S.H.I.T. Happens!



Let’s Talk about our Sex Hormones In Transition!  

As we hit our mental and professional peaks in life, our fabulous bodies that have served us well start to change. Starting in the late 30s and early 40s, both male and female sex hormones will start to decline. This can show up as a multitude of symptoms that we don’t attribute to menopause.  Yes—I said it—the dreaded word, menopause

And particularly for women, menopause has unfortunately become synonymous with getting old. Know that this is not true; you are still a vibrant woman, whether you’re conquering the world or your child’s homework (both equally important). The transition to officially defined menopause can last from four to eight years. As the hormones change, we start to have symptoms that we may or may not attribute to menopause. The reason we tend to overlook the possibility is because we are still menstruating and we are still young—it couldn’t be menopause! 

Perimenopause
-Having your period in the previous three months with no changes in menstrual regularity in the past year.

Early Perimenopause
-Menstrual cycle in previous three months with changes in the regularity in the past year.

Late Perimenopause
-No menstrual cycle in previous three months but having your period in the past eleven months.

The transition through these phases is often and erratic and unpredictable process. This is a result of the hormonal roller coaster of constantly fluctuating sex hormones. 

Symptoms of Perimenopause
-Menstrual Changes
-Vasomotor symptoms
    -Hot flashes
    -Night sweats
    -Vaginal dryness, painful intercourse
-Mood alterations
-Infertility
-Declining bone mass
-Increase risk for cardiovascular disease
-Difficulty sleeping
-Urinary incontinence/frequent urination 
-Anxiety
-Hair growth on face
-Loss of sexual interest
-Memory lapse
-Weight gain

O.K., so you looked at the symptoms, and you have to admit, this may sound a little like you. What now? 

Yes, there is a lot of information floating around out there. And no, you don’t have to tough it out. Everyone’s body and health history is different, so it’s important to talk with your healthcare professional about what options are best-suited for you and your symptoms and for your safety. Here at my practice, Downtown Doctor, we pride ourselves on this kind of care and assessment.   

 

Non-Hormonal Options

Mood Changes/Depression/Anxiety: Regular exercise, relaxation techniques, B-Vitamin replacement, or antidepressants. 

Urinary Incontinence/Frequent Urination/Bladder Infections: Stay well hydrated, drink plenty of water. Avoid caffeine and foods high in acidic content. Practice your pelvic floor exercises to strengthen the pelvic floor muscles. Explore antimuscarinics (overactive bladder medications) with your healthcare provider.

Night Sweats/Hot Flashes: Dress in thin layers (wicking fabrics), layer bed covers, sip cold water, place ice pack under pillow at night and down at feet.

Trouble Sleeping: Go to sleep and wake up at consistent times (even on weekends), avoid caffeine, avoid blue light before bed (that means turn off the cell phone, iPad, computer), develop a relaxation-promoting bedtime ritual, keep the bedroom for bedroom activities (sleeping and sex only). 

Sexual Discomfort/Vaginal Dryness: Use vaginal moisturizers (i.e. Replens,K-Y Long-lasting Vaginal Moisturizer), water-based vaginal lubricants (Astroglide, Moist Again, and Silk-E), and have sex—it promotes vaginal health by promoting blood flow.

 

Now, you tried all of the above and you’re still miserable. What are your options?

Hormone Replacement Therapy (HRT)

HRT is the replacement of the declining female hormones that cause the symptoms of perimenopause, such as hot flashes, night sweats, fatigue, brain fog, vaginal dryness, and the prevention of osteoporosis. The hormones replaced by HRT are typically estrogen, progesterone, and testosterone. 

 Based on your symptoms and your hormone levels obtained through lab work your medical doctor may recommend you starting either one hormone replacement such as Estrogen or a combination of hormones (estrogen, progesterone & testosterone). These hormones can be taken orally, topically, or by injection. 

Progesterone: Helps promote sleep, calming, acts as a natural diuretic, increases one’s metabolic rate and works as an antidepressant. Bio-identical progesterone has been shown to decrease breast cell growth, decrease the bad cholesterol, decrease blood pressure, and decrease the buildup of plaque in your arteries, thus reducing your risk for heart attacks and strokes. 

Estrogen Replacement: Helps with vasomotor symptoms of menopause, reduces vaginal dryness and improves skin texture. 

Testosterone: Helps increase sexual interest, promotes a sense of emotional well-being, necrosis muscle mass and strength. Improves sagging skin, decreases excess body fat, helps maintain bone strength and reduces brain fog.

 

Synthetic vs Bioidentical

Synthetic hormones are manmade often conjugated equine estrogens, which will breakdown into 45 percent estrone sulfate and 55 percent various equine estrogens. Bioidentical Hormones are derived from plant sources and are modified to replicate the structure of human hormones.  These most closely mimic natural human physiology. Most healthcare providers believe treatment with bioidentical hormones is the safest and some will not even prescribe synthetic hormones to their patients. 

Is HRT safe?  
As you might recall around 2002, news spread that HRT caused cancer. This was a result of the Women’s Health Initiative Study that reported an increased risk of breast cancer associated with the use of Premarin and Prempro (both synthetic hormones). No study has associated bioidentical hormone replacement with increased cancer risk. So, as you may suspect, women around the world grew concerned and stopped HRT. The current consensus of the medical community based on evidence is when bioidentical progesterone and/or estrogen were prescribed together the risk for cancer and heart disease was decreased. In general, women can reduce their risk by initiating HRT in perimenopause and early menopause. The risk increases as the time from menopause increases and with increasing age. 

Any type of HRT—including birth control pills—has been found to have a slight increase in risk for blood clots, which in turn does increases ones risk for stroke and heart attack.

Is the risk worth the benefits? 
Each individual woman is unique in their own right. For this reason, it is important to visit a healthcare provider such as Downtown Doctor who can evaluate your symptoms, medical history and risk ratio. You and your healthcare provider can then devise an individual approach to treating your symptoms that works for you and your lifestyle.  

What should you expect at your appointment?
During your visit, your medical professional should take a complete history including your current symptoms, past medical history, and family medical history. They will examine you and may perform a gynecological exam, pap smear, mammogram, bone density screening and a colonoscopy depending on your age and when your last screening for these things was. Your healthcare provider will also send you for basic lab work and check your hormone levels. Once your screening is completed and you and your medical provider have decided on the type HRT to start, you will follow up with your medical provider regularly to evaluate effectiveness and recheck your hormone levels. We here at Downtown Doctor would love to have the opportunity to discuss this and any of your other medical concerns with you.

Please feel free to visit our website at www.freemanmedicalclinic.com or give us a call at 512-391-9400 to schedule an appointment. 

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