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Bioidentical vs Synthetic Hormone Replacement in Menopause

roses grunge © lynette sheppard

This guest post was written by Dr. Jo Ann Holoka, Jacksonville Bioidentical Hormones Expert and part of BodyLogicMD, a network of highly trained physicians across the country who use BHRT (bioidentical hormone therapy) to help anyone suffering from hormone related conditions such as adrenal fatigue, menopause, and andropause (the male menopause).

The difference between bioidentical and synthetic hormones:

Ever since the Women’s Health Initiative studies came to a screeching halt in 2002, hormone replacement therapy (HRT) has garnered a pretty bad rep. The number of women using HRT declined significantly after it was discovered that the combination of hormones that most women were taking (namely progestin and estrogen) increased the likelihood of heart disease, breast cancer, blood clots and stroke.

The main problem with these studies is that they were only focusing on women who used synthetic hormones, such as Premarin, Provera and Prempro. Nearly a decade later, hormone therapy has become more popular among menopausal women, thanks to natural HRT alternatives, like bioidentical hormone replacement therapy (BHRT).

Bioidentical hormones are molecularly identical to the hormones that the body produces naturally. Bioidentical hormones are derived from naturally occurring, plant-based sources, such as soy and yams. There are several advantages when using natural bioidentical hormones, when compared to their synthetic counterpart.

Being that bioidentical hormones are exact replicas of the hormones your body already produces, the body can’t distinguish the supplemented hormones from the ones your body is producing naturally. So when you take a blood test, your total estradiol level reflects both the bioidentical estradiol and the natural estradiol. This makes it easier for your doctor to closely monitor your total levels and adjust your treatment regimen accordingly. Most synthetic hormones are metabolized differently and aren’t visible using standard lab tests.

Another benefit of using bioidentical hormones is that they’re typically not taken orally. Most synthetic forms of HRT are administered orally, in the form of a pill. Instead, bioidentical hormones are compounded in a laboratory and come in the form of creams, gels, pellets or injection (though not common). It’s best to avoid taking hormones orally (bioidentical or not), because it can lead to high blood pressure, weight gain, elevated cholesterol levels and has even been found to bring on sudden bouts of depression in some women.

Perhaps the most alluring of benefits is the fact that each BHRT regimen is individually tailored to meet your specific needs. There is no such thing as a one-size-fits-all treatment when it comes to balancing hormones. Two women of the same age, who follow the same diet and workout routine, could have wildly different hormone levels. Bioidentical hormones are custom compounded based on your hormone levels and your specific set of symptoms. This makes them far more effective than the synthetic HRT drugs that are currently on the market.

Be it hormone therapy or anything else that may relate to your health or well-being, it’s always a good idea to do your homework and research all of your options before making a decision. It’s also important to remember that you know your body better than anyone else. If you feel like your body is trying to tell you something, don’t hesitate to talk with your doctor about further testing to take a closer look at what’s going on inside.

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Menopause: Going Through A Dry Spell

Dry River Bed © lynette sheppard

Menopause means moist in all the wrong places. You’re dripping on the outside while your skin and tender membranes are desiccating as if they were exposed to a harsh Southwestern sun, 24/7.

We have feedback on our outer skin. We see it crack and peel, feel it itch or flake. And we pour on lotions. By the tubful. All that money we save on monthly feminine supplies? It’s nothing compared to what we have to budget now just to keep a semblance of moisture.

Inside we are dry too. Our natural vaginal moisture disappears. For some of us, it is noticeable in painful sexual intimacy. We buy and use lubricants to regain a healthy sex life. And thankfully, there are many products now mimic natural lubrication (see the Menopause Marketplace for some of our favorites.)

When vaginal dryness doesn’t cause painful intercourse, however, it can still cause health problems. Vaginal atrophy and thinning of the lining may manifest along with dryness. One of our own Venuses was having problems with drainage and recurrent infections. Turns out that sexual intimacy was resulting in microtears in the lining that were then becoming infected. Even though she couldn’t feel that. Using lubrication and taking estrogen intravaginally has alleviated the symptoms.

One of our faithful readers and satellite Venuses wrote me with a brilliant solution of her own. She was having urinary and bladder issues (again, which can be part of this whole post menopausal syndrome). She did not want to avail herself of HRT and was trying to find a more natural alternative.

Evening primrose oil has been used by some women for a variety of Menopause symptoms. This goddess had taken the capsules at one time for general relief of hot flashes and the like, but had to discontinue them because of nosebleeds. (Evening primrose oil can be a blood thinner. Remember, just because it is “natural” doesn’t mean “no side effects.”.)

She wondered about inserting the capsules as a vaginal suppository, where there would be a local effect (relief of dryness) without the systemic effects (blood thinning). Google turned up little information, so she tried it on her own.

And… it worked! No more dryness, relief of urinary symptoms, and reduction of hot flashes. “It’s not perfect,” she tells us. “There is a bit of leaking, so you need some light protection, but all in all, I think it’s fantastic, and I thought you might like to pass it on to others.” I think I’ll give it a try as well.

Another reader shared that she started drinking dong quai tea and lubrication was simply no longer a problem. Another potential remedy to try.

This is what we are all about. Women sharing wisdom – what works and what doesn’t. Our thought processes, experimentations, successes, and failures. Let us know what works for you. And doesn’t. We’ll gather around our virtual kitchen table here and help one another through the worst and best of the Big M. The best journeys are shared.

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Nighttime Hot Flashes Don’t Have to Disrupt Sleep Any Longer

My Breeze Fan on bed, cat not included

I’m into my third week of Operation Stop HRT (Hormone Replacement Therapy.) Days 4 through 15 have been much easier than I would have predicted. My main symptom has been nocturnal hot flashes. And thanks to a new “fan”, those have hardly been noticed.

Now I remember, pre-BHRT, that nighttime flashing was a real problem. I’d start burning from the inside and wake up sweating like the proverbial porker. I’d fling the covers off onto my unsuspecting spouse and wait for a nonexistent cooling breeze to manifest. After what seemed an interminable amount of time, I’d finally cool somewhat only to overshoot to the other side of the thermostat and freeze as dampness evaporated from my skin.

Worst of all, I’d be wide awake. And irritated. And sleep deprived the next day. Which irritated me more. You can see why I wasn’t crazy about going off my BHRT even though I’d decided that it was time.

Luckily, help manifested in an amazing form and right on time. My girlfriend’s husband sent me an email about a friend of his who’d invented a special fan to cool those nighttime flashes before they’d awaken his menopausal beloved. Seems she was suffering the same vicious cycle of sleep deprivation/crankiness so many of us are privy to with nocturnal flashing. When his invention gave her back her sleep and equanimity, he knew he had to make more of them. I had to have one! He sent me a prototype to try.

My Breeze Fan Closeup

This special Hot-Flash Cooling fan called My Breeze hooks onto the end of a goddess’s bed. A small remote control that can be worn like a necklace or sit on the bedside table is used to activate the fan at the first sign of that telltale heat.

The fan blows blessedly cool air for a couple of minutes (or for however long you have preset it; both time and power are adjustable for each goddess’s preference) thereby stopping the flash in its tracks, before it can overtake you. Most important, it stops before you become fully awake. Goodbye soaked sheets, freezing spells, and sleepless nights. Hello sweeter, gentler, more rested you. And me.

My Breeze comes with courtesy bars to keep the fan from disturbing your mate. And they’re pretty! Which is a big deal to me since I did spring for some nice bed linens recently.

For me, the My Breeze fan is a godsend. It may make the difference between gracefully easing off BHRT or going through a prolonged, uncomfortable withdrawal.

If you also suffer from nighttime hot flashes and resultant insomnia, I recommend that you try this amazing fan. Yep they offer a 14 day free trial. Visit the website and click on “Is it for you?” to ascertain the right fan for your bedstyle, sleeping habits -like whether you sleep with pets and are they trainable like my cat. Okay, maybe trainable is too strong a word. I basically told her that it was time to move to the other side of the bed or actually to occupy that fancy cat bed we bought her years ago. We worked it out.

As for the rest of the journey off BHRT, it’s too soon to tell if there will be other symptoms, but I’m betting no. I’ll keep lifting weights to prevent osteoporosis, exercising, eating right (most of the time), and of course, adjusting my attitude with wine and chocolate.

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Stopping HRT: A Menopause Goddess’s Daily Journal

Day One of Operation Stop HRT

Dear diary,
Today, I cut my patch in half and secured the non-adhesive end with waterproof tape. I’ve felt virtuous all day. No symptoms or adverse effects at all – not that I expected any. Estrogen will store in fat tissue, and okay, I’ve got a little storage depot around my middle and in my thighs. I expect no real change for the first week or so. (And hopefully, no real changes after that!) Because I’m tired of change. I haven’t heard from Dr. A yet re: her progress.
Off to bed, and hopefully to uninterrupted sleep.

Day Two
Another good (read uneventful) day from a hormonal standpoint. Delighted that my waterproof tape is holding. No hot flashes or other Big M symptoms. It seemed like an especially hot night, though not enough to wake me. Felt so much better when my husband complained “Geez, it was hot last night.”. Yay. It’s not me.

Being religious about using my natural progesterone cream. Feeling like this might be easy, but know that there exist loads of shoes just waiting to drop when I get too cocky. Called the clinic and left message for Dr. A. to call me. Has she reconsidered (read Chickened Out)?

Day Three
Pretty good day. Not flashing or sweating. The only glitch I’ve noticed today is a slight shortening of my fuse. Our computer genius is on one phone line, my husband is on the other and the conversations are filling the house with competing crosstalk. Add to that the weed eater droning at 3000 decibels around the house and I can feel my shoulders hunch up to my ears. But I’m not sure that this isn’t just a normal day of overload unrelated to decreasing my BHRT (Bioidentical Hormone Replacement Therapy.)

I engage in calming tasks like cleaning off my desk space while wearing my noise canceling headphones, sucking serenity from my iPod meditative music playlist. Ahhhhhhh, Technology as tranquilizer. What a concept.

No word from Dr. A. I may be doing this alone. Unless someone else would like to join me?????????

Stay tuned, dear goddesses. I appreciate all support and suggestions. And chocolate.

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Stopping HRT aka Hormone Replacement Therapy

Last spring I visited my family practice physician. She is a woman of Goddess age and I asked her if she was taking anything for Menopause symptoms. When she told me that she was on HRT, I Mentioned that I was considering titrating off my bioidentical estrogen, since I’d been on it nearly three years.

Research suggests that a woman can take hormones for 3-5 years with no increase in side effects like cancer, stroke, or blood clots. Bioidentical hormones might be safer, but we don’t know that for sure. So my goal had been three years of hormones and then au naturel.

“I tried to go off this month,” my MD shared. “But I was dripping on my patients and it is just too hot with summer right around the corner. So I’m going to wait.” Feeling that to be prudent, I decided that I’d wait also. Summer is enough of a trial for the thermically challenged without tempting fate!

This month I went back for my annual checkup and broached the subject again. Had my MD (we’ll call her Dr. A) decreased or discontinued her HRT (hormone replacement therapy)? She had not.

I proposed that she and I try to decrease and ultimately discontinue our hormone therapy together. “It’ll be fun,” I told her. “It might be fun,” she mused with a small frown.

Furthermore, we agreed to keep track on a daily basis of any symptoms or signs of withdrawal from estrogen addiction and to post our progress right here on Menopause Goddess Blog.

So, starting one week from today, two real Menopausal women, an MD and an RN, will attempt the terrifying, amazing feat of weaning ourselves from pill and patch. Evel Knievel, eat your heart out.

Like the Cowardly Lion as he prepares to storm the witch’s castle to rescue Dorothy in the Wizard of Oz, I have just one favor to ask our sister goddesses before we run this gauntlet. Talk us out of it! (Just kidding. Sort of. No really.)

Lastly, if you’ve already performed this heroic act of derring-do? Tell us how it went for you. We’ll take all the preparation, encouragement, and ideas we can get! And chocolate. Please send chocolate.

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Adrift On The Sea of Menopause

I’d like to be a jellyfish
‘Cause jelly fish don’t pay rent…

They’re just simple protoplasm
Clear as cellophane.
They ride the winds of fortune,
Life without a brain.”

from the song Mental Floss by Jimmy Buffett

Now that my menopause brain fog has lifted, I notice an interesting new mental phenomenon manifesting itself. It’s a little like what longtime meditators call monkey mind (and I call Menopausal HDD). Still, it’s different. Monkeys jump from tree to tree exuberantly. Monkey mind jumps from thought to thought, idea to idea quickly. There’s almost a manic energy to them.

This new syndrome is more like jellyfish mind. While myriad thoughts intrude themselves, one atop another, I find myself floating among them. I’m drifting in a sea filled with plans, ideas, to-do’s, memories, wishes. Like a jellyfish, I float from thought to thought as they wave and brush against me.

I don’t mind the floating either. Which is weird. Because I like to be focused. Heck, I need to be focused. But too often, I just float from one thought to the next, one thing to the next, serenely. I feel like a caricature of a Zen master (mistress?).

And since it is time for another blog entry and I am surrounded by flotsam and jetsam in my own little ocean, I’m going to write about the various kelp-thoughts that brush against me. The warning here is that these topics may not go together at all. Yet they have at least The Big M in common. Okay, there’s the disclaimer – don’t say I didn’t warn you.

Estrogen Addiction Say What?
Yep, Apparently our hot flashes are due to an estrogen addiction. UBC Professor of Endocrinology Dr. Jerilynn C. Prior presented her findings on estrogen addiction and its treatment with progesterone at Women’s Health Congress 2010 in Washington DC. Not a joke. Really.

According to Dr. Prior, when a woman has a hot flash:

“she’s experiencing a massive release of brain chemicals … Integrating what we know about hot flushes has led to the hypothesis that the brain exposed to prolonged high estrogen levels reacts like the brain of an addict without a fix when estrogen levels drop. The best animal model of hot flushes is the heroin-addicted mouse.”

Apparently, the treatment for this estrogen addiction is progesterone, since “estrogen and progesterone work together in every tissue of a woman’s body.”

Okay. I’ll bite. Massive release of brain chemicals sounds right on. Furthermore, I’m a big believer in natural progesterone cream. But as I’m floating in my little sea, these thoughts brush against me. Do we have to name everything so that it sounds like a disease or disorder? When Mom Nature cold turkeys us at Menopause, does she know what she has done? And is progesterone now our methadone?

Dr. Prior and her team suggest that women who have taken estrogen will have tons more hot flashes when they stop the hormones. Does that mean instead of 20-30 per day, I’ll have 40-50? I gotta tell you, it doesn’t make me excited about stopping my bioidentical patch anytime soon. And I am definitely planning to decrease and ultimately discontinue it, having passed that magical three year mark. Will I need truckloads of progesterone to combat the dreaded withdrawal from my estrogen addiction? Do I need a 12 step program?

There were a bunch of other kelp thoughts I was going to share, but I’ve drifted too far past them and run out of room. They’ll likely show up in the next post.

As Jimmy Buffett continues in his song,

“In one ear and out the other.
Don’t you get criss crossed.
I recommend you try a little
Mental floss.”

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Can We Prevent Menopause? Should We?

Recently, I came across a conversation on one of my favorite websites, Vibrant Nation, asking the question “Can We Prevent Menopause?”

It was started by a woman who calls herself BHRT For Me. Here’s what she wrote:

“I came across this site:

I think preventing menopause altogether makes good sense. I’m 57 and I keep saying that I am treating my symptoms of menopause with bioidentical hormones, when really what I want is to stop menopause. I realized that when I saw this site.

I cycle every month and have never been without periods because of the hormones I use. Still, don’t we stop ovulating because we are out of eggs? How do you prevent the loss of eggs?

Interesting concept though, since we live so much longer now (average life expectancy of a woman in 1900 was about 48).”

Responses from readers varied from enthusiastic to appalled. Of course, every woman has to choose her own path navigating the wild woods of Menopause, so the variety of responses was not surprising.

Then a perceptive reader who calls herself Dallas Lady posed this question to BHRT For Me:

“If it makes you feel better and you are OK with it–that is all that matters.

But I am curious and for the sake of full transparency I feel compelled to ask:

Do you have a professional interest in BHRT? Do you receive any income whatsoever from any source associated from BHRT?

It just seems unusual to me that it is so central to your identity that you choose that as a “screen name” on here and your reference to a website also struck me as a bit of an unexpected endorsement not usually seen by those here unless they have a sales interest.”

I kept checking back to see her answer. And there was nothing. Nada. Zip.

Oh, she managed to answer and converse with several other readers, but Dallas Lady’s question went unanswered.

That bugged me. But I figured I’d best give her the benefit of the doubt. Maybe she hadn’t seen Dallas Lady’s query. So I wrote the following:

“I have to say that preventing menopause sounds like preventing puberty. Menopause is not a disease, although I do concur that it can freaking feel like one sometimes.

I take BHRT in a low dose, did not start until I had fully transitioned into menopause for a couple years, so no periods for me. (Which I gotta say seems a little weird for any woman to have periods when we are meant to cease -just like it would be strange not to start having cycles when we hit our teens.)

I am taking hormones because of horrendous hot flashes and other symptoms. I plan to decrease and discontinue them soon. Other parts of our body begin to make estrogen after our ovaries seemingly come to a screeching halt, though it may take a little time. I think (read hope) mine might be kicking back in. But I sure don’t expect (or even want) my hormones to be at the same level as in my thirties.

There is no one right answer or solution for treating a woman’s menopause. Every woman must weigh risks vs benefits, severity of symptoms, and general life quality – then decide if or which remedies to take. Bioidentical hormones are one choice, as are soy, herbs, and the like. Or meditation. Or nothing.

No one thing works for every one – (and some things that work for a while may not work later.) Also everything may entail risk for a particular individual woman.

I am also very curious as to why I did not see an answer from you to Dallas Lady’s question about whether you have a professional or financial interest in BHRT and/or the website you mention. I believe she asked a very clear question – I tell all the women who write me on Wellsphere or my Menopause Goddess Blog site to be wary of any site or person that advocates one right answer for their menopause (or any health issue.) FYI – I do not receive any monies for my website or my involvement in Wellsphere. I always hope that sales of my book (The Big M) will keep me afloat. But it is a labor of love and as a health care professional and activist, I’ll keep going.

Would love to know more about your connection to the website – please answer here. thanks so much for bringing up the topic.”

Lynette Sheppard RN
Menopause Community Health Maven,
Creator/Moderator Menopause Goddess Blog
Blog Circle Contributor Vibrant Nation and Jane Nation
Menopause Examiner for
Author of “The Big M

Yep, I put in all my credentials just to make sure I got an answer. And did I? Of course not. Which brings me to the one Latin phrase I remember from nursing school: caveat emptor. Let the buyer beware. That’s you. And me.

I checked out the website she was pushing. It appears to be a one-right-answer site. And I couldn’t really ascertain who it represented. Another reason for caveat emptor.

I’m not at all bothered by BHRT’s choice of name for herself or by her wholehearted enthusiasm for her topic. I wouldn’t fault her for pushing an agenda that she might profit from. I do fault withholding information that might help us make informed decisions.

The question might not be “Can We Prevent Menopause”, but rather “Should We?” And “What Are the Costs?” What do you think?

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