Family practice 15 years of practice Bellevue Specializing in natural medicine : nutrition,...

Trina Seligman, N.D., L.Acwww.DrTrinaSeligman.com

Bio-identical Hormones:

The Treatment of Menopause

Naturopathic Medicine

Family practice 15 years of practice Bellevue Specializing in natural medicine : nutrition,

herbs, bio-identicals, lifestyle, Acupuncture My approach is Integrative: integrating the

best of conventional and natural medicines and integrating care with your other physicians.

Covered by all insurance companies

Why Use Hormones ?

The symptoms of menopause can start as early as the late-30’s, with most significant symptoms in the late 40’s

Symptoms include: hot flashes, nightsweats, sleep disturbance, depression, anxiety, weight gain, arrhythmia, vaginal dryness, low libido, cognitive changes, changes in pelvic floor/urethral tissue, menstrual cycle changes, headaches/migraines, fatigue etc……

What are Bio-identical Hormones

“Bio-identical” is a term that was coined to mean ‘biologically identical’.

Prior to menopause, a woman produces 3 different estrogens:

•Estrone

•Estradiol

•Estriol

A woman also produces Progesterone

DH

EA

Testo

stero

ne

Synthetic Hormones

Examples of Estrogen:Ethinyl EstradiolConjugated Equine Estrogens (Premarin)Estradiol Acetate

“Progesterone” actually, should be called a Progestin:MedroxyprogesteroneNorethindroneDrospirenoneLevonorgestrel

Methyl-testosteroneAlthough DHEA declines with age and can impact the symptoms of menopause, it is not usually treated by OBGyn’s

Bio-identical vs Synthetic Estrone Estradiol Estriol

Progesterone

Testosterone

DHEA

Ethinyl Estradiol Conjugated Equine

Estrogens Esterified estrogens Estradiol acetate

Medroxyprogesterone Norethindrone Drospirenone Levonorgestrel

Methyltestosterone

Bio-Identical VS Synthetic

PEPI study 1995

Postmenopausal Estrogen/Progestin Interventions Trial

Premarin + bio-identical progesterone, Premarin alone, Premarin +medroxyprogesterone

Increased HDL cholesterol was seen to the greatest benefit with the bio-identical progesterone group.

Women’s Health Initiative(WHI), 2002

Study of Premarin (conjugated equine estrogens) or Prempro (Premarin + medroxyprogesterone)

Over 16,000 women Study was halted due to increased risk

of breast cancer, stroke, and blood clots.

Bio-Identical Research

Estradiol is assoc. with increased risk of breast cancer when used for >5 years, but not <5 years.

French E3N-EPIC study of over 54,000 women found greater risk of breast cancer with synthetic progestins. 2005

Natural Progesterone has an anti-proliferative effect on breast tissue

Prometrium when compared to Progestin did not adversely effect HDL

Preliminary research shows E2 +Prometrium protect against coronary vasospasm (contrary to Progestin)

Estriol –preliminary research suggests it may be protective to breast tissue

More Bio-identicals….

Estrogen alone has a beneficial effect on bone density; estrogen + progesterone the results are mixed.

Progesterone has a calming effect on the nervous system, Progestins actually increased risk of dementia.

Reasons to Consider or Decline Treatment

Menopause is NOT a disease, it is a stage of life:

Treat based on Quality of Life symptoms

Genetics Personal Philosophy Treat with the lowest possible dose to

alleviate side effects, for the shortest duration (usually 5 years)

Lab Testing

Salivary testing Blood testing Urine testing

Testing of estrogen & progesterone is not necessary, unless needed to monitor efficacy & safety of treatment

Testing of DHEA-S and testosterone can be helpful

Benefits of Blood testing

Where are they from ?

Originally derived from soy or wild yam (dioscorea), chemically modified

Compounding pharmacies-benefits of individual dosing, different delivery systems, lack of additives/chemicals to formulations

“Bi-est” meaning two estrogens; estradiol and estriol (80/20)

Progesterone

Using the Hormones

Creams (transdermal) Sublingual drops Pills suppositories

Bio-identicals:Compounding vs Pharmacy Bi-est

Progesterone

Testosterone DHEA

Estradiol tablet (Estrace, Gynodiol)

-Vivelle, Climara, Estraderm, Menostar

Estring, Estrace, Vagifem

Prometrium

No testosterone or DHEA alternative from conventional pharmacies.

Bio-identicals from a Pharmacy: are they Natural ?!

Estrace: includes corn starch, lactose, blue 1, red 27, yellow 5 (tartrazine)

Estrace Cream: includes propylene glycol, sodium lauryl sulfate, methylparaben, EDTA (an organic pollutant), tertiary-butylhydroquinone (an organic phenol)

Prometrium : contains peanut oil, yellow 10 and red 40

What is “anti-aging” ?

Suzanne Somers What does “anti-aging” mean ? Dose of hormones Menstrual cycles Continued use of hormones > 5 years Long term safety is not known

Other Natural Treatments

Herbal medicine: Phytoestrogens: dang quai, black

cohosh, soy, cimicifuga, Phytoprogesterones: dioscorea, vitex, glycyrrhiza

No plant-based DHEA or testosterone Other libido-assisting herbs: maca,

damiana leaf, black cohosh, dioscorea, ashwaghanda, muira puama, ginko biloba

Other Herbs

Herbal medicine can also help with sleep issues, depression, anxiety, cholesterol

Nutritional Supplements: evening primrose oil, hesperidin, flax seed, ipriflavone

Vitamin D,calcium,magnesium strontium, boron, minerals Acupuncture: Lifestyle : Diet –alcohol, sugar, sleep, Decreasing processed foods exercise

Other Preventive Measures

Bloodwork: chemistry, CBC, TSH, lipid panel, 25-OH-vitamin D, CRP, homocysteine

Consider VAP testing Bone Density: 1 year post-menopause Colonscopy: age 50 Mammogram Annual pap/physical Consider advanced nutrition testing

In Closing…..

Hormone Replacement is an individual decision, based on quality of life issues, genetics and personal philosophy

Bio-identical hormones are “biologically identical”

Compounding pharmacies specialize in manufacturing natural products including hormones

Research is limited Safety is a balance Testing is not necessary, unless to

assess treatment efficacy & Safety Anti-aging has not been studied long-

term Acupuncture, herbal medicine, lifestyle

Trina Seligman425-646-4747

www.eimed.comwww.DrTrinaSeligman.com

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Additional Reading

Natural Progesterone: The Multiple Roles of a Remarkable Hormone. Dr. John Lee

The Wisdom of Menopause. Christiane Northrup

What your doctor may not tell you about menopause.

Dr. John Lee

Natural Hormone Replacement. Jonathan Wright

Smart Medicine for Menopause. Sandra Cabot

Screaming to be heard. Elizabeth Vliet

The Hormone of Desire. Susan Rako