October 2005

By Virginia J. Pillsbury

Menopause is not an illness, it's a fact of life! Menopause is no longer taboo spoken by women in hushed tones behind kitchen doors. Today's generation of women are afforded more knowledge about menopause and treatment, and play a more active role in deciding what's their best option.

Menopause is a natural stage in a woman's life when she can no longer reproduce and she gradually stops producing the hormone estrogen, which is what causes the lining of the uterus to thicken each month. When the body doesn't become pregnant, that lining leaves the body as the menstrual period. This decline in hormones, which also includes progesterone and testosterone, leads to a hormonal imbalance, causing the unpleasant symptoms of hot flashes, weight gain, irritability, sleeplessness and lowered sex drive.

Today, women have more choices in the approach they take to help manage their menopausal symptoms. "It's a very individual choice," says Joilynn Evans, M.D. of North Florida OB/GYN Associates located at St. Vincent's Medical Center. She says, women may now spend up to one-third of their life in menopause and healthcare professionals want to help ensure that they're good years.

If a woman still has a uterus - meaning she has not had a hysterectomy - a combination of estrogen and progestin is used to help reduce the risk of cancer in the lining of the uterus, prevent colon cancer, and protect against bone loss. "Menopause symptoms are eased as well," said Evans. "Especially with hot flashes and vaginal dryness."

Studies have shown that using estrogen alone may increase the risk of endometrial cancer because it promotes growth in the lining of the uterus; and the synthetic hormone progestin - a substitute for progesterone - that helps reduce the risk of uterine problems, may cause bleeding.

Until the 2003 Women's Health Initiative (WHI) reported that such synthetic hormones also may increase the risk of certain types of cancers, heart attack, stroke, and blood clots, hormone replacement therapy (HRT) was considered an ideal way of managing the symptoms that come with hormonal loss.

"Many [women] were scared by this report," says Evans, who advises that patients and their doctors discuss whether HRT is a reasonable choice for menopause management. "Each individual history needs to be addressed. If symptoms during menopause are too disturbing and HRT is the chosen option, then the patient should be put on the lowest dose for the shortest length of time possible. Also, an annual re-evaluation with your doctor is advised in an effort to decrease the dosage." According to Evans, menopause symptoms that begin with the pre-menopause phase usually decline after four or five years. "If a patient has been on HRT, then is it usually tapered off then."

If you're looking for another alternative to treat hormonal imbalance brought on by premenopause and menopausal symptoms, then Gary Bernard, M.D., founder of BodyLogicMD in Orange Park, says bioidentical hormone therapy may work for you.

"Bioidentical hormones are replicas of the body's own natural hormones," explains Bernard. "They are made from synthetic and natural plant products that replicate what the body produces. We replace exactly what hormones are missing or low with the appropriate bioidentical hormones."

According to Bernard, synthetic hormones aren't natural to the human body. "There is a great deal of scientific and biochemical research that shows how differently synthetic hormones act in the body compared to natural bioidentical ones."

Bioidentical hormones are generally cream-based. "Bioidentical creams work best," believes Bernard, who says women using these hormones feel better and notice a decline in menopausal symptoms within 1 to 3 months.

Usually, a combination of progesterone and estrogen is recommended for bioidentical hormone users. "Generally, progesterone is lost earlier than estrogen," said Bernard. "With an estrogen cream replacement, a biestrogen cream is used. We use the two types of estrogen that are most beneficial-estroiol and estradial," explained Bernard. "The third type of estrogen, estrone, is the bad player and may be a cause of heart disease as well as contribute to a higher incidence of breast cancer."

For registered pharmacist Kelly Davis, co-owner of Atkinson's Pharmacy in Orange Park, bioidentical hormone replacement therapy (BHRT), makes sense. For the past five years, his pharmacy has specialized exclusively in compounding medications for customers.

"We use nothing that is manufactured," says Davis. "Our challenge is to help doctors and nurses find out what's best for the patient." Compounding, he says, allows the drug to be more patient-specific. "We have seen such positive results with BHRT," says Davis. "Why not continue with what the body has been making all its life?"

There are several herbal remedies that may ease menopausal symptoms as well, such as soy products, which contain high amounts of Isoflavone, Black Cohosh, St. John's Wort, Wild Yam, Dong Quai, Evening Primrose, Valerian Root, Ginseng, and Chasteberry. But, since these products are not FDA-approved, there is no standard for dosage needed.

Vitamin replacement is also recommended because it will improve hormone uptake. Bernard suggests a range of herbs and supplements including Vitamins B-complex, C,E, multivitamins with minerals, calcium, fish oil and capceten.

Both Bernard and Evans say exercise and a balanced diet-at any age, but especially during the menopausal years-are excellent methods to help women balance the symptoms of menopause.

"It's important for women to know, whether they decide to use conventional synthetic hormones, bioidentical hormones, or natural therapies, it's their decision," said Bernard. "No choice is wrong or worse-they are only different options."