I'm Too Young for This!: The Natural Hormone Solution to Enjoy Perimenopause (23 page)

Q: Will using BHRT cause cancer and is it safe? What about thermography for scans?

DR. NEIL ROUZIER: Bioidentical hormones will not guarantee that you not get breast cancer. Cancer can be caused by genetic, environmental, lifestyle, and many yet to be discovered causes. Your question would require pages and pages to fully explain the difference in hormones, the protective effect of some and the harm of others. I will summarize this very complex and confusing topic. Thanks to the media sensationalism, most women (and physicians) are falsely led to believe that all hormones cause cancer, and this is simply not true. For years we have preached and taught that synthetic hormones can cause cancer, and it is well documented in scientific studies that medroxyprogesterone (Provera) increases the risk of cancer. The recent lawsuits against Wyeth are the result of this. The largest and most powerful study to date, the Women’s Health Initiative (WHI) trial, proved that the combination of PremPro caused an increase in breast cancer incidence. Other recent studies utilizing estradiol and natural, bioidentical progesterone did not show any increased incidence in cancer. So the culprit seems to be the synthetic progestin (Provera) and not progesterone. Although estrogen may cause a cancer to grow once it becomes established (estrogen + receptor tumor), all data prove that estrogen does not cause the cancer to occur in the first place. Rest assured that the most recent powerful scientific studies do not support the theory that estrogen causes cancer.

Here is the most important part of your answer, however. There are multiple studies in the literature that prove natural progesterone is protective against cancer. The largest and longest study in the world, the EPIC-E3N study published in the journal
Cancer
, has continuously demonstrated that addition of progesterone to estrogen decreases the incidence of breast cancer, whereas the addition of a synthetic progestin (Provera) does increase risk significantly. Multiple other studies demonstrate that progesterone does not increase the risk of cancer, yet Provera did. Multiple studies demonstrate that the higher your progesterone level is, the more down-regulation of breast tissues and protection against breast cancer, and this is through various mechanisms. Although many women falsely believe that natural estrogen is protective, it is actually the cancer-killing (apoptotic) effect of natural progesterone that is responsible for the protection against breast cancer. I hope this has cleared up any misconceptions about which hormones cause cancer (synthetic progestins), which ones protect against cancer (bioidentical progesterone), and which ones have a neutral effect (estrogen).

Thermography has become popular as a more benign, less painful alternative to mammography. Although modern mammograms are more accurate and sensitive due to advances in technology, thermography is another option that is painless and preferred by many who can’t tolerate mammograms or have an aversion to them.

Q: If you had breast cancer and thyroid cancer, is it okay to take hormone replacement? I believe my cancer came from taking Provera; after nine months, I took myself off but three months later I had a lump
.

DR. ANJU MATHUR: If your breast cancer was treated and you are cancer free at the moment, then hormones could be used with caution. I usually check twenty-four-hour urine tests to determine estrogen quotient, as well as 2/16 alpha-hydroxyestrone ratio. If they are abnormal, I treat them with natural supplements to lower the risk of recurrence. At the same time, every effort
should be made to boost your immune system. Failure of the immune system likely caused the cancer cells to grow unchecked in the first place. Provera is a synthetic progesterone called progestin and it is connected to an increased risk of cancer.

Q: Do bioidentical hormones increase your chances to get breast cancer?

DR. RON ROTHENBERG: There have been many studies to show that BHRT does not increase your risk for cancer. Having said that, anyone can get cancer with or without hormones, so taking hormones does not give you immunity to developing cancer. The idea that hormone replacement increases the risk of breast cancer came from the Women’s Health Initiative Study published in 2002. This flawed study produced a lot of confusion in physicians and in women in general. The drugs studied were Premarin or conjugated equine estrogens derived from horse urine (which is a very cruel process for us animal lovers) and Provera or MPA, which is artificial, chemically altered progesterone, not bioidentical progesterone. We now know that estrogens should always be bioidentical and administered through the skin with creams, gels, or patches, not taken orally. But even the orally given horse estrogen when used alone did not increase breast cancer risks.

The most dangerous component of “old school HRT” is the artificial nonbioidentical progestin, Provera or MPA. A study in France tracked 80,000 women who were using transdermal bioidentical estrogen and bioidentical progesterone versus estrogen and MPA (
see
Fournier
). After eight years, the risk of breast cancer in the bioidentical estrogen and progesterone group was the same as the risk of a woman who had not taken any hormones. In the MPA or Provera group, there was a 69 percent increased risk of developing breast cancer.

Replacing deficient estrogen, progesterone, and testosterone
at perimenopause and menopause with bioidentical hormones has significant quality of life benefits as well as protection of cardiovascular, cognitive, and sexual function, and preventing osteoporosis.

Q: Is there anything all natural that will help regulate your hormones? Or bring you to an equal median?

DR. MARSHA NUNLEY: A low glycemic diet with lots of brightly colored and green vegetables along with a daily exercise program, adequate sleep, and a stress-free life can help. Herbal supplements to consider include black cohosh, chastetree berry, a rhubarb supplement (Metagenics makes a good one), and all may be somewhat helpful. Bottom line: nothing works as well as bioidentical hormones.

Q: Adult acne! How to stop it?

DR. SUE DECOTIIS: Adult acne is an unpleasant surprise for many adults who never had teenage acne. The chief underlying cause is hormonal imbalances that present symptoms in the form of acne. Too often the cycle of stress and overproduction of androgens and cortisol by the adrenal gland causes overproduction of oil by sebaceous glands of the skin. The ducts of these glands become clogged with bacteria and debris, which leads to acne. During the second half of the menstrual cycle, progesterone levels rise and fall quickly and estrogen levels remain low. So even normal levels of androgens remain unopposed due to these
cyclical drops. This androgen dominance, be it ever so brief during the cycle, can also cause increased oil production and induce acne at this time. An antibacterial cleanser can be helpful for just about all acne sufferers. Traditionally adult acne has been treated by prescriptions of oral or topical antibiotics. Yet attacking the bacterial component of acne is merely treating a complication of the increased oil production. Hormone levels should be tested. Medicinal strength glycolic acid peels can also be helpful. If testosterone levels are elevated, an antiandrogen medication such as Spironolactone can often be effective. But trying to alleviate stress and reduce inflammation in the body is extremely important. Taking micronized omega-3 (fish oil) capsules as well as a medicinal-grade probiotic, avoiding refined carbohydrates such as starches and sugar, exercising, yoga, and meditation are all important steps. Stress is detrimental to general health and can affect every organ system. Learning to manage stress is key to your well-being as well as to clear skin. If there are other accompanying symptoms, such as excess hair growth, weight gain, menstrual irregularities, or headaches, your physician should look for other underlying causes.

Q: Is there a connection between perimenopause and an incredibly itchy scalp? I have seen a doctor and do not have dandruff or anything, yet nothing I do for it helps!!

DR. SUE DECOTIIS: Dry skin and itchy scalp can be seen with estrogen deficiency. BHRT can help by returning the moisture in skin that estrogen helps maintain. More specifically, estriol, an estrogen, can be used specifically on the skin and on the scalp in a compounded formula. It is also important to check for thyroid
deficiency, as this can be a cause of the symptoms. Don’t overlook obvious causes such as fungal dermatitis, eczema, and psoriasis. In addition to topical estriol and BHRT, moisturizing oils such as jojoba, and vitamins such as folic acid, B complex, biotin, and DL methionine could help. In my practice I often prescribe a compounded mixture of estriol, alpha lipoic acid, and coenzyme Q
₁₀
. Vitamin C ester can promote a youthful glow to the skin, too.

Q: Could anxiety be a sign of a hormone imbalance? Is it common to suddenly develop anxiety in your early forties, without any of the other typical menopausal symptoms? And what hormone would be responsible for these anxious feelings?

DR. SUE DECOTIIS: Anxiety is definitely a common symptom of perimenopause. It is often the first symptom to occur during the time that hormone levels are shifting. Progesterone levels can decline early on in the process, with estrogen levels staying the same. This leads to a relative “excess” of estrogen. Nervousness, irritability, moodiness, insomnia, and restlessness can all occur during this time. Anxiety can present along with other symptoms due to this hormonal shift, which I explain to my patients as the “FIVE B’s”—bitchiness, bloating, bleeding (abnormally heavy and or frequent periods), decreased libido, and breast tenderness. Many women start experiencing weight gain during this time. Progesterone decline, which occurs transiently during the menstrual cycles of premenopausal women, is responsible for PMS, PMDD, and menstrual distress.

After checking hormone levels on the twenty-first day of the menstrual cycle, bioidentical progesterone can be prescribed.
After correcting this imbalance, patients report alleviation of the symptoms mentioned and feeling like themselves again. The perimenopausal period may last quite a long time. Not diagnosing the real problem and correcting the hormonal imbalance can make for a very traumatic time in a woman’s life. Many perimenopausal women are treated for depression and insomnia, or see psychiatrists and marriage counselors, when an accurate diagnosis and treatment could avoid this.

Q: Are panic attacks and anxiety part of perimenopause?

DR. GOWRI ROCCO: Although most published symptoms of menopause do not usually include anxiety and/or panic attacks, these symptoms do get much worse or even start happening at the time of perimenopause. Women often complain of increased nervousness, irritability, unnecessary worrying, low resistance to stress, low confidence, and increased depression with lowering levels of progesterone. Rebalancing progesterone significantly reduces a lot of these symptoms, to the point that conventional drug treatments may not be needed for anxiety, depression, or sleep. L-theanine is an excellent supplement to take for decreasing anxiety after progesterone is rebalanced, and it also is a natural “chill pill” that has no addictive properties and hardly any side effects reported with even high dose use. I recommend 200 mg L-theanine as needed for anxiety, and 400 mg for panic attacks to my patients. L-theanine is also great for inducing calm and inducing sleep, especially if poor sleep is related to excessive thinking and worrying. L-theanine is an amino acid and has a short half-life, with no drowsiness effects when taken during the day.

Q: When you’re experiencing some unusual symptoms of anxious moments, when it has not occurred before, which hormones are most likely to be unbalanced? When do you take yourself to the M.D.?

DR. PRUDENCE HALL: That is such a good question; the symptoms could actually point to a few imbalanced hormones. Anxiety and nervousness are common in perimenopause and can be symptomatic of hormone imbalance. The adrenal hormones are also frequently stressed, causing surges of anxiety. Symptoms are a good way to measure your hormonal decline. Hot flashes, night sweats, weight gain, depression and anxiety, and a decreasing sex drive all suggest you should check in with your doctor to have your hormone levels balanced.

Q: I am forty-one and I am having more “blue” days than I have ever had. I am not depressed, but some days it sure seems like it. Is that normal?

DR. JOSEPH RAFFAELE: There are many things that can cause an increase in the days a woman feels “blue.” Difficult life events, stresses, and relationships can all contribute. These are the “normal” things that can build up and depress mood. By age forty-one, most women also have considerably lower testosterone levels than when they were in their twenties. The lower levels often leave women with less energy and “get up and go,” which they sometimes describe as “blue days.” If you also notice a decreased sex drive, it is more likely to be low testosterone causing your low mood. Low testosterone levels can be caused by taking oral contraceptives, so be sure to ask your doctor to check your free testosterone level if you are on a birth control pill and experiencing
more frequent blues and lower libido. Other possible hormonal causes include less than optimal thyroid hormone levels (particularly free T3) and reduced growth hormone secretion.

Q: I am forty-two years old, 245 pounds. I have next to no libido. Don’t sleep with my husband. Have mood swings. I would love to lose the weight, but I can’t. I know my hormones are totally out of whack and have been for years. I want to get well
.

DR. SEAN BREEN: The first step is to get blood work to check all your hormone levels, in addition to vitamin D and other nutrient levels. It is not uncommon for patients this age to have suboptimal thyroid levels, decreased levels of testosterone, vitamin D deficiency, and other nutrient deficiencies. Once your hormone levels are balanced the next step is to really study your diet. For example, patients who drink a lot of soda or diet soda get exposed to very high amounts of aspartame, which is an excitatory neurotransmitter that can cause psychiatric symptoms. Eating clean and drinking nothing but water for one month is a good start. Look at an elimination diet to see if there are foods that are contributing to the symptoms. Lastly, consider the environmental toxins that you may be harboring in fat cells. Things like heavy metal toxicity can cause a myriad of symptoms that typically get missed by the traditional medical doctor.