by Karen Asbury
Usually at about the age of 40, women’s hormones begin to change, and they may begin to have periods where they do not ovulate. If there is no ovulation, there is no production of progesterone. This can lead to estrogen dominance, which can cause irregular and/or heavy periods, uterine fibroids, water retention, fibrocystic breasts, increased forgetfulness, foggy thinking, tearfulness, weight gain, elevated blood pressure and other symptoms. This marks the beginning of menopause.
Progesterone has many functions in the body. It increases burning of fats for energy, it is anti-inflammatory, it protects the integrity and function of cell membranes, it protects against blood clots, it reduces cholesterol and inhibits coronary vasospasm. Most importantly, it offsets the growth effect of estrogen.
There is a difference between synthetic hormones and bioidentical hormones, which are the same as the body makes, but come from a plant source and cannot be patented by drug companies. The progestins are synthetic and some studies have linked them to an increased risk of cancer. Bioidentical hormones such as progesterone and estrogen may be obtained from a compounding pharmacy. Some women choose not to have hormone replacement therapy following menopause, and some are fortunate to have very few menopausal symptoms, if any. Hormones have been shown to be beneficial for the heart, bones and brain. There are studies documenting that women do better on hormone therapy even if only for the first five years, versus those that have no hormone therapy.
When the ovaries are no longer functioning, the adrenals must take over the production of hormones unless there is hormone replacement. The adrenals may be weak due to stress, poor diet, genetic methylation defects, hormone imbalances, emotional issues and multiple other factors. Strong adrenals are a very important part of maintaining health after menopause, and saliva testing is a good way to assess adrenal function and hormone levels.
Many women choose herbal products to deal with perimenopause and menopause symptoms that include hot flashes/night sweats, irritability, depression, anxiety, insomnia, libido, fatigue, vaginal dryness and more. The top five evidence-based herbs for symptom relief are black cohosh, maca, kava, St. John’s wort (especially with black co-hosh) and sidbhiric rhubarb. Pine bark, red clover, valerian, grapeseed extract and soy have also been shown to have benefit. Adaptogens such as ashwaganda or rhodiola are helpful during the time of hormone fluctuations and the need for the body to adapt.
Compounded bioidentical hormones not only have very little risk of cancer compared to the synthetic hormones, but they are effective in helping with osteoporosis, cardiac health and preventing dementia, as well as amelio-rating menopausal symptoms. The benefits go far beyond that; there is even evidence to show that estrogen helps osteoarthritis and joints. Studies have shown that after menopause, women on hormone replacement therapy maintain a higher level of health than those that don’t use any hormones.
If changes are noticed, don’t just chalk it up to age; have hormone levels and adrenal function evaluated. It is important to check estrogen, progesterone, testosterone, cortisol and thyroid. There are multiple options, so the choice is ours about hormones or not. Always look at the risks and benefits of any therapy then decide. The goal is healthy aging.
Karen Asbury, M.D., is an integrative physician practicing in Richardson. For more information or to book an appointment, call 972-479-9139 or visit KarenAsburyMD.com.