ARE YOU A WHOLE AND HEALTHY MIDLIFE WOMAN?

BY RANDI BURNHAM NP

Are You Suffering Needlessly? 

The most important thing that I have learned in the past 26 years as a Women’s Health Care Nurse Practitioner is this - there are tremendous numbers of women with hormone imbalances suffering needlessly, an amazing array of options are available to help and that many women just don’t know it! You can feel healthy, balanced, vital, sensual and energetic. Please don’t settle for any less. One of my favorite menopause experts, Christiane Northrup, M.D., is an OB-GYN physician, author of several best selling books and past President of the American Holistic Medical Association. She writes in her book, The Wisdom of Menopause (Bantam Dell, 2006), that the transition through menopause is not “simply a collection of physical symptoms to be fixed but a mind-body revolution that brings the greatest opportunity for growth since adolescence.” Unfortunately, not enough women understand what is happening to them as they move through their unique hormonal transition or realize what an empowering opportunity it can be to remake themselves.

One year ago I developed a comprehensive program to help women in their Midlife years (ages 30 – 70) learn to navigate their hormonal changes with ease.  I have been greatly saddened and profoundly impressed by the level of suffering that many women have endured.  I have been equally impressed with the wonderful results that happen after a woman learns how to take great care of her self. Getting and staying healthy usually requires most of us to make some changes but the rewards are well worth it.

Through our program we have partnered with hundreds of Midlife women to improve their health, overall sense of happiness and well being and avoid or delay many chronic illnesses. Perimenopause, a time of transition for women, typically begins in early to mid 40s and finishes with the ending of menstrual cycles usually around age of 52. Menopause is not a disease to be treated.  It is a normal process that happens to all women.  A woman who has not had a hysterectomy and bilateral oophorectomy (removal of uterus and both ovaries) is not considered menopausal until she has gone one full year without a menstrual cycle. Contraception is necessary to avoid potential pregnancy until this year is passed and menopause is complete.

Many factors can contribute to poor physical and emotional health during Midlife - hormone imbalances and changes, unrelenting lifestyles, poor nutrition, lack of exercise and high stress. Complaints such as hot flashes, night sweats, mood swings, anxiety, insomnia, vaginal dryness, decreased libido and pain with intercourse are common. There are many solutions to relieve these uncomfortable symptoms. Research into the changes that take place for the Midlife woman reveal that, in addition to the declining hormone levels that signify the end to childbearing, women’s bodies and specifically nervous systems are quite literally becoming rewired. Education and understanding of what is happening inside is necessary and reassuring for all women. Midlife is a time of re-evaluation of many relationships, most notably with one’s self. This search for meaning and value can result in increased wisdom and feelings of being fully present one’s life.

Often Midlife women report frustration when trying to sort out their symptoms and get help. Many women need an extended appointment time to thoroughly discuss their symptoms and get to the bottom of things. At the Center for Health and Healing, we invite women to share and we take the time to listen. We schedule ninety minute initial appointments that allow enough time to discuss concerns and develop a customized approach to treatment. We partner with each woman and, if desired, her primary care provider. No referral is needed.  We have found that our patients love this individual approach and specific information tailored to their unique needs. It is important to find out what treatment options feel comfortable and what is right for you.

Saliva hormone level testing, customized dosed bioidentical hormone therapy, diet changes, supplements, herbal remedies, relaxation techniques, stress management, exercise and numerous other options may be appropriate for most women.  Some women are afraid to consider hormones to help them feel better and may not need or are not appropriate candidates for hormone therapy. Many over the counter supplements and herbal remedies may be effective for mild symptom relief for these patients.

When needed, hormone therapy is a government approved treatment for menopause symptoms including moderate to severe hot flashes and vaginal atrophy (described as vaginal dryness, itching, possible discharge, burning, loss of elasticity, painful intercourse and urinary urgency) as well as for the prevention of osteoporosis. Hormone therapy should always be prescribed at the lowest effective dose for the shortest term necessary to achieve the desired outcome. Women who experience premature menopause at or before age 40 have more reasons to consider hormone therapy than women who reached menopause at the typical time between 45 and 55 years of age.

Our patients tell us that they feel better on customized dosed, bioidentical hormones. We prescribe hormones for patients after hormone level testing and thorough assessment of the severity of their symptoms. When needed, most women prefer to take bioidentical hormones once they understand the differences between synthetic and bioidentical hormones. Bioidentical female sex hormones (estrogen, progesterone and testosterone) act differently from other common synthetic or animal derived hormones (such as Premarin - an estrogen compound derived from pregnant mare’s urine and Provera -a synthetic progestin). Synthetic hormones are unfamiliar to your body and are harder to metabolize.

Bioidentical hormones are created in the lab from hormone precursors found in yams or soybeans and their molecular structure is designed to be an exact match of the hormones found in the human body. Dr. Northrup states “Because bioidentical hormones are just like the hormones that our bodies were designed to recognize and utilize, their effects are more physiologic – consistent with our normal biochemistry – with less chance of unpredictable side effects at low replacement doses than with synthetic, non-bioidentical hormones.” The challenge is really to find the correct lowest effective doses to help relieve a women’s symptoms and to help protect her bones from osteoporosis. For more detailed information on this, please read the book The HRT Solution (by Marla Ahlgrimm, R.Ph and John M. Kells, Avery 2003) available for purchase on the web site www.womenshealth com. Dr. Northrup calls this book the “Bible of hormone replacement for any woman who is on hormones or considering taking them. Any other approach just isn’t good enough.”

Many women are not aware that saliva testing is available to measure levels of estrogen, progesterone and testosterone as well as the levels of the stress hormones DHEA and cortisol.  Measuring hormone levels from the saliva allows us to know how much hormone is free and available to work in the body.  Blood (serum) tests do not always distinguish between free and bound forms of hormones so the results of a blood test are less precise than saliva testing. The World Health Organization as well as the National Institute of Health (NIH) endorses the use of saliva testing for steroid hormone analysis. The test assays we use are also FDA cleared tests. Testing is usually covered by insurance. Patients with Medicare insurance pay only minimal shipping and handling fees. The laboratory that we work with is a clinical test site for NIH funded salivary hormone testing thru the University of Wisconsin. Saliva testing is not yet condoned by the American College of Obstetricians and Gynecologists. While controversial in some expert’s eyes, I have, along with many other providers across the nation, found it a very helpful tool to use when evaluating a woman’s baseline hormone levels and to monitor hormone levels during a course of treatment. Using a woman’s saliva testing results, the prescribed hormone therapy can be titrated for the best symptom control and to avoid over-or under dosing of each woman. Hormone therapy is complex. The specific type of hormone you take, how much, when you take it and in what form all have an impact on how it works for you. I prefer to prescribe low dose, customized, compounded, bioidentical hormones for my patients to relieve moderate to severe symptoms and maintain optimal health without undesired side-effects.

As many of the savvy readers of this publication know, there are many different approaches to healing and wellness and finding the right approach and the right provider is very important. Learn all you can about the menopausal transition. In the words of Dr. Northrup “Make menopause a time of personal empowerment and positive energy – emerge wiser, healthier and stronger in mind and body. The decisions that you make now have the power to secure vibrant health and well-being for the rest of your life.”