Southpoint Medicine & Women's Health Associates
6216 Fayetteville Road, Suite 105 Durham, NC 27713
Phone: (919) 405-7000
Fax: (919) 405-7006

Managing Menopause in the 21st Century

Millions of women join the ranks of the menopausal annually. Consequently, there is increasingly more literature, more products and more dialog about the implications of menopause and how best to manage them. Unfortunately, we are more confused than ever before about how best to practice menopausal medicine. Never before have so many women lived into their 70s and 80s. But, as we improve medicine and technology so that the average woman’s lifespan is extended, we must also decide how best to improve her quality of life for those 30 or so years.

As everyone knows, the Women’s Health Initiative study found that Premarin and Provera, the most common forms of hormonal replacement used were actually a detriment in many ways. Though successful in ending hot flashes and night sweats, they did not decrease the risks of heart disease as previously thought and in fact increased the risk of blood clots, stokes and breast cancer. These findings resulted in many women abandoning their hormones and coping with the return of difficulty sleeping and the resultant irritability, decreased ability to function and malaise.

Many have begun herbs in the form of black cohash and soy and some quite successfully, I might add. For some women, with consistent use of both, they have found a significant decrease in night sweats and hot flashes that makes it easier to function. This regimen is not, however, effective in resolving vaginal dryness and difficulty concentrating.

As a gynecologist, I have long been frustrated with the way I was prescribing hormones to my patients. First of all, we, for the most part, would begin everyone on the same dosage regardless of their specific complaints, medical history, body type and size. This was never logical to me. In addition, there were an unsatisfactory number of side effects. Women had break through bleeding, tender breasts, bloating, and these were the patients who returned. We don’t know what happened to the estimated 50% who never returned and presumably discontinued their medication!

I am pleased to report that I have found a solution that my patients have been very happy with. This solution is Bio-identical Hormones. Bio-identical hormones are hormones that have the exact molecular structure as the hormones we produce. They are derived from a plant source and can be compounded, or prepared for use, in a variety of ways. Synthetic hormones must be altered slightly biochemically for a patent to be obtained. Since natural hormones cannot be patented, no pharmaceutical company can manufacture them and consequently, you will not see any commercials or read any ads in magazines about them. In other words, there is no company, or individual for that matter, who stand to make mega dollars from their use.

How do we individualize treatment? By testing your hormone level prior to prescribing the medication for you. The preferred method for testing for me is the saliva. Salivary hormone testing has advantages over blood. First of all, it gives the level of hormones actually in the tissue. This is the bioavailable and consequently the bioactive hormone. Secondly, we can test for several hormones with one specimen. We might want a progesterone and testosterone level in addition to the estrogen level. After all, these are all hormones that women make and that affect the way we function. Thirdly, it avoids needles, which is a plus for many patients. And lastly, if we need a specimen to be collected at a specific time, our patient has no problems doing so in the privacy of her own home.

After obtaining this information, and reviewing the specific patient’s symptomatology, I am able to consult with the pharmacist who will be making the medication to determine the best dosage and delivery system. These medications can be compounded to be used in creams, capsules, troches or lozenges. In other words, the medication is made for the individual patient, not prescribed in cookie cutter fashion.

The results have been overwhelmingly favorable. My patients return happy and with no intolerable side affects. They are able to function at work and at home. Many are able to enjoy sex again when before it was painful.

Of course there is more to feeling your best as a post-menopausal woman than taking hormones. Diet and exercise are an integral part of feeling and looking great. It is also important to take an adequate amount of vitamins and minerals. And you must take time for yourself and nurturing the woman you are. We cannot be who we would like to be for our families and loved ones if we are not balanced physically, emotionally and spiritually. If you have not started, begin your journey to the new you today!