While my job description includes many things, I mostly “do hormones.” Hormones are not just women’s hormones that need replacing at menopause, but women’s hormones that are out of whack for years before menopause begins, men’s hormones that may be on the decline sooner than they are prepared to handle it, and pretty much everyone’s thyroid and adrenal glands. Even when people come to me for other reasons, hormones are almost always assessed because they have to be. So, is it your hormones? Probably, yes
What distinguishes the work I do from most primary care providers and OB/GYNs, is that I am a naturopathic physician. I went to four years of med school, took my board exams, have a license which I update yearly with continuing medical education, and a DEA number to prescribe. In Arizona, I am fully trained to do just about everything your primary care provider will do, and then some. I integrate all of regular “western” medicine with Chinese medicine, herbal medicine, acupuncture, nutrition and physical medicine. I even include meditation when necessary. I look at you, the patient, coming to me with your problem, and ask a lot of questions. I ask the ones you didn’t think would be relevant. Apparently, for many of my hormone patients, I appear to be a psychic, because I seem to be able to get what they are talking about before they have said all of it themselves. It’s not that each patient is not unique, it is that hormone problems are so predictable when you look at the larger picture. This means history, and this also means personal habits. What astonishes me, is that for many women our visit is the first time it has been reflected back to them as the picture of one person, rather than the mini pictures of different problems they see several different doctors for.
Recently, it was announced that possibly 70,000 women had died early or unnecessary deaths because they had stopped estrogen replacement during and after menopause. This is causing alarm among women who did stop hormones due to doctors’ advice warning them that the Women’s Health Initiative (WHI) had indicated that women taking hormone replacement died too frequently compared to their non-HRT (hormone replacement therapy) counterparts. What is the deal?
Retrospective analysis is good at looking back at trends among a community of people who have self-reported symptoms and habits.This is not the highest level of health study, but it is important because we can’t put everyone in a controlled clinical trial. Unfortunately, during the time of the study, certain questions are routinely asked, and the patient is asked to be honest and have a fair, self-critical assessment in their life, and good recall. Many important factors are ignored because they weren’t considered relevant, or the patient didn’t think it mattered.
The results of the WHI study have been routinely debunked from being useful, as the application of hormone replacement therapy included all hormones, of all kinds, for all women, of all ages, with all habits, with all possible schedules of replacement. This is not a good picture, as that included estrogens like conjugated equine estrogen (extracted from horse urine, such as Premarin), which is not native to the human body and can act up to 1000 times stronger on receptor sites than native estrogens such as estradiol, estriol, and estrone. It included progestins such as MPA (medroxyprogesterone acetate, in Prempro) as well as native progesterone. A quick Google search of MPA vs. progesterone shows that the “same” chemical family has completely different biological and physiological effects. MPA is great for birth control, but it’s also the primary cause of blood clots, strokes, heart attacks and some cancer for women taking it that developed these problems. Other versions of these progestins carry the same risk.
Progesterone is native only to humans, and carries essentially the anti-risk of these drugs. It’s pretty fascinating, really, because most doctors will not actually know the difference between the two and assume they carry the same risk.Women routinely have their uterus removed, and are told they no longer need progesterone. Had they had progesterone earlier, they might have avoided the hysterectomy, the anxiety meds, the sleep meds, and possibly developing breast cancer. If your doctor doesn’t understand what progesterone deficiency and pregnenolone steal syndrome look like, this will not be addressed at all. I have fixed this imbalance with a simple and safe (to most) prescription, I have even fixed it with herbs and vitamins.
So, what’s up? For one, there are at least six major hormones that need to be balanced, in different ratios for women than for men, and that balance is also specific to a woman’s personal history and individual tolerance. There are clear side effects from too much or too little of any hormone. If a woman is still menstruating, it makes a difference. If she has had a hysterectomy but her ovaries intact, it makes a difference. If she has had a complete hysterectomy at 30 because of fibroids and ovarian cysts vs. natural menopause at 51, it makes a difference. How many symptoms she had before and after “the change” makes a difference. If she is obese, it matters; if she smokes, it matters; if she drinks alcohol, it matters; if she exercises, it matters; if she works long days or night shifts, it matters. Her symptoms tell us how her body handles the hormones she makes, which ones are deficient, and why she started having certain problems. In my experience clinically, with hundreds of patients, problems usually start about six to ten years before seeking treatment.
These six hormones — pregnenolone, progesterone, DHEA, estradiol, estrone, and testosterone — are the main players on routine labs. There are other metabolites of these, and a urine sample is a different picture than serum labs. Unfortunately, lab reference ranges vary among labs. If you have a doctor unschooled in the nuances of what lab ranges mean, and they get back your labs, chances are you are normal. But normal can mean post menopausal levels to fertile Myrtle. Most “normal” ranges include feeling really lousy at either end. Synthetic hormones, the ones not native to the human body, cannot even be measured with labs.
So where to go? Well, for one, deciding to take on HRT should not be decided lightly. It is only done well with a commitment and awareness. Taking hormones when you have a lot of health issues will not resolve them if you are not willing to handle the whole picture. You will hear the full gamut from friends, those who had no hot flashes to those who had them for ten years. Those who never did hormones and did just fine, and those who did them and got cancer. Those who never did hormones and got cancer and those who did them and felt awesome. Hormones are not a requirement, but hormones make us feel younger, happier, healthier, more vital in many ways because they (when applied safely and appropriately) have an anti inflammatory and anti-aging effect. Done correctly, they reduce the risk of cardiovascular disease and cancer, prevent bone and muscle loss, protect the brain from atrophy. They impact mental and physical health on every level, as they are active on every cell in the body.
Why do hormone replacement? Most women I know don’t expect to be old at 50. They are working full-time, many in demanding careers, maybe married, usually still raising children or helping their adult children who are struggling with adulthood and child rearing themselves. They want to be physically and sexually active, they want to sleep through the night, and they want to remember things they just talked about earlier that day. Hormones have an effect on all of those things.
Major stress is usually the huge interrupter of healthy hormone balances, typically starting in the mid to late 30s, early 40s but clinically I am seeing this start in the 20s for some women. This disrupts sleep, mood, menstrual cycles, weight control, and fertility. It is only addressed when one of these things or more starts to require a lot of medication or disrupts their lives, often after years of problems. It may be sex hormones, it may be adrenal and thyroid hormones, but all of these things impact health. Diet and exercise play in, and let me be the first to say that diet soda is the same as a “cigarette in a can,” in what it can do to your mental, metabolic, endocrine (hormonal) and cardiac health. Energy drinks are no laughing matter.
Until physicians and patients wake up to the reality that the diet and life choices of young women are negatively impacting their hormonal health, these problems will continue to show up much earlier in life than menopausal symptoms. While no one has to go on hormone replacement therapy, the same risks for cancer, heart disease, diabetes and Alzheimer’s exist with or without hormones — it is what you do with your body, what you put in your face most of the time. With bio-identical hormones, the aging process seems to slow, and these risk factors may be diminished, and damage slowed or reversed. Even with genetic risk factors, how you live will have the largest impact on how your hormones are handled by your body. The worse it is earlier in life, the worse it is later.
As a practitioner, I am always hopeful and I am always helpful. There is not a patient I see that I cannot help, even if that just means cleaning up their diet and nutrition while they are facing the reality of breast cancer. I don’t believe that all hormone replacement, managed well with a lot of oversight, is dangerous even for women who have had hormonal cancers. Unfortunately, the fear generated in them is enough to make them stop looking for help when they still have many issues to resolve that will make a huge impact on their health future. Our high stress and high toxin environment doesn’t make menopause a safe or easy time for any women. With a well-informed practitioner, hormone replacement should hopefully make it a little bit better.
Guest contributor Dr. Christine Hicks, NMD practices in Phoenix and Mesa, AZ, specializing in hormone replacement, weight loss, digestive disorders, pain management and general health. Visit her at www.drchristinehicks.com. You can follow her on Twitter at @DrChristineNMD.
** This article is not intended to dispense medical advice with respect to abstaining from or seeking medical treatment from a qualified health practitioner. Dr. Hicks does not endorse taking hormone replacement therapy for any person without a full health history and physical exam, from a trusted practitioner and prescriber, and using a reputable compounding pharmacy. Any opinions expressed here are the opinion of Dr. Hicks from direct clinical experience, and may conflict with the advice from your family physician or specialist, or the National Institute for Health. **