DR. N – Page 5 – Menopause Hysterectomy

Sex and Menopause

Karen is an attractive and young looking menopausal patient

For an appointment or a phone consultation with Dr. N call (248) 644-7200 and speak to Caroline

Dr. N provides treatment regimens that resolve your hot flashes, sweats, sleep disturbances, headaches, fatigue, depression and restore sexual intimacy even when your previous treatments have been unsuccessful. Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Click link below to see videos of Dr. N’s patients discussing their menopause and their therapy

Menopause – Symptoms, Sex and Hormones – YouTube

Loss of sexual desire and ability to participate in and enjoy sex is not a normal part of aging. Dr N explains why a menopausal woman’s desire to have sex and her capacity to physically participate in sex are influenced by her menopause…

Disturbance of sexual desire or sexual function was given as the primary reason for scheduling the initial appointment by approximately half of the menopausal patients seen in my office. Almost all of these patients had seen at least one physician prior to coming to my office and most two or more. Many women had sought out the services of a female physician in the belief that another woman would be more knowledgeable about menopausal issues and more sympathetic to their problems. Several each year came from out of state. Most ranged in age from 35-60, although some were as young as their 20’s and some in their 70’s. Almost all of the patients had had at least one unsuccessful treatment attempt by a physician. Half of these women related, that a physician had told them that since appropriate treatment had been provided and was unsuccessful, that their sexual problems “couldn’t possibly” be related to menopause, or “maybe you’re having a problem in your relationship”, or “maybe you need to see a therapist” The most severe and life altering sexual problems were experienced by women who had undergone a “surgical menopause”, especially if one or both ovaries were removed during the procedure. Almost all of the women who had undergone a hysterectomy had been assured that there would be no unpleasant effects following the surgery which could not be resolved with HRT, if needed. Many are unsuccessful in their repeated attempts to find someone who can help them, provide a rational explanation for their problems, or even believe them. Even though they are certain initially, that their sexual problems are due to their menopause/hysterectomy, many women begin to doubt themselves. They start to wonder if …”maybe all those people are right, maybe I am crazy and all this is in my head”. Ultimately, hopeless and feeling betrayed, they begin to doubt that their previous sexual state will ever be regained …and stop looking.

Does all this seem a little strange and difficult to believe?

Unfortunately, for many women it’s a frighteningly familiar scenario.

It is possible for almost all of these women to regain their previous sexuality if the alterations in function are secondary to menopause, irrespective if it’s natural or surgical. The “gold standard” for determining if the changes are secondary to menopause is simple; if you had a great sex life prior to menopause and following menopause you don’t and you think it’s related to your menopause … you’re probably right. If anyone tells you otherwise, they are almost always going to be wrong.

WHAT ARE THE EFFECTS OF MENOPAUSE ON A WOMAN’S SEXUALITY?

A menopausal woman’s desire to have sex and her capacity to physically participate in sex are both affected by her menopause. This not to imply that the majority of women do not continue to function sexually following menopause, but rather that they are no longer able to achieve their optimum sexuality.

WHY DOES THIS HAPPEN?

These changes are a direct result of the alterations in sex hormone levels that precede and accompany menopause and are not related to aging. They are almost always preventable and/or reversible by appropriate HRT.

IS THIS A PROBLEM FOR EVERY WOMAN?

Yes …and no.

Sex is an important quality of life issue for menopausal women but as with most things everyone has their own agenda.

To begin with, not every premenopausal woman has a strong sex-drive and the transition to a state of lessened sexual interest may not present a significant problem.

Some women who were highly libidinous and sexually active premenopausally, may welcome a diminished sex drive as it may present the opportunity for a less distracting life-experience. Some menopausal women reflect that they would prefer acts of intimacy such as “cuddling” as opposed to intercourse. In addition, a lower libido may lessen the sexual tension presented by fewer opportunities for sexual expression, as there is a diminishing pool of available companions due to increasing rates of sexual dysfunction, health problems and death. Health issues, divorce, alterations in living environment dictated by advancing age or finances, perceptions of aging, changes in body image and self esteem play a part as well.

However, it’s important to not lose sight of how influential sex hormone levels are as a determinant of sexual attitudes and behavior. The catch-22 of low hormone levels that result in a diminished sexual interest is that there is no compelling need for those affected to remedy the situation, as they are usually quite content. Unfortunately, their partner may not be so content. Shared sexual intimacy in the context of a committed relationship enhances the existing spiritual bond and even subtle changes in preexisting patterns of sexual behavior and response are readily discernible by a partner and can be a source of distress. This can result in significant conflict in a relationship if their partner still has a good libido and a compelling need to continue to be sexual. If the woman believes that her decreased interest in being in sexual intimacy is an inevitable aspect of aging and is unrelated to her hormone deficiency this can be a problem. It bears repeating if you were sexual before your menopause and experienced loss of interest following your menopause it is almost certain you can regain your previous level of sexuality if you desire.

I am reminded of a patient who was referred to me in the mid-80’s for treatment of Osteoporosis. She was a widow, about 60 years old and had been without the benefit of HRT for several years. As part of her treatment program I prescribed a program of HRT. I mentioned that the HRT might increase her libido. She responded angrily, “I don’t care about that ” I saw her for follow-up care and about six months later she was accompanied by a man who had been her grocer in tow. They looked like teenagers, faces flushed and holding hands as they revealed plans for their impending marriage. It was a very educational moment for me. Hormones, replacement may have potent effects on sexual attitudes, behavior and agenda.

Part 2 – Sex & Libido – Hormone Replacement Therapy

This section addresses the role of sex hormones in maintaining libido and sexual function. It discusses the manner in which a natural, or surgical menopause, or medications may affect the sexual experience and provides treatment options to restore sexual desire and function.

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Progesterone, Progestins & Progesterone Cream

Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Dr. N provides bio-identical treatment regimens that will resolve your hot flashes, sweats, sleep disturbances, headaches, fatigue, depression, give you back your sex life and keep you looking younger.

Do I need to take progesterone if I am on HRT?

If you still have your your uterus it is important that your HRT regimen includes a progesterone. The reason for this is that one of the natural functions of estrogen is to stimulate lining of the lining of your uterus. Before you reach menopause during your natural menstrual cycle you produce progesterone to prevent the uterine lining from being over stimulated.

Unfortunately, some menopausal women experience unpleasant symptoms while using progesterone. The challenge becomes how to individualize a regimen, that allows menopausal women to receive the documented health and quality of life sustaining benefits of estrogen replacement, while both adequately protecting the uterus and avoiding any potential progestin-related side effects.

What exactly are progesterone and progestins?

Progesterone is a naturally occurring hormone produced by the ovary following ovulation in premenopausal women. Progestins, are synthetic products, which mimic the effects of progesterone. The term progestogen, is used to describe hormones that provide progesterone-like activity, and this includes both progesterone and progestins. Although it may seem a little confusing at first, when I am referring to both progesterone and progestins collectively, I will use the term progestogen.

What kind of side effects?

Many women are intolerant to progesterone and progestins experiencing unpleasant symptoms, ranging from mild, to severe and life altering. Other menopausal women object to the withdrawal bleeding that may accompany progesterone and progestin use.

In addition, there is evidence that some progesterone, or progestin regimens may interfere with the beneficial effects of estrogen.

Will I definitely have unpleasant symptoms while using a progestogen?

No, the majority of women may not experience significant symptoms while using a progestogen. However, those women who do are often discouraged from continuing their HRT program.

What unpleasant symptoms can accompany progestogen use?

Unpleasant symptoms may include irritability, fatigue, depression, diminished libido, emotional volatility, breast tenderness, muscle aches, fluid retention, constipation, uterine cramping, changes in appetite, headaches and insomnia. Some women may experience none of these symptoms while others may experience all of them.

What kind of problems can “unopposed” estrogen stimulation cause?

“Unopposed” estrogen administration may result in irregular and excessive vaginal bleeding and abnormal changes of the uterine lining, including estrogen-induced endometrial cancer. Progestogens downgrade the sensitivity of the estrogen receptors in the uterine lining and reduce the frequency of these problems. It is so effective in preventing excessive stimulation of the uterine lining, that appropriate administration of progestogen, lowers the incidence of endometrial cancer to below that of non-users of HRT.

How do I include a progestagen in my HRT regimen?

There are 2 basic regimens, along with some variations.

In the first the estrogen is given continuously and the progestogens are taken for 10-12 days each month. In this method, after finishing the progestogen, women using this regimen will usually have what is referred to as “scheduled withdrawal bleeding,” beginning 1-7 days after the final progestogen dose each month. This is referred to as “sequential therapy.” Some women find the bleeding unacceptable and are less likely to continue HRT.

In the second method, estrogen and a smaller dose of a progestogen are combined and taken daily. This is often referred to as “continuous-combined therapy.” The rationale for this regimen is to prevent any vaginal bleeding, but some women experience persistent spotting, or bleeding. This regimen is available in both oral and transdermal formulations. It is recommended by many experts and has gained wide patient and physician acceptance in the United States.

Which method do you recommend?

I almost always suggest sequential HRT regimens. On the surface it might seem more attractive to use continuous-combined therapy and avoid any withdrawal bleeding, but this method may be less optimal than using a progestogen for 10-12 days each month.

Why?

There are many women who are users of continuous combined-therapy and are happy with this regimen. They have good control of menopausal symptoms, are not bothered by the daily progestogen dose and are able to avoid any withdrawal bleeding. For women who consider scheduled vaginal bleeding unacceptable and would not use HRT if it necessitated bleeding, continuous combined therapy is likely the best option.

Nevertheless, there is preliminary research evidence that suggests that a commonly used oral continuous-combined HRT formulation containing conjugated equine estrogen and medroxyprogesterone may interfere with the cardioprotective benefits of estrogen.

In addition, studies funded by the National Cancer Institute demonstrated an increase in the incidence of lobular carcinoma, a relatively uncommon form of breast cancer in patients using this formulation. The over all increase in cancer risk appears to be small and further studies are needed to define the issue, however for the moment, it might be more prudent to use either sequential therapy, or a non oral formulation of continuous-combined therapy.

There are alternate oral continuous-combined formulations and the status of these preparations relative to the aforementioned studies will be addressed in ongoing and future research.

If a woman has had a hysterectomy does she need to take a progestogen?

If the uterus is not present, there is no need for a progestogen, natural, or synthetic. Some make the argument that progesterone should be used “for balance,” in women without a uterus, as it more closely resembles a woman’s natural cycle. I do not recommend this as a premenopausal woman’s progesterone level is for practical purposes nearly undetectable for most of the ovulatory cycle and there is no reason to unnecessarily expose her to any potential negative consequences of progestogen use.

There is one subset of women who have had a hysterectomy where progestogen replacement would be a consideration. Those women who have had a surgical menopause because of endometriosis and residual endometrial tissue is known, or suspected to remain in the body. There have been a few cases reported in the medical literature where residual endometrial tissue has undergone malignant transformation. This is rare, but if residual endometriosis is a consideration, 10-12 days of a progestogen at 1-3 month intervals would be reasonable.

I suffer from a number of the symptoms you mention while using a progestin, is there any way to lessen the problem?

In some, but not all cases, it is possible to diminish the impact of these problems by changing the type, dose, schedule, or route of administration of the progestogen, but ultimately the symptoms are a direct effect of the progestogen, whether synthetic or natural. Many women have fewer symptoms when using a product such as micronized progesterone, either from a compounding pharmacy, or from the local pharmacy, where it is sold under the name of Prometrium. Women who are allergic to peanuts should not use this compound, as it contains peanut oil. Some women find they experience fewer symptoms when using a progestogen by the vaginal route, either in suppositories, or in cream form.

One strategy that is useful is to increase the progesterone free interval to 2, 3, or 4 months taking care to monitor for signs of endometrial overstimulation. Some doctors have had good results with the use of a progestin-releasing intrauterine device, which some research indicates is capable providing endometrial protection. However, in some women it is virtually impossible to include a progestogen in their HRT regimen due to the severity of the negative effects. In this extreme situation, it may be necessary to leave the progestogen out of the program entirely. However, users of unopposed estrogen who have a uterus should be monitored carefully, without exception, for the development of abnormal changes of the uterine lining.

I have heard a lot about natural progesterone skin creams, including one that contains Yam progesterone. Is this a good thing for me to use?

I do not believe there is any benefit to using progesterone skin creams, as they do not provide any protection from the long-term negative health consequences of hormone deprivation. Yam and other plant progesterones, cannot be metabolized in the human body, unless they are modified pharmaceutically and any suggestion that they provide benefit, other than skin lubrication, is without basis. Progesterone skin creams that purport to be “natural,” often contain micronized progesterone as the active ingredient. There is one study that suggested that a progesterone skin cream was mildly beneficial in reducing the severity of hot flashes.

There are those that recommend the use of progesterone skin cream as it is “natural” and counteracts any “estrogen dominance.” However, the defining feature of menopause is ovarian failure and its accompanying estrogen deficiency. As such, by definition, all menopausal women are estrogen deficient and the concept that they are suffering from “estrogen dominance,” is not plausible. These products are very effectively marketed and I believe that careful scrutiny will reveal that a significant number of those who advocate their use profit by their sale.

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years. His office is located in Bingham Farms, Michigan. Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Unpleasant Side Effects of HRT

For an in office or virtual visit call (248) 644-7200 and speak to Caroline

Dr. N provides natural hormone regimens that will make your skin more youthful, restore your sex life, resolve your hot flashes, sweats, sleep disturbances, headaches, fatigue and depression.

Click the link below to see videos of Dr. N’s patients discussing their therapy

Menopause – Symptoms, Sex and Hormones – YouTube

Side effects … Why they occur and strategies to avoid them.

Most unpleasant side effects of HRT, are related to (1) the oral route of administration, (2) progesterone and progestins and (3) the physiologic action of the hormone on its target tissue.

Side Effects Related To The Oral Route Of Administration:

The most frequent unpleasant hrt side effects associated with the oral route of administration are nausea, vomiting and loss of appetite. These hrt symptoms can be due to either a direct effect of the hormone replacement on the lining of the stomach, or secondary to the affect of the rapidly rising hormone levels on the brain. In the latter case this is not unlike “morning sickness.” If the symptoms do not resolve after a few weeks a reduction in dose, or switching to another oral product may be in order. If this does not alleviate the symptoms a change to a non-oral route of administration will be likely be required.

When a hormone is taken orally it is absorbed by the gastrointestinal tract and transported “en masse,” or as a “bolus” to the liver. This is referred to as the “first-pass” affect. During this passage the absorbed hormone alters the normal production of liver proteins. While most women seem to be unaffected in some women the alteration in the blood levels of these substances have the potential to cause an elevation of blood pressure and/or an increase in the frequency of migraine headaches.

Side Effects Unrelated To The Oral Route Of Administration:

One problem that is not specific to the oral route and can occur with any route of administration is breast tenderness. It can be perfectly normal for a woman who has been hormonally deficient to have breast soreness beginning a few weeks after starting estrogen replacement. Low estrogen levels can result in an involution of breast tissue and when the breast tissue is stimulated by estrogen replacement the breast tissue can be sore and tender for 2-3 months as the breast tissue regenerates. Women who have been estrogen deficient may notice a reduction in breast size and then notice a return to their pre-deficient state after taking replacement estrogen. If a woman does not recognize the reason for the breast soreness, she may suspect the discomfort has a more serious origin, become frightened and stop her HRT. If the tenderness persists for more than 2-3 months, a reduction in dose may be required. Of course it would be prudent for her to discuss this with her physician and have an examination if it persists, or if the physician believes it is warranted.

It is also possible to experience allergic reactions to HRT preparations. Women who are allergic to peanuts need to be aware that some hormone replacement preparations including Prometrium contain peanut oil and are capable of producing serious allergic reactions in those who are susceptible. Many women are allergic to the adhesive in transdermal estradiol patches, or find that they are intolerant to the vehicle in the patch resevoir that contains the medication. In some instances this can be resolved by using another brand of transdermal estrogen patch.

One frequent reason given by women for not starting HRT, or discontinuing its use is the prospect of continued uterine bleeding. A woman who has an intact uterus and is an estrogen user requires the use of a natural, or synthetic progestin to prevent potential overstimulation and the development of abnormal changes of the uterine lining. Women who are on a program of sequential therapy in which the progestin is give for 10-12 days a month will experience an expected withdrawal bleeding. HRT preparations are available that contain a combination of estrogen and a smaller dose of progestin which have been designed to be taken daily and prevent any uterine bleeding. These preparations are widely used and are preferred by many physicians, but others have a concern about the affects of daily use of progestins. Most women tolerate this combination well, but others are intolerant to daily use of even a small dose of progestin and/or find that they continue to experience spotting, bleeding, or cramping while using it. The subject of progestin and progesterone intolerance will be addressed further in the next section.

Many women are concerned that weight gain may occur if they use HRT. The research evidence does not support this and suggests that women who are users of HRT are actually less likely than non-users to put on extra pounds. This is discussed in the section of the web page, Menopause & Weight Gain.

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Finding An Ideal HRT Regimen

Look younger, avoid wrinkling, prevent hair loss and have a great sex life

Dr. N provides natural hormone regimens for both women and men including hormone pellet implants that keep you looking years younger, restore your sex life, resolve hot flashes, sweats, sleep disturbances, headaches, fatigue and depression. To schedule an office or virtual visit call (248) 644-7200

Peppy a 75 year old menopausal woman who had a hysterectomy 30 years ago and attributes her youthful appearance, health and sexuality to her bio-identical pellet implant therapy.

Click the link below see videos of Dr. N’s patients discussing their therapy.

Menopause – Symptoms, Sex and Hormones – YouTube

Information on Bio-Identical and Natural Hormone Therapy, Hormone Pellet Implants, Compounded Hormone Gels, Patches and Creams. A review of the most effective and safest options for you. Dr. N has specialized in care of menopausal women and hormone deficient men for over 30 years. His office is located in Southeastern Michigan. For an appointment or phone consultation call (248) 644-7200 and speak to Caroline.

Dr. N with 2 wonderful patients, mother and daughter

The rationale for women to use HRT following menopause is to sustain quality of life and to be afforded protection from the negative health consequences of hormone deficiency. Accordingly, an ideal HRT regimen would prevent menopausal symptoms, maintain libido, preserve sexual response, maintain the integrity of hormone-dependent tissues and prevent cardiovascular disease, osteoporosis and dementia. Finally, it would accomplish these goals without causing unpleasant symptoms.

These goals can almost always be accomplished if, (1) the hormones used are bio-identical to those secreted by the ovary and are (2) delivered into the bloodstream with their chemical structure intact in (3) amounts sufficient to exert their intended affect that (4) remain at relatively stable blood levels.

Menopausal women who have a negative experience with their initial hormone replacement program may become disillusioned and assume that all hormone replacement programs will effect them in the same way. Their physician may not be aware that other treatment options are available capable of relieving the menopausal woman’s symptoms without causing unpleasant side effects. If a patient fails to respond to therapy, a physician may regard them as uncooperative or just being a “problem.” It is not enough to write a prescription for hormone replacement and schedule a follow-up appointment in 3 months or longer. Every menopausal woman is unique and will have her own unique response to therapy. Ideally a follow up appointment should be scheduled in a timely fashion and the patient should be able to call sooner and to speak to her physician directly if she has problems or questions.

How does a woman find an hormone replacement program that relieves her symptoms and doesn’t cause side effects?

She can accomplish this by learning about hormone replacement options and routes of administration. Thus, she will be able to recognize a physician who has the skills and share in the decision-making process. Often women are under the impression that all gynecologists and endocrinologists are knowledgeable about menopause and treatment options but unfortunately this is not the case.

Where does she learn this?

She can start by reading the rest of this section and the other sections of the web site, especially those under the HRT & Hormones heading. When she finishes, she may be more knowledgeable about HRT than many physicians.

Information on Bio-Identical and Natural Hormone Therapy, Hormone Pellet Implants, Compounded Hormone Gels, Patches and Creams. A review of the most effective and safest options for you. Dr. N has specialized in care of menopausal women for over 30 years. His office is located in Southeastern Michigan. For appointments and phone consultations with Dr.call (248) 644-7200.

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Part 3: What Is Optimum Hormone Replacement?

What is optimum hormone replacement?

In this section Dr N discusses optimal hormone replacement regimens.

Few women in the United States are on an optimal hormone replacement regimen. It is always sub-optimal to be on oral estrogen. The issue becomes not whether to use hormone replacement, but how.

Orally administered estrogen is transported to the liver and during its metabolism induces the liver to produce undesirable elevations of a number of substances. Oral estrogen raises the level of triglycerides and C – reactive protein (CRP), as well as increasing insulin resistance.

All of these alterations are known to be associated with an increased risk of cardiovascular events. In addition, levels of Sex Hormone Binding Globulin (SHGB) are elevated, which has the effect of decreasing libido, sexual response and energy levels.

Optimum estrogen replacement is always non-oral and utilizes estradiol, the biologically active form of estrogen secreted by the ovary. It is delivered intact into the bloodstream by the use of a transdermal patch, gel, cream or subcutaneous implant.

In contrast to oral hormone replacement, these methods do not cause unwanted elevations of liver substances. In those instances where symptoms persist, an implant of an estradiol pellet is almost always effective.

In women who have had their ovaries removed, or are deficient in androgen production, testosterone can be safely administered non-orally and will enhance libido, sexual response, preservation of lean body mass and sense of well being.

Progesterone

When the uterus is present, administration of a progestin is almost always indicated to prevent the development of abnormal changes of the uterine lining associated with unopposed estrogen stimulation.

Natural progesterone is the hormone of choice, but as it is relatively weak in its activity an alternate form of progesterone is often necessary. The progesterone can be administered orally, vaginally, or in some instances by transdermal patch, or intrauterine device.

It is most physiologic to use the progesterone for 12 days every 4-8 weeks depending on individual response. However, some women find that the “withdrawal bleeding” associated with progesterone given at intervals is unacceptable. In those instances, the use of a combined estrogen-progestin patch, although not as physiologic, can be useful. It is also important to note that some women are intolerant to progesterone experiencing PMS-like symptoms. Altering the type of progesterone, dose or method of administration can reduce this problem.

Important considerations

Hormone replacement with Prempro appears to have a less favorable risk-benefit profile than other replacement preparations, particularly those that are non-oral and those where a progestin component is not used continuously. This is “old news” and has been recognized by menopausal experts since the latter part of the 1990’s.

If your doctor has suggested that you discontinue hormone replacement because of the Heart and Estrogen/progestin Replacement Study Follow Up (HERS II) and The Woman’s Health Initiative (WHI) study both (both published in the Journal of the American Medical Association in July), ask the following two questions: Have you read either of the studies and why any of the recommendations apply to me? What are the short and long-term effects of hormone deficiency on my health, longevity and quality of life?

If you are on an orally administered estrogen consider switching to a non-oral preparation containing estradiol. If a man in the United States was determined to be hormone deficient, he would almost certainly and without trepidation be offered hormone replacement.

Whether you choose to be a user, or non-user of hormone replacement this decision is yours and cannot be dictated by your physician. Remember: “A woman in the autumn of her life is entitled to an Indian summer rather than a winter of discontent.”

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Part 2: Hormone Replacemnet Therapy Is a Personal Choice

Appointments with Dr. N can be made by calling (248) 644-7200 and speaking to Caroline

Whether you choose to use hormone replacement therapy must always be your personal choice. Your physician should never be able to tell that you can or that that you can’t.

The key to making the appropriate decision is based on both the knowledge of what menopause represents in terms of its potential impact on health, quality of life and sexuality and an understanding how hormone replacement options differ in their potential benefits and risks.

Without this knowledge, a woman cannot effectively participate in her own healthcare decisions. In essence, she becomes the passive recipient of her doctor’s store of knowledge and individual bias.

Acquiring the necessary information may be difficult for most women as the physician is the source she usually turns to for information. Doctors may have only scant knowledge of the menopausal process, its global nature, or the extent of its potential impact on health and quality of life. In addition, most physicians are not aware of what constitutes an optimum hormone replacement regimen.

Menopause 101

A “natural menopause” is characterized by cessation of the monthly menstrual cycle and occurs because of an expected age-related failure of the ovaries to continue to produce estradiol, the biologically-active form of estrogen. Most often, this will occur between the ages of 48-52. It is the rise in the estradiol level at puberty that is responsible for the physical and mental metamorphosis from a young girl to an adult female. This includes all the changes that that we characterize as “secondary sexual characteristics.”

An early or “premature menopause” is one that occurs prior to age 40 and can be the result of genetic factors or autoimmune processes. An “induced menopause” can be due to surgical removal of the ovaries with or without a hysterectomy, by chemotherapy or radiation.

After menopause, estradiol concentrations in the blood fall to their prepubertal level. The aging process is accelerated as the hormonally-dependent tissues that have relied on estradiol for their support begin to regress and their ability to function optimally is compromised. Virtually every organ system is affected including the vagina, bladder, brain, skin, skeleton and cardiovascular.

Hormone Deficient

Many women think in terms of “going through menopause.” What they usually mean is that they have stopped having symptoms such as hot flashes, sweats and insomnia. However, unless a menopausal woman chooses to use hormone replacement she will spend the remainder of her life in a hormone-deficient state. The central issue for most menopausal women is whether to use hormone replacement.

Menopause – assuming it is a “natural menopause” – is normal. There is no “right choice” for everyone. Whether a woman chooses to live in a hormone-deficient state or use hormone replacement is a personal decision. In most cases, menopausal symptoms such as hot flashes, sweats and insomnia will disappear within 2 years. However, long-term consequences of estrogen deficiency cannot be predicted on an individual basis, but many women on the surface do not seem to be affected.

If a woman has experienced a premature or induced menopause the effects are magnified. Those who have had their ovaries removed are at greatest risk of osteoporosis, cardiovascular disease and atrophic changes of the vagina, urinary system and skin especially when this occurs prior to an expected natural menopause.

Women who choose to use hormone replacement have a better quality of life according to a recent pole conducted by The Gallup Organization. This is not meant to imply that postmenopausal women who are not on hormone replacement are incapable of a fulfilling life and sexual experience. They are capable of both. We have all heard about “Aunt Sadie” who never touched a hormone, or any other medication for that matter, yet lived to age 94, remained “sharp as a tack,” had a sexually satisfied boyfriend thirty years younger, drove a car every day and mowed her own lawn. However, the point is that it is unlikely that anyone, regardless of gender, can function optimally in a hormonally deficient state.

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Part 1: Hormone Replacement Therapy, Panacea or Poison?

Appointments with Dr. N can be made by calling (248) 644-7200 and speaking to Caroline

Appropriate Hormone Replacement Therapy (HRT) remains a viable and important health care option for postmenopausal women.

The most significant effects of HRT are increased longevity, a better quality of life and prevention of the accelerated aging associated with hormone deficiency. This remains true despite a media conflagration generated by the publication of the findings of The Women’s Health Initiative (WHI). The study was published in the Journal of the American Medical Association (JAMA) in July 2002. The article seem to question the wisdom of hormone replacement.

The media response was explosive. Although there was no difference in the number of deaths between hormone users and non-users, many postmenopausal women were concerned and stopped taking their hormones. This impression was reinforced as scores of physicians told their menopausal patients -based on the results of the study, which most had not read – to discontinue hormone replacement therapy.

Are these legitimate responses that reflect the findings of the published study It doesn’t seem so. Five key points follow:

1) It was not clear to most women that the study did not address hormone replacement in general, but was limited to users of Prempro, which is a sub-optimal hormone replacement preparation. Prempro is a combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) and is taken daily as continuous combined therapy. It is indicated for use in women who have not had a hysterectomy and require protection of the uterine lining with a form of progesterone, in this case MPA.

2) Hormone replacement with Prempro appears to have a less favorable risk/benefit profile than other replacement preparations, particularly those that are non-oral and those in which a progestin component is not used continuously. The summary of WHI trial suggested that the specific combination in Prempro resulted in: 1) a less favorable effect on coronary arteries than other regimens and 2) a small, but significant excess of breast cancer that in the opinion of the head of the WHI study, Dr. Jacque Rossoux was not due to the hormones used in the study and that the cancers found in the study were there before the study began as the trial was not long enough for any new cancers to be discovered.

3) The weight of previous research utilizing other regimens of hormone replacement had suggested a more positive outcome. The commentary in both studies did state that it was “possible” that the unexpected negative findings were due to the combination in Prempro. Surprisingly, unencumbered by the limitations of the data, the researchers included all forms of hormone replacement in their conclusions and recommendations.

4) Physicians are encouraging women to stop using HRT, without a legitimate rationale. This is an irresponsible and potentially life-altering recommendation. Dr.Rossouw stated that it was his impression that few physicians had actually read the studies or had an in-depth knowledge of the details, or conclusions and went on to say that in his opinion appropriate hormone replacement does not cause breast cancer, or coronary artery disease and that he was “comfortable” with this type of hormone use “for as long as it is necessary.”

5) The big losers are menopausal women who have been deterred from using hormone replacement as a valuable health care and quality of life enhancing strategy.

Dr. Trudy L. Bush, who was one of the nation’s preeminent researchers and teachers of issues related to women’s health – particularly the effects of hormones and replacement therapy on the cardiovascular and reproductive systems – published a hallmark study in the Journal of the American Medical Association in February of 1983. This examined all-cause mortality in estrogen users compared with non-users. During the 5.6 years of the study, the risk of death among non-users was twice as high as users of estrogen if they had no gynecological surgery. It was three times higher if they had a hysterectomy and eight times higher if both ovaries had been removed. Since that time, Dr. Bush and a number of other respected authors, have published numerous articles confirming the association of estrogen use with lower all-cause mortality.

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Bio-Identical Subcutaneous Hormone Pellet Implants

Dr. N provides natural hormone regimens for both men and women including hormone pellet implants to keep you looking years younger, restore your sex life, maintain lean body mass, resolve hot flashes, sweats, sleep disturbances, headaches, fatigue and depression. Get back to being you. Call (248) 644-7200 or email: jln35210@gmail.com

Dr. N chats with Amber and her hormone implant therapy following her hysterectomy

Relief from Persistent Menopausal Symptoms And Sexual Dysfunction “…a wonderful hormone replacement option for my patients.” Get back to being you.

Click link below to see videos of Dr. N’s patients discussing their menopause and their therapy

Menopause – Symptoms, Sex and Hormones – YouTube

For an appointment call (248) 644-7200 and speak to Caroline

I have tried several types of hormone replacement therapy and I still have severe menopausal symptoms. Is this just me or do other women have this problem?

It’s not you. While most menopausal women do well while using the routine methods of hormone replacement 10% to 20% experience persistent life-altering menopausal symptoms unresponsive to their prescribed therapy. It happens more often in women who have had a hysterectomy irrespective whether the ovaries have been removed. However it can and does occur following a natural menopause.

“My desire for sex is completely gone and this is causing problems in my relationship with my partner. Is this because of my menopause, or is it a normal part of aging?”

It is not not a normal part of aging. If you were sexual before your menopause you can be sexual again. An optimal program of hormone replacement therapy will restore your sexuality.

I would really like to feel like myself again. Will this really help?

Subcutaneous implantation of hormone pellets may be the treatment of choice for you. This hormone replacement option is almost always successful in restoring, libido, sexuality, quality of life and sense of well being. The pellets used are derived from plant source and contain estradiol. This form of estrogen is biologically identical to the natural estrogen produced by the ovary. Usually patients who have lost their libido are testosterone deficient and a pellet containing testosterone will be implanted as well. Testosterone is a naturally occurring female hormone and is the hormone most closely related to sex drive, energy levels and the maintenance of muscle mass. This rarely fails to relieve even longstanding menopausal symptoms, or restore sexuality.

How is this done?

The procedure is performed in the physician’s office with a minimum of discomfort and takes only a few minutes. A small amount of local anesthesia is injected into the area where the hormone pellets are to be placed, usually the buttock. The hormone pellets are then inserted into the subcutaneous tissue through an instrument designed for this purpose. Pressure is applied to the site for 5-10 minutes. No sutures are required as the actual incision is very small. As with any other surgical procedure, postoperative infection, or bleeding is possible but uncommon. The pellets, which contain the biologically identical form of natural estrogen produced by the ovary are absorbed into the blood stream producing hormone levels that are physiologic and remain relatively constant day-to-day. The hormones are absorbed slowly directly into the bloodstream and mimics natural ovarian secretion. Depending on the metabolism of the individual and the number of pellets implanted they last from 3-5 months and the procedure is repeated at that time.

I have never heard of this method of hormone replacement, is it something new?

Actually, it has been available in the United States and other countries for over 50 years. In general, it is offered by physicians who specialize in menopausal issues. This method of hormone replacement was developed by Dr. Robert B. Greenblatt, of the Medical College of Georgia, a pioneer in menopausal medicine and a founder of the International Menopause Society.

Have you used this method in your patients?

I have offered this method of hormone replacement to my patients for over 30 years. It is the most successful treatment for decreased sexuality and persistent menopausal symptoms even when the problems have existed for several years and have been unresponsive to other therapies. It has been a wonderful hormone replacement option for my patients, capable of restoring them to a previous quality of life, sexuality and intimacy.

Dr. N has specialized in the care of menopausal women for over 30 years. His office is located in Bingham Farms, Michigan. For an appointment call: (248) 644-7200 and speaking to Caroline.

IMPORTANT: This website is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

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