcium for these processes speeds bone loss. That's why it's important to consume adequate amounts of calcium in your diet (see "Keeping Healthy").

Estrogen's Effect on Your Heart

The majority of past clinical studies have shown that women who use estrogen substantially reduce their risk of developing and dying from heart disease. One or two studies demonstrate conflicting evidence, but they are far outnumbered by the positive reports. Results from a 1991 study showed that after 15 years of estrogen replacement, risk of death by CVD was reduced by almost 50 percent and overall deaths were reduced by 40 percent. Some researchers credit this reduction to oral estrogen's ability to maintain HDL and LDL at their healthier, premenopausal levels, through its interaction with proteins in the liver. Others believe it is estrogen's direct effect on the blood vessels themselves (through receptors on the vessel walls) which creates this benefit. In the latter case, both oral estrogen and the skin patch would be effective. Studies are underway to determine which mechanism contributes most to a healthy heart.

Many doctors now believe that estrogen replacement benefits women at risk for heart disease (but not those with blood clots--see "Cautions to Estrogen Use"). Risk factors for heart disease include a strong family history of CVD, high blood pressure, obesity, and smoking.

At any time of life, women who smoke are much more likely to develop heart disease or have a stroke than women who do not smoke. But after menopause, a smoker's risk climbs dramatically. Low estrogen levels and smoking are separate risk factors for CVD. When the two are combined, the risk is much higher than either one alone. Smoking also raises your risks for some types of cancer and for chronic lung disease, such as emphysema. Fortunately, quitting smoking--at any age--can cut the risk of disease almost immediately. Studies have shown that when older people quit, they increase their life expectancy. Their risk of heart disease goes down, their lungs function better, and blood circulation improves. So quitting smoking, whether before, during or after menopause, can have a definite impact on both the length and quality of your life.

Many women who have quit smoking say they found support in group counseling sessions. Local chapters of the American Cancer Society and the American Heart Association are good places to start looking for a smoking cessation group. Nicotine gum and nicotine patches prescribed by a doctor may also help.

While we know that estrogen users have a decreased risk of CVD, women with certain preexisting heart conditions are usually advised not to take HRT or ERT. These conditions include blood clots and recent heart attacks. Researchers hope to further investigate nonhormonal methods of preventing heart disease such as weight reduction or control, exercise, smoking cessation, and dietary modification. According to a 5-year study reported in 1988, weight gain (a common occurrence among many menopausal women) significantly raises blood pressure, total and LDL cholesterol, and fat levels. Together, these make up a dangerous recipe for heart disease. Several other studies also noted that having about one drink per day had a protective effect on the heart.

Physicians advise caution in this area, however, as excess alcohol can increase risks for other serious problems.

While cardiovascular benefits associated with oral estrogen are fairly well-known, there is surprisingly little information on the cardiovascular effects of progestin combined with estrogen. Some studies suggest that progestins counteract the favorable effects of estrogen alone, while other studies show no such effect. This remains just one more gray area where questions outnumber reliable answers.

Cautions to Estrogen Use
Serious risk Relative risk Subjective Complaints
Recent heart attack
Breast cancer (current or family history)
Uterine cancer
Acute liver disease
Gall bladder disease
Pancreatic disease
Recent blood clot
Undiagnosed vaginal bleeding Cigarette smoking
Benign breast disease
Benign uterine disease
Migraine headaches Nausea
Breakthrough bleeding
Fluid retention
Source: R.L. Young, N.S. Kumar, and J.W. Goldzieher, Management of Menopause When Estrogen Cannot Be Used, Drugs, 40(2):220-230,1990

Drawbacks of HRT: The Cancer Risk

A major issue surrounding HRT and ERT is the influence of estrogen on breast cancer. Researchers believe that the longer your lifetime exposure to naturally occurring estrogen, the greater your risk of breast cancer. It has not been proven, however, that estrogen administered at menopause has the same effect. There is disagreement on the many trials conducted to date because of wide variations in the populations studied and the doses, timing, and types of estrogen used. A recent analysis of previous studies suggests that low-dose estrogen taken on a short-term basis (10 years or less) does not pose increased risk of breast cancer. Long-term use (more than 10 years) at a high dose may significantly increase the risk. By how much is still a matter of heated debate. At the very most, researchers think long-term use could possibly increase the risk of getting breast cancer by 30 percent. This means that incidence would rise from 10 women per 10,000 each year to 13 women per 10,000 each year. To reach any consensus, however, more women need to be monitored for an extended period of time. The fear of cancer is one of the most common reasons that women are unwilling to use HRT. Interestingly, actual death rates for breast cancer have not risen at all. This may be because estrogen users have more frequent medical visits and obtain more preventive care including yearly mammograms.

While no one can determine who will eventually develop breast cancer, there are certain risk factors you should be aware of when considering HRT. A family history of breast cancer (sister or mother) is probably the most important risk factor of all. You may also be at an increased risk if: you menstruated before age 12; delayed motherhood until later in life; or have a late menopause (after age 50). Also, the older you are, the higher the risk. Most doctors believe that if you are not in a high-risk category for breast or endometrial cancer, the benefits of HRT far outweigh the risks. However, for some women, the side effects of therapy make it impossible to use. This is a personal decision to be made by each woman with help from her doctor.

Other Risks

Physicians usually caution women not to use HRT if they are already at high risk for developing blood clots. Obesity, severe vericose veins, smoking, and a history of blood clots put you in this category. A history of gall bladder disease could also be cause to avoid HRT, as women taking estrogen may have a greater chance of developing gallstones.

Hormonal Therapy
Here is what scientists can say so far about the advantages and disadvantages of hormone replacement therapy (HRT--estrogen and progesterone) and estrogen replacement therapy (ERT--estrogen alone). More research is underway.
Pro Con
HRT and ERT reduce the risk of osteoporosis.
HRT and ERT relieve hot flashes.

HRT and ERT reduce the risk of heart disease.

HRT and ERT may improve mood and psychological well-being.
ERT increases the risk of cancer of the uterus (endometrial cancer).
HRT can have unpleasant side effects, such as bloating or irritability.

HRT and ERT may increase risk of breast cancer; long-term use may pose the greatest risk.

In women with blood clots, HRT and ERT may be dangerous.


Good nutrition and regular physical exercise are thought to improve overall health. Some doctors feel these factors can also affect menopause. Although these areas have not been well studied in women, anecdotal evidence is strongly in favor of eating well and exercising to help lower risks for CVD and osteoporosis.

There is no consensus within the medical community about the risks and benefits associated with hormone therapy. There is no agreement on normal hormonal changes associated with aging.


While everyone agrees that a well-balanced diet is important for good health, there is still much to be learned about what constitutes "well-balanced." We do know that variety in the diet helps ensure a better mix of essential nutrients.

Nutritional requirements vary from person to person and change with age. A healthy premenopausal woman should have about 1,000 mgs of calcium per day. A 1994 Consensus Conference at the National Institutes of Health recommended that women after menopause consume 1,500 mgs per day if they are not using hormonal replacement or 1,000 mgs per day in conjunction with hormonal replacement. Foods high in calcium include milk, yogurt, cheese and other dairy products; oysters, sardines and canned salmon with bones; and dark-green leafy vegetables like spinach and broccoli. In calcium tablets, calcium carbonate is most easily absorbed by the body. If you are lactose intolerant, acidophilus milk is more digestible. Vitamin D is also very important for calcium absorption and bone formation. A 1992 study showed that women with postmenopausal osteoporosis who took vitamin D for 3 years significantly reduced the occurrence of new spinal fractures. However, the issue is still controversial. High doses of vitamin D can cause kidney stones, constipation, or abdominal pain, particularly in women with existing kidney problems. Other nutritional guidelines by the National Research Council include:

Choose foods low in fat, saturated fat, and cholesterol. Fats contain more calories (9 calories per gram) than either carbohydrates or protein (each have only 4 calories per gram). Fat intake should be less than 30 percent of daily calories.
Eat fruits, vegetables, and whole grain cereal products, especially those high in vitamin C and carotene. These include oranges, grapefruit, carrots, winter squash, tomatoes, broccoli, cauliflower, and green leafy vegetables. These foods are good sources of vitamins and minerals and the major sources of dietary fiber. Fiber helps maintain bowel mobility and may reduce the risk of colon cancer. Young and older people alike are encouraged to consume 20 to 30 grams of fiber per day.
Eat very little salt-cured and smoked foods such as sausages, smoked fish and ham, bacon, bologna, and hot dogs. High blood pressure, which may become more serious with heavy salt intake, is more of a risk as you age.
Avoid food and drinks containing processed sugar. Sugar contains empty calories which may substitute for nutritious food and can add excess body weight.
For people who can't eat an adequate diet, supplements may be necessary. A dietician should tailor these to meet your individual nutritional needs. Using supplements without supervision can be risky because large doses of some vitamins may have serious side effects. Vitamins A and D in large doses can be particularly dangerous.

As you age, your body requires less energy because of a decline in physical activity and a loss of lean body mass. Raising your activity level will increase your need for energy and help you avoid gaining weight. Weight gain often occurs in menopausal women, possibly due in part to declining estrogen. In animal studies, scientists found that estrogen is important in regulating weight gain. Animals with their ovaries surgically removed gained weight, even if they were fed the same diet as the animals with intact ovaries. They also found that progesterone counteracts the effect of estrogen. The higher their progesterone levels, the more the animals ate.


Exercise is extremely important throughout a woman's lifetime and particularly as she gets older. Regular exercise benefits the heart and bones, helps regulate weight, and contributes to a sense of overall well-being and improvement in mood. If you are physically inactive you are far more prone to coronary heart disease, obesity, high blood pressure, diabetes, and osteoporosis. Sedentary women may also suffer more from chronic back pain, stiffness, insomnia, and irregularity. They often have poor circulation, weak muscles, shortness of breath, and loss of bone mass. Depression can also be a problem. Women who regularly walk, jog, swim, bike, dance, or perform some other aerobic activity can more easily circumvent these problems and also achieve higher HDL cholesterol levels. Studies show that women performing aerobic activity or muscle-strength training reduced mortality from CVD and cancer.

Just like muscles, bones adhere to the "use it or lose it" rule; they diminish in size and strength with disuse. It has been known for more than 100 years that weight-bearing exercise (walking, running) will help increase bone mass. Exercise stimulates the cells responsible for generating new bone to work overtime. In the past 20 years, studies have shown that bone tissue lost from lack of use can be rebuilt with weight-bearing activity. Studies of athletes show they have greater bone mass compared to nonathletes at the sites related to their sport. In postmenopausal women, moderate exercise preserves bone mass in the spine, helping reduce the risk of fractures.

Exercise is also thought to have a positive effect on mood. During exercise, hormones called endorphins are released in the brain. They are "feel good" hormones involved in the body's positive response to stress. The mood-heightening effect can last for several hours, according to some endocrinologists. Consult your doctor before starting a rigorous exercise program. He or she will help you decide which types of exercises are best for you. An exercise program should start slowly and build up to more strenuous activities. Women who already have osteoporosis of the spine should be careful about exercise that jolts or puts weight on the back, as it could cause a fracture.




To gather more data to help women make a well-informed decision regarding hormone therapy, researchers at the National Institutes of Health (NIH) launched the Postmenopausal Estrogen/Progestin Interventions Trial (PEPI) in 1989. With 127 women enrolled at each of seven medical centers, PEPI will address the short-term safety and efficacy of various methods of HRT. The study will compare women who take estrogen by itself to those who take it with different types of progestin. It will also examine the effects of both cyclical and continuous progestin on cardiovascular risk factors, blood clotting factors, metabolism, uterine changes, bone mass, and general quality of life.

Several new studies are looking at normal body changes as women move from pre- to postmenopause. Up to now, the lack of such data has been one problem in assessing the value of HRT. Without knowing what "normal" is, scientists have difficulty judging the effect of a particular treatment. Another problem with past studies is the "healthy user effect." In many trials preceding PEPI, the HRT users studied had freely chosen to begin treatment, with advice from their doctors. In general, most physicians discourage women with a preexisting illness or long family history of breast cancer from taking HRT. This factor could skew study results to appear that nonusers became ill or died more frequently simply because they failed to take estrogen. Only by randomly assigning study participants to the treatment can this bias be overcome. Until more random trials are completed, the jury is still out on HRT.

Many women feel that their physicians do not listen to their concerns. Nor do they give them enough information to make an educated decision about hormone therapy.

Another NIH study is the Women's Health Initiative, a multicenter trial involving 70,000 postmenopausal women ages 50 to 79. The study will assess the long-term benefits and risk of hormone therapy as it relates to cardiovascular disease, osteoporosis, and breast and uterine cancer. It will also help determine the effects of calcium supplementation, dietary changes, and exercise on women in this age group. Some of the specific questions to be addressed by the Women's Health Initiative include:

* How long is estrogen effective for each system of the body (skeletal, cardiovascular, nervous, endocrine)?
* What is the best dose and route of administration of estrogen and progestin to prevent side effects yet maintain efficacy?
* How long is estrogen safe to take?
* Does estrogen act the same way in older women as in younger women?
* Are there effective alternatives to HRT?
Clearly, no one has all the answers about menopause. Medical research is beginning to give us more accurate information, but some myths and negative attitudes persist. Women are challenging old stereotypes, learning about what's happening in their bodies, and taking responsibility for their health. The important thing to remember as you go through menopause is to be good to yourself. Take time to pursue your hobbies, be they gardening, painting or socializing with friends. Have a positive attitude toward life. Sharing concerns with friends, a spouse, relatives or a support group can help. Don't fight your body--allow the changes that are happening to become a part of you, a part that is natural and that you accept.

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com

Tuesday, May 11, 2010


Numerous studies and the epidemiological trends over recent years support the theory that people need significantly more vitamin D than has been commonly accepted. A University of Toronto study involving 796 women between the ages of 18 and 35 showed that the generally recommended amounts of vitamin D for women are too low to offer any benefit. According to Reinhold Vieth and his colleagues, any amount of daily vitamin D intake under 800 IU wasn’t enough to prevent a vitamin D deficiency.
Despite this information and more, the US Food and Nutrition board for osteoporosis-related matters still recommends only 400 IU per day for women under the age of 50.
I’ve written in past issues about the seriousness of decreasing levels of vitamin D, and the problem seems to just keep getting worse. The evidence continues to grow, but, for some reason, it also continues to be ignored. You already know the important role it plays in building and maintaining a strong immune system, and vitamin D levels also are linked to more than just proper bone growth and strength. Some of the most common health ailments today can be directly linked to inadequate vitamin D levels:
Heart Disease and Diabetes
Heart disease continues to reign as the number-one killer in this country. Although dozens of factors are involved in developing heart disease, excess sugar consumption and the inability to regulate blood sugar levels properly are undoubtedly two of the major contributing factors. Studies have now shown that low vitamin D levels decrease insulin levels and increase insulin resistance, both of which are associated with diabetes and subsequent cardiovascular problems.

Numerous studies have found a direct association between low vitamin D levels and cancers of the breast, prostate, colon, and the skin.
Studies have now shown that a lower-than-optimal level of vitamin D contributes to degenerative arthritis (the “wear and tear” form of arthritis) in the hip and the knee.
Since you know adequate levels of vitamin D are also essential for proper immune system response, it shouldn’t come as any surprise that vitamin D deficiencies are also associated with such diseases as rheumatoid arthritis and even multiple sclerosis.
Sunlight exposure is a necessary requirement for vitamin D production in the body, and is also necessary for proper mood health. However, with the fear of skin cancer and wrinkling, tanning or even getting sun exposure has become taboo. The result is that depression is becoming more and more commonplace.
The problem is that, even under normal circumstances, it would be difficult for many people to get enough sun exposure to avoid depression in most of the Northern and Northeastern US cities. Only during a few summer months are there enough UV-B rays reaching those areas to allow for proper vitamin D production. (The three main forms of UV, or ultraviolet, radiation from the sun are UV-A, UV-B, and UV-C. UV-B rays are the ones we need to produce vitamin D naturally, but they are also the ones that can produce sunburn and tanning.)
Even when UV-B rays are adequate, most people now either slather on the sunscreen or avoid the sun altogether. Any sunscreen with a protective factor of 8 or more will block almost all of the UV-B rays from reaching the skin.
The ironic thing about all of this is that the incidence of skin cancer has more to do with consuming the wrong fats (too many omega-6 fatty acids and not enough omega-3s) than it does with exposure to the sun. Until the general public understands this fact, skin cancer problems will continue to increase, which will in turn cause even more fear of sunlight exposure and more depression. This whole situation has gotten way out of control. Because of the fats we’re now eating and our fear of sunlight, it’s becoming necessary to supplement our diets with vitamin D. But in the natural scheme of things, our bodies can manufacture enough vitamin D when given regular exposure of the entire body to sunlight for 20-30 minutes daily.
Decreased vitamin D levels result in less production and secretion of the hormone leptin. Leptin is one of the primary hormones involved in fat storage and weight loss. Millions of dollars are now being spent on trying to duplicate these effects by artificially increasing levels of leptin in the body or turning it into a weight-loss drug. The simple answer, of course, is to ensure you’re producing and/or receiving adequate amounts of vitamin D.
On a very interesting, related note, researchers appear to have found a connection between bulimic dieting behavior, binge-eating, and light. Individuals with these characteristics apparently prefer to eat in dim or more subdued light compared to individuals without such problems.
Obviously, this information is still being researched and analyzed, but, based on what we know about vitamin D and leptin levels, it certainly may be more than just a simple coincidence. If you’re concerned about losing weight or have the above problems, there would certainly be no harm in opening the shades and turning up the lights at mealtime.

The connection between light, our body’s biological clock (or circadian rhythm), and our health is one that has always been a big interest of mine. Our relationship with light may seem primitive, but it is one of our most basic connections to our environment. Vitamin D is only one of the links in this connection. The other link is our biological hormones Estradiol and Progesterone and Testosterone.
You Don’t Need the Government’s Permission to Increase Your Vitamin D
When you look at the increasing incidence of heart disease, diabetes, cancer, et cetera, it becomes obvious that most government agencies and health organizations are far too slow in changing or modifying their recommendations. I think much of the problem stems from bureaucracy and, oftentimes, politics.
For example, there’s now a huge market for drugs to treat osteoporosis, and I seriously doubt that anyone developing or selling these drugs would really want the problem to be solved through diet. Even though osteoporosis and associated hip fractures have become a major problem in this country, the regulating authorities continue to recommend a daily dose of 400 IU of vitamin D. The same regulating authorities are also not approving bioidentical hormone replacement at biological levels needed to prevent bone loss through the use of estrogen and progesterone. They are way behind the times. Just don’t let your supplement be behind the times. Make sure you’re getting 2,000 to 5,000 IU of cholecalciferol (Vitamin D3) a day – not cod liver oil due to it competing for the receptor site of Vitamin D due to it’s abundance of Vitamin A. Don’t get worried about that much causing an overdose. Although various foods do contain vitamin D, unless you’re taking something like cod-liver oil, you won’t be getting much vitamin D. Milk is fortified with 10 micrograms per quart, which works out to about 400 IU per quart or 100 IU per each eight-ounce glass.
Make a point to get outside regularly and enjoy the sunshine, without the sunscreen. There’s no need to overdo it and get sunburned. Once your skin turns red, vitamin D production will stop anyway. Twenty minutes a day is all someone with fair skin needs to get enough vitamin D during the summertime. If your skin is darker, you’ll need more sunlight exposure to produce the same amount of vitamin D. And always keep in mind that, in addition to helping produce vitamin D, sunlight exposure can help regulate your biological clock, fight depression, and possibly even help you to control your appetite and lose weight. As time goes on, we’ll undoubtedly learn dozens more reasons why people weren’t made to live underground, in a cave, or in a dark house or office.
Numerous studies and the epidemiological trends over recent years support the theory that people need significantly more vitamin D than has been commonly accepted. A University of Toronto study involving 796 women between the ages of 18 and 35 showed that the generally recommended amounts of vitamin D for women are too low to offer any benefit. According to Reinhold Vieth and his colleagues, any amount of daily vitamin D intake under 800 IU wasn’t enough to prevent a vitamin D deficiency.
Despite this information and more, the US Food and Nutrition board for osteoporosis-related matters still recommends only 400 IU per day for women under the age of 50. That isn’t enough! And the FDA also allows Vitamin D2 to be sold. Make sure the label says D3 and is cholecalciferol not cod liver oil.

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com

Understand How Hormones Change Stem Cells

Cancer Researchers Link Ovarian Hormone to Breast Stem Cells Growth
ScienceDaily (May 7, 2010) — Cancer researchers at Princess Margaret Hospital (PMH) have discovered that the ovarian hormone progesterone plays a pivotal role in altering breast stem cells, a finding that has important implications for breast cancer risk.

The findings, published online in Nature, are significant because reproductive history is among the strongest risk factors for breast cancer, says principal investigator Rama Khokha, a molecular biologist at Ontario Cancer Institute and the Campbell Family Cancer Research Institute, PMH. Other major known risk factors are age, genetics and breast density.

"Our study shows how and when hormones affect breast stem cells during the natural reproductive cycle. There are well accepted links between ovarian hormones and breast cancer, and there is mounting evidence that stem cells are seeds for breast cancer. We now show a direct connection between hormones and breast stem cells. "

Lead author Purna Joshi adds: "Our research demonstrates that when progesterone peaks during the second half of the menstrual cycle, it starts a cross-talk between stem cells and neighbouring cells that propels normal breast stem cells to expand in number, and may trigger an environment where cancer can begin."

Until now, breast stem cells were thought to be generally inactive in the adult female breast, says Dr. Khokha, whose speciality is modelling human cancer in the laboratory. In this study, the research team replicated the human natural reproductive cycle in mice to determine the impact of hormones on breast stem cells.

How hormones change these stem cells opens a new pathway to understanding the cell growth that begins breast cancer, and, with further research, will open new ways of targeting stem cells.

"It is the first evidence, to our knowledge, for progesterone-driven dynamic shifts in the mammary stem cell pool. This activation provides an opportunity to start the process of cell transformation leading to breast cancer."

The research was also supported by the Canadian Cancer Society Research Institute and the Canadian Breast Cancer Foundation.

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com

Thursday, May 6, 2010

400 reasons you need Estrogen

You need to think about starting natural estrogen bioidentical hormone replacement therapy when approaching menopause in your late 40’s and early 50’s. Why? Well, for relief of symptoms like hot flashes, night sweats, vaginal dryness, and low libido among others, nothing works better than estrogen. Long term benefits of estrogen bioidentical replacement therapy include prevention of memory loss, maintenance of heart health, prevention of heart disease, bone production (prevention of osteoporosis), prevention of Alzheimer’s disease, prevention of cataracts and macular degeneration, maintenance of mood and prevention of depression, and quality and youthfulness of your genital tissues and skin. Vitamins and herbs cannot do all these things (although they may temporarily improve some symptoms like hot flashes). Quite simply, estrogen keeps women’s cells healthy. Only estrogen in women can prevent disease and improve quality of life…and only bioidentical transdermal estrogen!
What is natural bioidentical hormone replacement? It means using hormones that are biologically identical to what your body makes. In other words, the hormones are the same chemical structure as the ones that your body makes. Customized natural hormonal therapy is the only way to replace hormones safely. One size does not fit all.
Studies have shown that women who use hormone replacement live longer than those who do not. To be effective in preventing disease, estrogen must be started in women in their 50’s. For example, you need 10 years of estrogen replacement to help prevent Alzheimer’s disease.
Estrogen has 400 functions in your body. It increases your metabolic rate, enhances energy, improves insulin sensitivity, and regulates body temperature. It prevents muscle damage and helps maintain muscle.
In the cardiovascular arena, it helps maintain the elasticity of your arteries, dilates your small arteries, increases blood flow, inhibits platelet stickiness, decreases the accumulation of plaque on your arteries, decreases blood pressure, decreases LDL (bad cholesterol) and prevents its oxidation, acts as a natural calcium channel blocker to keep your arteries open (pharmaceutical companies make alien molecules to do this in patients with heart disease), decreases lipoprotein A ( a bad fat that is a risk factor for heart disease), reduces homocysteine (another risk factor for heart disease), increases HDL (good cholesterol) by 10 to 15%, and reduces the overall risk of heart disease by 40 to 50%.
Estrogen has many benefits for your brain and nervous system. It helps maintain your memory, increases reasoning and new ideas, helps with fine motor skills, enhances the production of nerve-growth factor, improves your mood, increases concentration, helps prevent Alzheimer‘s disease, improves your mood, aids in the formation of neurotransmitters in your brain such as serotonin which decreases depression, irritability, anxiety, and pain sensitivity.
For eye health, it protects against macular degeneration and helps prevent cataracts.
For beauty, it maintains the amount of collagen in your skin increases the water content of your skin and is responsible for its thickness and softness, improves breast firmness, maintains the moisture and thickness of the genital tissues, and decreases facial wrinkles.
For bones, it maintains bone density and helps prevent tooth loss.
It increases sexual interest and decreases your risk of colon cancer
Your body has receptor sites for estrogen everywhere: in your brain, muscles, bone, bladder, gut, uterus, ovaries, vagina, breast, eyes, heart, lungs, and blood vessels, so it is needed for health is all these areas.
So with decreased estrogen you get thinner skin, more wrinkles/aging skin, decrease in breast size, stress incontinence, oily skin, acne, decreased sex drive, decreased dexterity, increase in insulin resistance and possible diabetes, vaginal dryness, decreased memory, osteoporosis, urinary tract infections, and increased cholesterol.
Perimenopause and menopause occurs in our 40’s and 50’s. Most women of that age group can expect to live to be a mean age of 83. You may spend 30-40 years without the benefits of estrogen and experience resultant and inexorable disease and decline from loss of estrogen.
With a safe and effective way of replacing estrogen with bio-identical hormones, women no longer need to bear the disease and decline of estrogen deficiency.
A few things to remember:
1. Estrogen must be balanced with progesterone (not progestins or medroxyprogesterone which are piosons), even if you had a hysterectomy. Estrogen without progesterone or not enough progesterone equals 10 pounds. Besides, progesterone also has many benefits of itself.
2. Never take any type of oral estrogen, even bioidentical. It can cause or make cardiovascular heart disease worse due to a protein that is made in the liver when a great deal of estrogen hits the liver when absorbed from the gut. Transdermal estrogen doesn’t do that because it is absorbed more evenly.
3. Take only bioidentical estrogen that has estradiol (your main estrogen) and estriol (a weaker estrogen with cancer and heart protective effects). This compound is generally called Biest (bi-estrogen). Another bioidentical estrogen compound called Triest is now considered to be outdated since it contains estrone, another one of our week estrogens. We need a little estrone for bone health, but we do not need to replace it especially since estrone can be metabolized in the body into cancer causing metabolites.

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com

Testosterone For Men

Testosterone in Men byCandice Lane, M.D.
Filed under For Men

There has been a lot of buzz about women’s hormones, but you hear very little about men. To make it worse, men do not seek or share this information as women do. How many men do you know who go out for coffee with their buddies and talk about their hormones? Few people appreciate the pervasive effects of testosterone on men’s general health.

The fact is that as men age, they lose their testosterone. The loss of youthful levels of testosterone with the onset of its associated symptoms is sometimes called andropause. It is the natural diminution (or pause) in production of male hormone (an androgen) as men age.

Testosterone loss in men is a gradual process. Testosterone decline starts around age 30, and may drop 1% to 3 % per year depending on genetics and lifestyle. That means that men can sustain a 20% drop in testosterone by age 50, and a 50% drop by age 80. Each man may experience the symptoms of a decline in testosterone differently depending on what his normal was at his hormonal peak. Often the symptoms are ignored or rationalized away until the resultant decreased functioning becomes a way of life.

The most obvious and disturbing changes for men are those of sexual function, but equally troubling symptoms of low testosterone may manifest as a decline in mental functions, musculoskeletal conditions, and metabolic or physical diseases.

Changes in mental functioning may manifest as spells of mental fatigue and inability to concentrate, feeling burned out, low energy, tiredness or sleepiness in the afternoon or evening, decrease in mental sharpness, attention, and wit, or a change in creativity like getting spontaneous new ideas. There may be a decrease in desire to start new projects, or a decreased interest in past hobbies or new work-related activities. Competitiveness may diminish and irritability increase. Memory functions may become impaired with increased forgetfulness. Men can experience a sense of depression with a sense that work, marriage, or recreational activities have lost their significance.

Musculoskeletal symptoms may appear as sore-body syndrome with aches and joint and muscle pains. A decline in flexibility and mobility may be noticed with increased stiffness. Muscle size, tone, and strength may decrease. Physical stamina and athletic performance may decline. Some men experience back pain, neck pain, or a tendency to pull muscles or get leg cramps. Some develop osteoporosis or inflammatory arthritis.

Low testosterone levels correlate with more risk factors of heart disease than any other individual factor in the male body. Cardiovascular risk factors increase in men as testosterone decreases. Cholesterol and triglyceride levels increase, coronary and major arteries constrict leading to a greater risk of cardiac events, and blood pressure rises. Insulin resistance increases with obesity, adult diabetes, and increased cortisol levels. There is increased central abdominal fat with increased waist to hip ratio. Estrogen levels associated with higher stroke and heart attack rates (and increased fat in the breast and hip area) increase. Another increase associated with decreased testosterone is in lipoprotein A and fibrinogen, which correlate with cardiac events. Also, human growth hormone output decreases leading to a decline in energy, strength, stamina, and heart muscle mass and output. Low testosterone levels are associated with increased incidence of death even after researchers adjust for age, medical problems, and variables.

Although not all signs and symptoms of aging are due to hormonal decline, many correlate well with a decline in hormones and can be alleviated by hormone adjustment.

Treatment of low testosterone should be administered by a doctor trained in hormone therapy after a full history, examination, and laboratory testing. Regular follow-up is important to control symptoms, prevent side effects, and to make sure hormone levels are optimal.

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com

Women To Women - Not Hormones, Only Vitamins.

When you search Google for “bioidentical hormones”, what’s the first site to come up? It’s Women to Women. I find this astounding because Women to Women has nothing to do with bioidentical hormones.

“Women to Women” is a vitamin sales website that proclaims it’s devoted to women’s health. They say they use phytotherapy to achieve natural hormone balance. So what is phytotherapy? It’s vitamins and herbs. On Women to Women, they are basically saying you can rebalance your hormones with vitamins.

Hormones decline in women because our ovaries shut down with age. There is no vitamin in the universe that will bring back ovarian function or hormones once in the process of menopause. Some vitamins may improve your symptoms and improve health, but no vitamin can replace the beneficial functions of estradiol, progesterone, or testosterone. As far as balancing your hormones, eventually they will all be balanced by being gone, and no vitamin will prevent that!

Don’t get me wrong. I am a devoted believer in using vitamins to help treat many problems including adrenal fatigue, adrenal stress, thyroid problems, hypertension, high cholesterol, osteoporosis and a number of other disorders. Vitamins and herbs can overall improve our general health. But without hormones to direct your cells functioning, vitamins are limited in what they can do. The fact is that you need both hormones and vitamins, and the way you get hormones just like with vitamins, is with replacement! Hormones can totally relieve your symptoms and keep you healthy. Vitamins, even with diet and exercise, cannot do this.
Women to Women has an extensive library of many legitimate disorders and there is a lot of good information there. However, most every conclusion is that there is no good hormonal treatment and the best treatment is to use their vitamins. Admittedly, those writing the articles are very skillful in coming round to this conclusion, but be aware that the people writing the articles are nurses without any specialized hormone training, not doctors with bioidentical hormone training.

The fact is Women to Women is basically a site dedicated to making money by selling vitamins to women who are suffering from menopause. Granted vitamins may mildly and usually temporarily improve some symptoms of menopause like hot flashes, but they falsely claim that women can “rebalance women’s hormones without the use of drugs”. O.K. I agree with balancing your hormone without the use of drugs; that is, without the use of pharmaceutical drugs like the synthetic hormones Premarin and Provera (HRT), but bioidentical hormones (BHRT) are not drugs. They are natural hormones with the exact same molecular structure as in the human body.

Women to Women goes on to say “We have found that about 85% can find relief through an approach that combines medical-grade nutritional supplements, gentle endocrine support, and dietary and lifestyle changes.” Relief of what and for how long? This is a fundamental misunderstanding or misrepresentation of menopause and hormone imbalance.

Menopause is a hormone deficiency of estrogen and progesterone caused by ovarian failure and cessation of ovulation that is genetically dictated by our life cycle. How can you balance hormones that are not there? Vitamins will not put back your hormones or keep you ovulating until you are 90. The symptoms, aging, and decline of menopause are due to losing your hormones. As you become deficient, the only remedy is to replace your hormones.

Estrogen is the woman’s hormone for health. It has 400 functions in the human female body. It is responsible for heart health, eye health, brain health, and bone health. When estrogen is started early (at least in your 50’s) the medical literature has shown it can help prevent heart disease, osteoporosis, cataracts, macular degeneration (blindness), Alzheimer’s disease, depression, colon cancer, wasting of our genital tissues, urinary leakage, cholesterol problems, loss of sexual desire, loss of skin beauty, loss of memory and other things. (Estrogen-Natural Bioidentical Hormone Replacement) The current medical literature has shown that bioidentical hormones are safe. They do not cause breast cancer. To prevent disease, bioidentical hormones need to be used on a long terms basis. At least 10 years use is needed to prevent Alzheimer’s. Current bioidentical experts recommend lifelong use to stay healthy and vital.

Women to Women has said bioidentical hormones are not the fountain of youth. Well that may be. None of us will get younger with hormones (except maybe with growth hormone), but we don’t have to experience the disorders of aging either that are more likely to occur without our sex hormones. Progesterone has its very own functions (Progesterone Deficiency) and is necessary to balance estrogen.

Women to Women staff comes from a sect of alternative medicine that believes in aging naturally by allowing your hormones to decline and only alleviating, if necessary, the symptoms (hot flashes, night sweats, etc.) of this slow and painful decline. But what about the diseases that occur due to hormone loss like Alzheimer’s, osteoporosis, and colon cancer? Why not try to prevent these diseases by replacing our hormones?

Women to Women recommends using vitamins first to treat the symptoms of menopause (remember vitamins don’t put hormone back). Why? Well maybe because they sell vitamins…that’s their business. They do not recommend bioidentical hormones. Why? Well, because they can’t sell a pharmacy product online with the click of a button and a charge of the card, and that would put their vitamin business out of business. Their articles minimize Suzanne Somers’s writings and claim that she is in the minority of women needing replacement. Why? Maybe because she writes about bioidentical hormones as the basis of health, and again, they can’t sell hormones online.

Let the buyer beware. The formula used by Women to Women is not anything special and can be easily duplicated at a lower cost. Their lifestyle coaching might prove beneficial if personal support is your goal
What’s my problem with all this? The vitamins won’t hurt, right? Wrong. It shakes confidence in real medical treatment, deters seeking treatment, and is a financial drain. I have had several patients that have come to me after trying Women to Women’s program which did not work. They spent a large amount of money with Women to Women without relief (of course you have to do the 3 month program). This financial loss discouraged and inhibited them from seeking medical advice from doctors trained in hormone replacement therapy. For about the same price of their premium plan you can get bioidentical hormones for replacement from a pharmacy.

So how does Women to Women get to the top of Google search for bioidentical hormones? They spend huge amounts of money on advertising with Google Adwords for one thing. In addition they have a large amount of content on their website which pushes them up in the page rankings.

There is a way to actually balance and replace your hormones that really works and has immediate and long term benefits – and that is natural bioidentical hormone replacement

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com

Bioidentical Hormones are Safe Bioidentical Hormones are Safe

by Candice Lane, M.D.

There is no doubt that there is improvement in the symptoms of menopause by using hormone replacement therapy. It includes elimination of symptoms such as hot flashes and night sweats, reversal of bone loss leading to osteoporosis, improved sleep, emotional stability, libido and quality of life.But extreme confusion revolves about the safety of taking hormones.

Some doctors are telling patients to get off all hormones. Some are prescribing Premarin and Provera, while others are prescribing “bio-identical hormones”. Still others are switching back and forth between the two.

Hormone replacement therapy or HRT is a broad category. Some people use this term to refer to all hormone replacement therapy. When you hear this term in the media, they are generally referring to Premarin and Provera which are not natural to the human body. These drugs are referred to as synthetic hormones because they are synthesized with molecules that do not occur in the human body in nature.

Premarin is a type of estrogen obtained from horse’s urine. Although it is natural to horses, it is a different molecule than occurs in the human body. It is a very potent estrogen that can alleviate many symptoms but has negative effects as well.

Provera is a progestin used to prevent tissue from building up in the uterine lining while taking Premarin. A progestin is NOT progesterone. It is a different molecule. Progestins actually inhibit production of progesterone by the human body and have dangerous effects on the human body.

The new classification of hormone replacement therapy is called bio-identical hormone replacement therapy or BHRT. This therapy includes estrogens and progesterone that are made from soy and wild yams obtaining a compound that has the exact same molecular structure as these substances in the human body… therefore, bio-identical.

The dangers of Synthetic HRT (Premarin and Provera) were discovered in the Women’s Health Initiative Study in 2002.

This study analyzed the outcome of women taking Premarin (conjugated equine estrogen or horse estrogen from pregnant mare’s urine) and Provera (medroxyprogesterone acetate or synthetic progesterone) and found increased rates of breast cancer and cardiovascular disease. Since the drugs used were not bio-identical hormones the results only apply to Premarin and Provera, not BHRT.

Premarin is taken orally. Any oral estrogen can be a problem for heart health. It can activate coagulation and inflammation. Descenci in Circulation in 2005, found that transdermal estrogen does not have this effect.

The main breast cancer problem is the synthetic Provera (medroxyprogesterone). When the Women’s Health Initiative patients who received only Premarin without Provera were analyzed the rate of breast cancer was not increased. (Anderson, JAMA, 2004). This indicated that it was the Provera that caused an increased incidence of breast cancer.

BHRT (bio-identical hormone therapy) does not increase the chance of breast cancer. The main danger of synthetic HRT is the non-bio-identical progestin (Provera).

In the Fournier et al. study in the International Journal of Cancer, 2005 studied 54,000 women who were taking bio-identical estrogen and either bio-identical progesterone or synthetic progestin. The women taking the bio-identical progesterone had a 10% decrease in risk of breast cancer and the women taking artificial progestin had a 40% increase in the risk of breast cancer.

The De Lignieres study from Climacteric 2002 could not show an increased risk of breast cancer with use of bio-identical hormones but showed an increased risk with the use of synthetic progestin (Provera/medroxyprogesterone). In fact, they could not justify stopping BHRT(bio-identical), which is beneficial for quality of life, prevention of bone loss and cardiovascular risk profile without activating coagulation and inflammatory protein synthesis as in users of oral estrogens.

The real problem with synthetic HRT is the synthetic progestin(Provera). In contrast, several studies document that higher progesterone levels during pre-menopausal years or during pregnancy are protective against breast cancer. (Campanoli, Journal of Steroid Biochemistry and Molecular Biology, 2005).

In any case, estrogen should not be taken without progesterone which counters the proliferative tissue effect of estrogen on breast and uterine lining.

Bio-identical hormone therapy, which is different from Premarin and Provera, is safe, effective, and proven beyond any reasonable medical and scientific doubt

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at jones.gretchen@gmail.com