I'm Too Young for This!: The Natural Hormone Solution to Enjoy Perimenopause (24 page)

Q: Can you please tell me how to get rid of my uterine fibroids without surgery? I am forty-one. Is this hormone related?

DR. PRUDENCE HALL: Uterine fibroids are benign growths on the uterus that are common to many women as they age. They are considered to be inflammatory in nature, like most benign and cancerous tumors are. They don’t have to be removed unless they cause profuse, troublesome bleeding, bad cramping and pressure, or are rapidly growing in size. I love treating fibroids naturally and suggest the following: first eliminate any dietary foods that can cause inflammation. The main ones are gluten, dairy, soy, peanuts, sugar, eggs, and red meat. Next, drink a nice healthy green drink for breakfast, made of detoxifying greens such as kale, dandelion greens, celery, cilantro, or parsley, and also add turmeric and ginger. Shakes made from natural plant-based proteins are also helpful, and enzymes are important to seal the deal. These “rotor-rooters” go into the body to dissolve abnormal tissue. I love the PuraDyme enzymes, which I feel are the highest quality available. Take four to six of their digestive enzymes (LiyfZymes) with each meal, and then on an empty stomach take six to eight of the supersystemic enzymes called Puraliyf. You can follow your progress with pelvic ultrasounds. Good luck!

Q: I am forty-eight years old. I had a polyp removed last October. My next period, I bled twice as much as my regular periods; I thought I’d bleed to death. The doctor put me on a three-month course of birth control. I don’t know what to do once the course of treatment is over. Not to mention no sex drive left. What solution(s) do you have to offer? Thanks
.

DR. THERESA RAMSEY: First of all, it is best to inform whoever removed the polyp about the heavy bleeding. He or she is the
best one to evaluate whether this may be related to the procedure performed. Putting a woman on birth control, oftentimes continuous, is a common treatment for heavy bleeding. Although this helps the heavy bleeding, it does not address the underlying cause, which likely is related to your hormones. The uterine lining is stimulated by estrogen and clearly you have plenty of this as is evident from the monthly bleeding. Estrogen will cause the lining to thicken each month and part of this is what you slough. Progesterone has an important role of opposing the stimulating effects of estrogen. I refer to progesterone as the disciplinarian of estrogen. If there is plenty of estrogen around and not enough progesterone, there will be heavy bleeding, and this is common in a woman nearing menopause. Typically progesterone levels decline before estrogen levels do and heavy bleeding will result. In the end, what you need is progesterone and enough of it to oppose the effects of your estrogen. There are many options for starting prescribed progesterone, but you definitely want to make sure it is bioidentical (e.g., Prometrium or compounded progesterone) and not medroxy progesterone acetate (e.g., Provera). Starting progesterone will offer you more benefits than just controlling the bleeding. It protects your breasts and uterus from cancer and can help you sleep better, not to mention help abate hot flashes and night sweats. You will want to take enough to slow the bleeding.

Irregular bleeding may continue, though, and this is simply the nature of perimenopause, as your hormones go up and down differently than they did earlier in your life. As far as the sex drive goes, be sure to have your doctor test your free testosterone and DHEA-sulfate levels, as these are important hormones that tend to be low at this time in a woman’s life, and get you started on a dose that is right for you.

Q: I understand that saliva hormone testing is not accurate if I’m taking birth control pills. How can it be accurately tested if I don’t want to stop taking the pill? I find it keeps me on an even keel for at least the time being. I am fifty and don’t have any problems (yet!)
.

DR. JOSEPH RAFFAELE: As with many things, the truth is somewhere in the middle. Saliva testing is relatively accurate for testosterone and can be used when a woman is on birth control pills. However, birth control pills contain a very potent estrogen, called ethinyl estradiol, that takes over the menstrual cycle, rendering saliva testing for estradiol, estriol,
and
progesterone useless. (It would also be relatively pointless to check
blood
levels for estrogen and progesterone while a patient is on a birth control pill.) Birth control pills put you on an even keel, but they come with a price in adverse physiological changes. You also won’t be able to tell when you have gone through menopause (or even if you’ve entered perimenopause) while you are on the pill.

Q: I decided in the last year to have bioidentical creams made up by my compounding pharmacy. I have been on them for almost one year, and my memory still has not gotten back to normal. I still am in a fog all the time!

DR. GOWRI ROCCO: You have definitely taken the right steps by starting BHRT creams. If you have been on the creams for a year now, you should have felt much improvement in your memory and brain fog. If not, I suggest getting your estradiol, progesterone, total/free and bioavailable testosterone, and DHEA
levels retested. It is important you are not being undertreated and that these values are in optimal ranges for you. Testosterone, especially, is important not only for increased libido, but also for increased cognitive functioning. Other supplements that greatly help with memory recall and improving brain fog are phosphatidylserine, fish or krill oil, and vitamin D
₃
. It is important that you are not deficient in any of these levels as well. Phosphatidylserine is a brain nutrient that has been shown to improve memory, learning, and other cognitive functioning. It is easily tolerated. It is best to take 200 mg of it with 250 mg of DHA+EPA omega-3 fish oil or krill oil. Vitamin D
₃
is best to keep at levels between 80 and 85 ng/mL. Generally, to keep D
₃
at this level, it depends on the blood results, and may require between 5,000 and 10,000 IU daily. Work with your physician.

Q: I have been having heart-racing episodes since I was forty-three years old … tests reveal nothing is wrong with my heart, yet it will race out of control during my sleep and sometimes when I’m awake. Why? When this happens while I’m asleep and I wake up to it beating out of control, I simply change positions and within a minute or so my heart rate goes back to normal. I can actually feel some type of “surge” going through my body when the episodes begin; is this from my hormones fluctuating and if so, what can I do to get things under control?

DR. THERESA RAMSEY: It is common to have heart symptoms as our hormones change. There are two steps for you to take. One is to have a cardiac workup with a cardiologist for a stress echo and Holter monitor. The other is to have your entire hormone panel tested. Since you are cycling, the best time of the month to
do your blood work is within the week before anticipated menses. Make sure you are having your blood work reviewed by a hormone specialist, because if a physician is not a hormone specialist, he or she will tell you that your levels “normally” drop as we age. A hormone specialist will tell you that although it is “normal,” it is not “optimal.” Hormone specialists understand how to optimize hormone levels, which brings with it symptom resolution as well as preventive aging.

Q: I’m forty-nine and still have regular periods. However, I’m experiencing hot flashes and night sweats. As a result my doctor put me on estrogen for the hot flashes. Unfortunately, it made me swell and bloat. My breasts became painful, and the bleeding and cramps were intense, so I stopped the estrogen and felt better. However, now I have hot flashes and can’t sleep at night. I’m damned if I do and damned if I don’t
.

DR. NEIL ROUZIER: You are entering perimenopause, during which time your hormones will fluctuate from very high to very low. There are two ways to describe perimenopause: (1)
Anything
that happens is normal. This is due to the extreme fluctuations of hormones. (2) Perimenopause is also termed no-man’s-land as no man knows how to treat it (as in your case) and no man wants to deal with it (maybe your husband). Let’s review some physiology to understand why you have what you have and then we will understand how to fix it.

In the past, doctors treated perimenopausal women with birth control pills to wipe out ovarian function and thereby eliminate the yo-yoing effect of their hormones. Many women, however, do not want to take BCPs due to side effects and complications.
Normally in premenopause, your pituitary hormones (FSH) remain within the normal range of around 10 or less. As time goes on, however, the production of a particular hormone, inhibin, from the ovaries diminishes and the brain (pituitary gland) senses the loss of this hormone and tries to compensate for loss. The brain then releases follicle-stimulating hormone in an attempt to stimulate the ovaries to produce more inhibin. This increase in FSH increases production of all hormones from the ovaries, primarily estrogen. The less and less inhibin the ovaries produce, then the higher the production of FSH by the pituitary to stimulate the production of inhibin. It is the loss of inhibin that results in the early symptoms of hot flashes and night sweats. And it is the increase in estrogen production by the ovaries that results in your symptoms of excess estrogen in spite of the fact that you are experiencing hot flashes. If we tested your estrogen level during a hot flash (when you would normally think that it would be very low), it is actually quite high. Remember that it is the loss of inhibin that first triggers hot flashes in perimenopause. Your doctor interpreted that your hot flashes were due to loss of estrogen, when in reality your estrogen was quite high as evidenced by your symptoms of excess estrogen. In fact, your estrogen can be two to three times normal in perimenopause and the inhibin will fall to zero. When the inhibin falls to zero, inhibin no longer inhibits FSH; production of FSH increases, which increases production of estrogen to excess, which causes symptoms of excess estrogen in spite of continued hot flashes. See how important it is to understand the physiology behind perimenopause in order to understand how to treat it? And it’s not with estrogen as many physicians think.

Since your ovaries are already working overtime to produce excess estrogen from increased production of FSH, you do not need estrogen at this time, which in fact will increase your symptoms of excess estrogen (breast swelling, bleeding, bloating).
The treatment is, therefore, to oppose the high levels of estrogen that you produce in perimenopause. The treatment is simply the same as for PMS and that is high-dose progesterone. The higher the estrogen, the greater the symptoms, the more progesterone is needed. Progesterone is excellent at alleviating the hot flashes and symptoms of perimenopause. It also opposes the side effects of increased estrogen. Oral progesterone is also soporific, which improves sleep and eliminates the insomnia of perimenopause. Progesterone is an excellent sleep aid and antianxiety treatment, in addition to being the treatment of choice for perimenopause.

Testosterone is also an important therapeutic hormone for hot flashes, loss of strength and energy at menopause, and for the loss of muscle and metabolism (and weight gain) seen at menopause. Even though you may not need estrogen at this time, optimizing all your other hormones (progesterone, testosterone, DHEA, thyroid) will help improve symptoms and well-being and will make your friends wonder how you skated through perimenopause so easily. There is also nothing better that you can do to maintain your optimal health.

Q: I have tried hormone replacement and did not see much relief. I was using the Vivelle patch and progesterone in pill form. I am now fifty-two and experiencing an increase in weight gain, hot flashes, and an overall feeling of worthlessness, tiredness, no libido, no desire for much of anything.… Should I try the hormones again?

DR. RON ROTHENBERG: Optimizing hormones requires balancing all the hormones that are deficient to produce optimal results in quality of life. First, let’s consider what you were taking. The patch you were using is bioidentical estradiol but does not
contain the weak cancer-protective estrogen, E3 or estriol. “Biest” is a mixture of estradiol and estriol, which can be made by a compounding pharmacy and is preferred by most women. You state that you were taking a “progesterone pill.” I hope that was bioidentical progesterone but sometimes “progestins” are referred to as progesterone by those who are not experienced in this field. (Please see my earlier explanation of the difference between the two in terms of cancer risks [
this page
].) There is also a major difference in terms of quality of life. Bioidentical progesterone is a natural mood stabilizer and brain builder, and it helps to produce natural sleep. It can be a natural diuretic and can help with weight loss. Progestins, or artificial nonbioidentical progesterone, often have the opposite effect. The use of the “patch” and the progesterone pill are to treat estrogen and progesterone deficiency; however, the third hormone that is often missed by traditional practitioners is testosterone. In replacing the estrogen and progesterone alone, your available testosterone level drops, which for most women will decrease your libido, decrease your motivation, increase fat, and generally give you an off-balance feeling. I would definitely consider restarting hormone replacement, but in doing so, check all your hormones. Look at thyroid and cortisol, testosterone, and insulin, and be sure all deficiencies are being addressed. In addition, each woman is unique and her balance of hormones is unique. One size does not fit all and the balance of hormones must be optimized for you.