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Women & Hormones

It Matters

Currently, more than 50 million women in America are in menopause and an additional 6,000 more join these women daily.  Hormonal imbalance affects a large number of women on a daily basis. Displayed in conditions such as menopause, perimenopause, premenstrual syndrome, thyroid dysfunction, and hypoactive sexual desire disorder, each linked to hormonal fluctuations or changes.  Experiencing the symptoms of such disorders can be life-altering and make you feel like you are losing yourself.  Symptoms such as mood swings, fatigue, poor sleep, weight gain, and hair loss could all point to a hormonal imbalance.  But recognizing the possible symptoms as well as the options that exist for treatment, can not only restore that balance but your quality of life.

Dr. Melissa Loseke and family

Women of any age can be affected by hormonal fluctuations and early symptoms are often dismissed, or pushed off as “life”, leading to longer, unnecessary suffering.  Menopause is one of the leading causes of hormonal imbalance. Menopause is defined as lack of menses for a period of one year.  The average age of menopause in America is 51 years old but by 2025 nearly 1.1 billion women will be in menopause.  But what many don’t realize is that the symptoms of menopause, known as perimenopause, could start years to decades before truly entering menopause. This can lead to declining personal relationships, poor function at work, decreased ability to cope and declining health. It can also result in frustration with the medical community or your provider; who without training specializing in hormone replacement, likely is prescribing treatments that are out of date, appear as a “band-aide” or simply do not improve your symptoms. This can leave you feeling like they aren’t listening or you are being heard, without knowing where to turn for help.  

Symptoms Associated with Hormone Imbalance

  • Weight gain
  • Fatigue or low energy
  • Insomnia or restless sleep
  • Decreased libido or desire
  • Hot flashes
  • Night Sweats
  • Joint pain/stiffness
  • Poor focus/lack of concentration
  • Urinary symptoms including incontinence
  • Hair loss
  • Dry itchy skin
  • Vaginal dryness
  • Painful intercourse
  • Decreased muscle tone or strength
  • Irritability
  • Mood changes
  • Depression/Anxiety
  • Restless Leg syndrome
  • Increase in headaches

 There are numerous hormones in a woman’s body but when referencing hormone replacement therapy for imbalance, we are typically referencing estrogen, progesterone, testosterone and thyroid.  When functioning properly, a woman has 60% estrogen and 40% testosterone.  That’s right not only do women have testosterone but they NEED it.  As women age, all hormones will deplete but testosterone typically does so at a faster rate. 

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Testosterone

Testosterone is made primarily in the ovaries with a small portion produced in the adrenal glands.  It is structurally similar to estrogen but it’s actions are different, yet complimentary.  Testosterone levels will typically start decreasing in the mid- to late-30’s, leaving a woman with less than half of her testosterone by the time she is 40.   And when it does it can drastically alter your life.  

Causes of Testosterone Deficiency in Women

  • Genetics
  • Chronic illnesses
  • Adrenal insufficiency or injury
  • Low DHEA levels
  • Hypopituitarism (under active pituitary gland)
  • Oophorectomy (removal of one or both ovaries)
  • Early menopause
  • Oral estrogen therapy, including contraceptive pills

Symptoms of Testosterone Deficiency in Women

  • Weight gain
  • Shift in fat from thighs to mid-section (abdomen)
  • Decreased libido
  • Anxiety/Depression
  • Mood swings
  • Memory loss
  • Poor focus or concentration
  • Joint pain
  • Increase in sugar cravings

With this decrease in testosterone, women often begin feeling like they are losing control of their life, along with their ability to cope and their tolerance.  As these symptoms progress you can feel a strain on your relationships and less emotion for life. 

Benefits of Testosterone Replacement Therapy in Women

  • Increase in energy
  • Increase in libido
  • Enhanced clitoral sensation
  • Improved ability to orgasm
  • Increase in vaginal lubrication
  • Improved short term memory
  • Increased focus and concentration
  • Better ability to process new or abstract ideas
  • Prevents weight gain
  • Improved insulin resistance
  • Decrease in joint pain
  • More stable mood
  • Enhanced vitality for life
  • Increased muscle tone and strength

Estrogen

Estrogen is not only the dominant hormone in the female body but the most well-known, or first thought of in regards to women.  Estrogen is found naturally in plants, men produce estrogen and it is even found in sperm cells.  All living species have some degree or form of estrogen.  The role of estrogen is to feed our cells and help maintain vitality.  The primary function of estrogen is for reproduction, both sexual development during puberty and by promoting ovulation.  Estrogen also controls the growth of the uterine lining in preparation for pregnancy each month and stimulates breast changes.  As estrogen levels deplete in a maturing female, symptoms will progress, initially sporadic in nature but increasing in frequency and often in severity.

Causes of Estrogen Deficiency

  • Excessive exercise
  • Eating disorders such as anorexia
  • Low functioning pituitary gland
  • Premature ovarian failure, whether from genetics or toxins
  • Turner’s syndrome
  • Chronic kidney disease
  • Oophorectomy, removal of one or both ovaries

Symptoms of Estrogen Deficiency

  • Early symptoms
    • Hot flashes and poor sleep before and during menses
    • Worsening PMS
    • Migraines even with no history of before
  • Mid symptoms
    • Hot flashes increase, occurring more randomly
    • Worsening PMS
    • Night sweats
    • Poor focus and recall
  • Late symptoms
    • Irregular menstrual cycle
    • Worsening of all other symptoms

What most people do not realize is that there are three primary types of estrogen and not all are created equal.  Cells respond differently depending on the type of estrogen present, making it crucial to use bio-identical estrogen in the treatment of deficiency or symptoms.  Estrone, or E1, is of moderate strength and is made in fat cells.  It a weaker estrogen but more toxic.  Since it is produce in fat cells, it tends to have a higher prevalence in obese or overweight woman which can lead to an increased risk of breast cancer.  Estradiol, also known as E2, is a positive estrogen that is considered strong.  It is the most common estrogen used in hormone replacement therapies.  It is the estrogen that keeps us looking and feeling great.  Estradiol maintains health and is the form found in Climara, Vivelle dot patches, troches and pellets.  Estriol, E3, is made in large amounts when females are pregnant.  It is a weak hormone that can help provide balance.  Estriol can function by blocking estrone from estrogen receptors, leading to the thought that it can be protective in nature.

Benefits of Estrogen Replacement Therapy in Women

  • New bone growth leading to decreased risk of osteoporosis
  • Collagen production for skin hydration and suppleness
  • Protection from heart disease
  • Facilitates proper communication with the brain
  • Keeps blood vessels flexible
  • Improves hot flashes and night sweats
  • Improves sleep quality
  • Decreases vaginal dryness
  • Improves pain with intercourse
  • Improves urinary incontinence
  • Decreases the risk of dementia

Historically, women didn’t live long enough to experience menopause.  They typically died from childbirth or from disease.  Today though, women can expect to live one-third to one-half of their life in menopause.  Most women are fearful from the misinformation that continues to be a dominating force in media and education to even seek out treatment for hormone replacement therapy.  In the past decade, more than 10 major medical organizations have endorsed hormone replacement therapy.  Leading to the revolution and understanding that with proper education and training as well as selection of therapy, women can safely be treated for their symptoms while avoiding dangerous side effects and increased risk of chronic disease conditions. 

Most of the negative press so to speak regarding women’s hormone replacement therapy was a direct result of the 2002 Women’s Health Initiative (WHI). A large study that was halted prior to completion due to numerous subjects suffering from heart attack, stroke or osteoporosis.  Since then the study has been analyzed and reviewed in detail and most of the negative statements regarding hormone replacement retracted. What they found in addition to faulty design and methods, many of the women were already high risk for the disease states found, but that synthetic estrogen and progestin were largely to blame. Despite this retraction, many women are still concerned and cautious in pursuing hormone replacement therapy. On a whole, since the WHI, primary practitioners began limiting use of replacement therapy in women and as a result we have seen a steady increase heart disease and osteoporosis in women.  Hence, the recent surge in bioidentical hormone replacement therapy, a treatment for women that uses products that are designed to structurally identical to those made by our bodies. Under the care of the expertly trained physicians and hormone specialists at Re-new Institute, in combination with bio-identical hormone products, you can safely and effectively restore balance, optimize your hormones and starting feeling like you again. 

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Progesterone

Progesterone is a hormone that is secreted by the corpus luteum and produced in the second half of the menstrual cycle.  Progesterone stimulates and regulates various bodily functions.  It has roles in maintaining pregnancy, preparing the body for conception, and regulating monthly menstrual cycles.  Progesterone also plays a function in sexual desire.  When the female body produces high levels of progesterone, ovulation will not occur.  If pregnancy does not occur, the corpus luteum breaks down and the progesterone levels decrease leading to menstration. 

Low Progesterone Levels Can Cause

  • Abnormal bleeding
  • Irregular or missed periods
  • Spotting
  • Abdominal pain during pregnancy
  • Miscarriages
  • Estrogen excess which can lead to sex drive, weight gain, gallbladder problems

Uses for Progesterone

  • Menstrual/Bleeding concerns
  • Endometriosis
  • Polycystic Ovarian Syndrome (PCOS)
  • Breast, kidney, uterine cancer
  • Appetite and weight loss in cancer and AIDS patients
  • Infertility
  • Diagnostic aide to measure estrogen effect
  • Birth Control/Pregnancy prevention

Progesterone is the yin to the yang that is estrogen.  Estrogen needs progesterone to maintain reproductive capabilities.  When that balance is not achieved, women can begin to experience numerous symptoms.  If that ideal between progesterone and estrogen is present hot flashes and night sweats improve, sleep gets better, vaginal dryness and painful intercourse resolves, urinary incontinence improves and the risk of dementia declines. 

Progesterone is often thought to be the cause of most pre-menstrual syndrome symptoms such as breakthrough bleeding, cramping, bloating, mood lability and irritability, fatigue and occasionally more severe symptoms including depression, lightheadedness or dizziness and severe headaches.  And for those with decreased levels, those symptoms can seem exacerbated by elevated estrogen, leading to a wider gap in the balance.  Progesterone is a key hormone that should be evaluated and considered as a part of any hormone replacement treatment regimen.  It is also crucial to know that any woman with a uterus on estrogen MUST be on progesterone as well. 

Treatment at Re-New Institute provides you with a plan that customized to your goals, your health and your desires.  We understand that a one-size-fits-all method is not ideal for optimal health and that you may require a combination of therapies to reach your objectives.  While keeping in mind that there may be more than one puzzle piece beyond hormones to the greater picture, such as dietary modifications and exercise, supplements, peptide therapy or others to support the recommendations for optimal living.  Simply put, your plan is designed to fit you.  

Your treatment plan will encompass:

  • A consultation with a Re-new physician specializing in hormone replacement
  • Thorough history and physical, including medications
  • Advanced lab testing
  • Detailed review of lab data
  • Education on treatment options available
  • Determination of optimal treatment based on your goals and objectives
  • Lifestyle modification and stress management plans
  • Routine follow ups
  • Regular access to physician for questions and concerns
  • Revisiting and maintenance of goals

FAQs

What are the causes of hormonal imbalance in women?

The causes of imbalance in woman are vast due to the intricate balance of estrogen, progesterone, testosterone and thyroid hormones.  There are many other hormones that are crucial to the balance of our body but these are the most commonly associated with symptoms in women.  Menopause and perimenopause are two of the most common causes of hormone imbalance in females.  Other causes are dependent on the hormone in question.  See above for more details or contact Re-new today to speak with our hormone specialized physicians today. 

What symptoms suggest I have a hormone imbalance or am in menopause?

Again, this is dependent on the specific hormone that is decreased or not in ideal balance.  Some of the common symptoms of testosterone deficiency in women include decreased energy, weight gain, low libido or sex drive, poor sleep, lack of focus or concentration, increased joint pain, loss of muscle tone or strength, increased irritability or mood lability.  Decline in estrogen typically results in hot flashes, night sweats, weight gain, vaginal dryness, painful intercourse, restless leg syndrome, dry skin, hair and skin thinning, and loss of collagen production leading to a more “aged” appearance.  When progesterone levels are decreased or not in ideal balance with estrogen, women exhibit an increase in PMS symptoms-bloating, irritability, poor sleep, night sweats, palpitations, increase in anxiety or depression, headaches or migraines.  If you are experiencing any of the above symptoms, call Re-new today to schedule your free consultation. 

How do I know if I am a candidate for hormone replacement therapy?

It is best to start with a thorough medical history including medications, review of your symptoms and your goals for therapy, along with bloodwork to determine your levels. Our highly trained hormone replacement physicians at Re-new can help you determine if therapy is right for you and what treatment options exist. 

What types of hormone replacement are available for women?

Bio-identical hormone replacement is the most recommended form of replacement therapy because products are made specifically to be identical to the hormones naturally produced by your body. While creams and gels are an option for female hormone replacement, they are not highly recommended at Re-new due to their difficulty to greatly improve levels and symptoms as well as their transferability.  The most common types of hormone replacement available at Re-new are sublingual troches or rapid dissolve tablets, injections and pellet therapy. Certain hormones often respond better in a specific delivery system while others achieve greater results through a different treatment option. Our goal is to provide you with all the treatment options available as well as education on the various types, so that treatment is designed for you, your life and your needs. 

How long will it take to notice improvements once I start hormone replacement therapy?

Some patients will notice improvements as soon as the first week of treatment, others may take several weeks. We recommend a trial of 6-12 months for maximum benefit and determination of symptom improvement. Which symptoms improve first are highly specific to the individual.  Our physicians will work with you to optimize your results and help you meet your goals. 

What are the benefits hormone replacement therapy?

In females undergoing, hormone replacement therapy the benefits extend far beyond the relief of symptoms. You also benefit from delayed or improved aging, decreased risk of heart disease, protection against osteoporosis, dementia and diabetes mellitus, less depression and anxiety, thicker hair, more youthful skin, stronger immune system and feeling like YOU again. 

Is hormone replacement therapy safe?

Yes! Bio-identical hormone replacement therapy when diagnosed and managed by a skillfully trained hormone physician, it is absolutely safe. There are some conditions in which specific hormones may be avoided or not suggested, so make sure that you talk to your provider about your medical history. The Women’s Health Initiative scared many women as well as physicians, away from hormone replacement.  What many don’t realize is that those results were based off synthetic hormones, not bio-identical. And the WHI has retracted nearly all of its statements regarding the negative outcomes related to hormone replacement therapy, citing faulty study design and poor patient selection. Contact Re-new Institute today to learn more about bio-identical hormones. 

Can I use hormone replacement therapies if I am not in menopause?

Absolutely.  Female hormones require a delicate balance for women to feel their best.  That balance can be altered with pregnancies, sleep, stress, injuries, illnesses and many others.  Even if you are not in menopause or perimenopausal, one or more of your hormones may not be functioning optimally, affecting you and how you feel.  Preventing you from living your best life or interacting with family, friends, significant others, children or co-workers the way you desire.  There are no rules on “normal” aging and you don’t have to live feeling like you aren’t yourself. 

What are the side effects of hormone replacement therapy?

That depends on the specific hormones being replaced. Typically, the easiest way to consider side effects is to think of the symptoms that led you to seek help in the first place. Well, the symptoms associated with too little often are the same of “too much,” reminding us of that delicate balance. Some other side effects can include acne, clitoral enlargement, breakthrough bleeding, increased facial hair, elevated blood pressure, increase in the red blood cell count or hemoglobin, breast tenderness and bloating. Most of these can be managed with simple dosing adjustments, over the counter or prescription medications, or simple increased water intake and activity. The physicians at Re-new Institute are certified and skilled in managing all aspects of hormone replacement for optimal results with minimal side effects. 

Does hormone replacement therapy cause breast cancer?

Breast cancer can be estrogen and/or progesterone receptor positive, meaning that the presence of either of those in higher levels can increase the rate of tumor growth. Bio-identical hormone replacement therapy will NOT cause breast cancer. However, in a female with unknown breast cancer on therapy could accelerate tumor growth. It is crucial that all women on replacement therapy have regular mammograms and disclose full personal medical history, as well as family history. 

Do I need to or have to replace estrogen, progesterone and testosterone?

That depends on your symptoms, the levels of your hormones from your bloodwork, your medical history and your goals for therapy. Generally speaking, no you don’t have to replace all but in some instances you may want to for optimal results. 

Does insurance cover hormone replacement therapy?

There are many variables that influence this answer such as the specific insurance you have, your deductible, your bloodwork results and your symptoms as well as the type of hormone replacement. The best way to find out is to schedule a consultation at Re-new today!

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