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[caption id="attachment_2897" align="alignright" width="216"] Community member Amy Fleischer with husband, Kurt Mullen[/caption]
Here's a great question from a member of our community named Amy Fleischer, pictured here on the beach with her husband. Amy's question popped up in response to the September Vogue article on hormones by Ginny Graves.
Amy's QuestionI have all the classic perimenopause symptoms, and yet even with all I do with nutrition, exercise and meditation, the impact on my everyday life is noticeable and significant – muscle fatigue, anxiety, memory, insomnia, libido. Tweaking my chemistry may be my next step, but it is so complex and nuanced, it's hard to know where to start. And, even with updated research, I am still concerned about long-term health impact of hormone therapy – bioidentical or otherwise. But, I also think hormonal imbalance could contribute health issue/breed disease. And really, what's worse? Being a ditzy, pudgy, anxious, dull wife or tweaking my internal chemistry a bit for balance and peace of mind? -- Amy Fleischer, Creator of MoodyBeauty - Down to earth beauty with an attitude.
I love Amy's question because it illustrates 3 important points.
1. The fear of hormones women have since 2002 with the release of the Women's Health Initiative.
2. Women feel limited in their choices - they feel they have a black and white choice betweens hormones or slow death by dullness and dementia.
3. Ultimately women feel stuck. Do they risk taking hormones and dying of breast cancer or stroke, or do they martyr their way through night sweats, weight gain, anxiety and dullness? The stuckness keeps women from moving forward and making the changes they most need.
Here's what I believe: women have far more choices than they realize.
Beyond whole foods and lifestyle foods such as environment, and targeted supplements or nutraceuticals, proven herbal/botanical therapies, and seeing how far they get before moving on to the Big Mama, bioidentical hormones.
Another choice is with dose - it's not yes/no but what is the lowest dose that's effective for you? For some of my patients, that's a quarter-dose of estrogen or a tiny dose of thyroid.
Another choice is when to start and duration - it's not take it forever or not. I recommend to many of my patients that they take bioidentical hormones for 3 months and track their particular outcomes such as memory or sex drive or executive functioning or bone density.
Window of Opportunity? Say What?
Here's where science lends a hand. Have you heard the "window of opportunity" hypothesis? From the Women's Health Initiative, we know that women who took hormone therapy, albeit the devils we know - synthetic estrogen and progesterone in the form of Prempro (which I do not recommend unless you are a horse), had the best outcomes if they were within 10 years of their final menstrual period. In other words, you will have a better result if you start hormones before age 61 (the average age of menopause in the US is 51). For women who wait to see if hormones improve their quality of life after age 60, well, the data shows that's not a good idea.
Back to Amy for a Moment
My suggestion to Amy is to take a 3-step process.
1. Know the very small risks and benefits of hormones for a woman in her forties (1.9% risk of breast cancer over 5 years, compared to 1.5% in the placebo group; 1.5% risk of stroke compared to 1.1% in the placebo group; 1.9% risk of heart disease compared to 1.5% in the placebo group but this happened within the first year of treatment - all from the Women's Health Initiative). I do not know your particular family history and genetic risk, so I cannot personalize your risks further, but that would be a valuable addition here to do with your clinician.
2. Try proven herbal therapies first, if you haven't already. Test your adrenal, thyroid and sex hormones for a baseline. Take adaptogens to help with muscle fatigue and dullness. Augment your progesterone production with Chastetree. Get your TSH to your optimal zone. Try hops before bedtime.
3. If you're still not feeling like a rockstar, try low-dose bioidentical hormone therapy for 3 months. Track that "dull wife" vibe. Keep a sleep log. Notice your mood every morning and sense of feeling restored by sleep. See if your energy dips 2-4pm. I'M A FIRM BELIEVER IN EVIDENCE: TRACK YOUR MOST IMPORTANT SYMPTOMS LIKE YOU'RE TIM FERRISS. Adjust as needed. After 3 months, assess the benefits vs the risks outlined in #1 above.
When it comes to bioidentical hormones, I individualize and adjust dosing as needed, based on your symptoms, your lifestyle, stressors and genetic risks. It's not one-size-fits-all. It's what makes you feel most alive, and I believe, feeling most alive lowers your risk of disease as you age. That's not just wishful thinking, it's science. It's what I call evidence-based integration.
The average doctor visit in the U.S. is 7 minutes. The average visit in my office is 50 minutes. I believe women need a generous amount of time to identify what they most need and to understand their choices. Without sufficient time, changes and treatments are often premature, misguided and not effective.
Amy, hope I answered your questions. If you are a member of our community and want to ask a question, send it over to info (at) SaraGottfried MD (dot) com and we'll do our best to answer you in a future blog.