JUDITH INGALLS MD SUPPORTS BIOIDENTICAL HORMONES

Bioidentical hormones are derived from a plant source.  A substance called a “sterol” is extracted from a plant, usually soy or yam, and changed in the lab to estradiol , progesterone, and sometimes testosterone.  These hormones are chemically identical to the hormones we produce in our bodies. 
Very few studies have been done comparing bioidentical hormones with synthetic, however, one recent study suggests that the bioidentical progesterone (used with estrogen) may be safer for the breast than the synthetic. I prefer the bioidentical hormones for a few reasons.  First, I can prescribe the amount I think a client needs to relieve symptoms and keep the dose as low as possible.  In the past this has not been possible with synthetics.  It was a “one size fits all” dosing philosophy.  Another reason I prefer the bioidenticals is because they can be measured in blood (or saliva).  When I prescribe bioidenticals hormones I like to occasionally check hormone levels to make sure the person is not taking too much. In the past twelve years of prescribing the bioidenticals I have observed minimal negative side effects. Women (and men) feel better.
Bioidentical hormones are available from compounding pharmacies that make the exact prescription that your doctor recommends; it is a “customized” product just for you.  There are a few bioidentical products available from regular pharmacies. Examples are Vivelle Dot patch, estradiol tablets, and Prometrium (the only bioidentical “progesterone” available).
The controversy around bioidentical hormones made by the compounding pharmacists is that the final “customized” product is not FDA regulated.
How could it be? Those bought from a regular pharmacy, i.e., Vivelle Dot patch are FDA regulated.
So, it is important to find a reputable compounding pharmacist. Physicians who use compounding pharmacists know who they are. 
Women feel better when using bioidentical hormones and repeat blood levels show improvement as well.

Judith A. Ingalls MD

What is menopause?

Menopause is a time in a women’s life that marks the end of her reproductive life.  It formally begins one year after the last menstrual period.

This usually occurs in the early 50’s but can occur sooner.  Hot flashes, memory loss, fatigue, sleep disturbance, weight gain, mood swings, dryness, reduced sex drive, increased heart disease risk, and bone loss coincide with the rapid loss of estrogen production in the ovaries. About five percent of women do not have noticeable symptoms and experience an easy transition; however, most women have some symptoms that can last years. Over the life of a woman estrogen is a key factor in the vitality of many organs and rapid loss of this important hormone just prior to and during menopause is an issue that needs to be addressed.

What is perimenopause?

Perimenopause is considered that time, usually in the 40’s, when hormonal fluxes cause symptoms such as PMS, night sweats, abdominal weight gain, and irregular periods.  Pregnancy is still possible so birth control is still needed. Good nutrition (including a quality multiple vitamin and fish-oil supplement), daily exercise, and stress reduction can minimize symptoms. Hormone therapy is an option if symptoms are severe.

Why is heart health an issue after menopause?

Estrogen stabilizes the lining of blood vessels thereby making the vessels less apt to produce plaques that cause blockage.  This is why a woman’s risk for heart disease after menopause begins to parallel that of a man.  Heart disease is the major cause of death for women.  It is important to work with a practitioner who offers screening for heart risk factors…comprehensive cholesterol screening, hs-crp, and homocysteine to name a few.

Why is bone density an issue after menopause?

Bone is a dynamic organ that is in a constant state of building up and breaking down. Peak bone density occurs in the late 20’s and loss occurs after that time.  So, if bone density is good at age 30 due to a life-time of consistent weight-bearing exercise and calcium/vitamin D consumption, a woman is more apt to have good bone density as she ages. Estrogen prevents bone loss so when estrogen levels dive, bone density follows.  The best technique we now have for measuring bone density is DEXA imaging of the hip and spine.  This technology offers a small amount of radiation in exchange for a lot of information that can be used to advise women about their bone health. Dramatic changes occur in the quality of life of a woman who suffers a hip/spine fracture.  We are lucky to have medications that treat bone loss (osteoporosis). Get tested.

What is the latest on hormone replacement?

Estrogen replacement is an option for women who have severe hot flashes. Taking it in low amounts for less than five years is what is presently recommended. Other low-estrogen symptoms will improve as well. Bio-identical hormones are plant-derived, pharmaceutical grade hormones that can be measured with blood tests. Women with breast cancer should not take estrogen.

What can I do for menopause symptoms if I can not take hormones?

Continue a healthy life style by doing weight-bearing, aerobic exercise and eating a balanced diet that includes whole grains, fruits, vegetables, fish, and lean meats.  Take a good food supplement to provide the micronutrients that are low in our present food supply. Eat organic if possible.  Don’t skip meals.  Learn stress reduction techniques.  Create a balance between work, play, and family.  Get restful sleep for 8-9 hours a night.  For hot flashes consider black cohash, soy, vitamin E or prescription medication (other than estrogen) that are known to reduce the intensity and frequency of flashes. Paced breathing, five slow breaths in and out, can stop a hot flash.

How do I know that I am getting the best advice for this time of my life?

A woman knows when she is getting quality care for her health needs.  Search for a practitioner with whom you feel comfortable and who knows and cares about mid-life and menopausal issues.  Learn more from the award-winning website of the North American Menopause Society.  Consider working with a certified menopause practitioner.

Guys…are you feeling left out?

Men experience a mid-life transition that some call “andropause.”  That is when symptoms such as fatigue, depression, loss of strength and muscle structure can be caused by low testosterone.  If you are a man over 40 and experiencing these symptoms consider a testosterone blood test at your next physical exam.

DR. INGALLS IS A FAMILY PHYSICIAN AND A CERTIFIED MENOPAUSE PRACTITIONER IN TELLURIDE, COLORADO, AND CAREFREE, AZ.  CONTACT: drjudithingalls@yahoo.com  970-708-9588

First, read the question on “what are compounded bioidentical hormones” to familiarize yourself with what they are.  The pellet therapy uses bioidentical hormone, usually estradiol and/or testosterone, prepared in a small tablet the size of a grain of rice. This pellet is then surgically implanted in the fat pad to the rear of your hip.  The procedure is simple and requires a small incision which usually does not require stitching.  As in any surgical procedure side effects can be bleeding, bruising, tenderness, and infection at the incision site.  These side effects are rare when sterile technique is used.  The hormone is released over time into the blood stream.  Hormone blood testing is done prior to the procedure and at time periods after the procedure.  Pellets usually last 3-6 months.  A person with a fast metabolism will deplete the hormone sooner.
Pellet therapy is effective for only a small “select” group of patients.  It is not for everyone.  In fact, only 5% of my hormone patients are using the pellets.  I recommend an initial trial of daily, topical, bioidentical hormone therapy in the form of creams, drops, or lozenges. Daily application keeps levels more consistent.  If daily dosing does not relieve symptoms I then recommend the pellets.   Pellets release hormone such that the level in the blood “peaks” and then “troughs.”  This means that the level starts low, gets high, then tapers down again over time.  Estradiol and testosterone peak (and trough) at different rates.  Testosterone wears off much faster than estrogen. This is not desirable.
Patients enjoy the convenience of pellets but the cost can be prohibitive especially if frequent dosing is required.  Also, what is surgically implanted cannot come out.  Allergic reactions cannot be easily controlled and in some patients testosterone can cause side effects such as hair loss, anxiety, and sleep loss. More frequent blood testing is required.  Pellets are not FDA approved, but neither are the other types of compounded bioidentical hormones which I prescribe. 
My opinion about the use of pellets is guarded.  Hormone practitioners who prescribe only pellets may not be customizing your care as you deserve.