At some point in life every women will start to experience symptoms of hormone imbalance. For most women this happens in their 4th decade of life and is often referred to as perimenopause. In my anti-aging medical practice, I successfully treat hundreds of women in perimenopause using bioidentical hormone replacement and within weeks they start feeling fantastic. It is critical that women who start experiencing any symptoms of perimenopause start treatment as soon as possible to reduce the sequela that accompany hormone imbalance.
- What are the typical signs and symptoms that women will experience as a result of a hormone imbalance in perimenopause?
The first thing that brings women into my office during this period of time is the complaint that they are gaining weight and are having a very hard time losing any weight. They will often say to me, “I just can’t seem to lose these last 10 pounds around my abdomen. I used to be able to lose this belly fat if I ate clean for 2 weeks and exercised. Now it won’t come off!” So if you find this is happening with you then it’s likely you are experience a decline in testosterone, thyroid, human growth hormone and progesterone and also seeing an increase in cortisol and insulin. Secondly, women will tell me that their periods are becoming more irregular. Either it’s “I am getting them every 21 days when they used to be 28 days on the dot.” Or they will tell me that “my periods are heavier and longer than they have ever been and they are very erratic.” The reason why this happens is because women will stop ovulating which reduces progesterone levels and cause a relative excess of estradiol. Women will also tell me that they are having difficulty sleeping, are more moody, are starting to get hot flashes or night sweats, have declining libido, depression, vaginal dryness, painful sex or foggy memory. Some women have one or two of these symptoms where others will have all of them. Doctors often refer to perimenopause as “no mans land” because anything can happen and anything that happens is normal. Here is an informative interview with Suzanne Somers about perimenopause published in life extension magazine: http://www.lifeextension.com/magazine/2013/11/im-too-young-for-this-the-natural-hormone-solution-to-enjoy-perimenopause/page-01
2. What is the first thing that you should do if you are experiencing symptoms of hormone imbalance?
Any women who is having irregular bleeding and menstrual cycles should start out by having a gyn exam to rule out any pathology that typically causes bleeding (fibroids, uterine cancer, ovarian cysts etc). Even though in 90% of cases it is a result of imbalances in hormones we need to make sure we rule out anything serious. Once you have a normal gyn exam you should have a battery of hormone tests. I typically recommend the following labs to my patients so feel free to ask your primary care doctor to order if you don’t have access to a bioidentical hormone doctor like myself. You want to check FSH, LH, estradiol, progesterone, total and free testosterone, IGF-1, IGF-BP3, DHEA-S, TSH, free T3, free T4, reverse T3, insulin, cortisol (8AM), CRP, Complete Blood Count, Chemistry Panel, 25-OH Vitamin D and urine N-telopeptide. I also recommend a few specific labs to predict your risk of heart attack and stroke as we can detect the likelihood of arterial plaque while it’s treatable through nutrition. These tests are Lp-PLA2, Lipoprotein (a), apolipoprotein B, NMR Lipoprofile, Microalbumin to creatinine ration, myeloperoxidase and homocysteine. Once you have this panel done I will have a very good idea of exactly what is going on in your body both hormonally and metabolically.
3. How are the hormone imbalances in perimenopause treated?
Every single women is unique when it comes to treatment but there some general principles that I tell all women experiencing hormone imbalance symptoms. The first is to drink nothing but water and make sure you are getting 0.5 ounces per pound of ideal body weight. So if your ideal body weight is 120pounds then you need to drink 60 ounces of water daily. Dehydration is a major cause of fatigue and can in itself cause hormonal imbalances. The second thing is to make sure you are getting 7-8 hours of sleep per night. Here is a clinical pearl: bioidentical micronized progesterone in a CAPSULE form is THE BEST natural sleep aid for women because of how it is metabolized. The dose will depend on many things but make sure you don’t use a progesterone cream during this time as they are very POORLY absorbed. The third key is to avoid sugar like the plague. Sugar drives insulin which drives inflammation which has a negative effect on the hypothalamus and pituitary gland which are the master endocrine organs. And lastly, moderate exercise on a daily basis is THE only way to help lose the increases in fat stores that accompany perimenopause.
Now once we get those four things in order I will generally treat women in perimenopause with the following:
a. Micronized bioidentical progesterone capsules to take at bedtime: this will improve sleep and also reduce heavy bleeding, reduce irritability, and protect against excess estradiol. Every single women in perimenopause needs bioidentical progesterone, no exceptions. Here is a link to a video where I discuss the importance of progesterone in women: http://www.doctorbreen.com/portfolio-archive/what-you-need-to-know-about-progesterone-for-women/
b. I will typically give women bioidentical testosterone cream to apply to their vaginal area each night. This helps drive libido, clitoral sensitivity, reduces inflammation, reduces body fat, helps lean muscle development and also protects against breast cancer.
c. Most women will need some thyroid support during this time which will improve energy, help with weight loss, improve mood and memory and also improve cholesterol.
d. Some women will get DHEA in a sustained release capsule form. I don’t give this to every women because of acne that can accompany its use. I will use this if women are having issues with cortisol as DHEA helps balance cortisol levels.
e. Vaginal stimulant cream or “scream cream”. A lot of women tell me that they have decreased sensitivity in the labia and clitoral area during intercourse in perimenopause and menopause. This is a combination of tadalafil and arginine and increases the sensitivity of the labs and clitoris during sex dramatically.
Unfortunately every women will experience hormone imbalance at some point in their life. For most women this will happen at some point in their forties and is commonly known as perimenopause. The good news is that you can easily reduce or eliminate these symptoms using bioidentical hormone replacement therapy. The key is to go to a doctor that has experience using natural hormone replacement and not synthetic hormones like premarin or provera. If you are suffering from any of the above symptoms and would like me to review your labs you can do so by contacting my staff through my website at www.DoctorBreen.com