MENOPAUSE is a normal, natural event defined as the final menstrual period and is usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes, such as a hysterectomy). Menopause is associated with reduced functioning of the ovaries due to declining levels of estrogen and other hormones (progesterone and testosterone). It marks the permanent end of fertility. Menopause occurs, on average, at age 51 in the United States. Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning “around menopause”). It can last 6 years or more, and by definition, ends 1 year after the final menstrual period. Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes estrogen can even be higher than during the reproductive years. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached. OPTIONS for hormone replacement therapy in women have received considerable attention for at least two generations, and hormonal solutions for women have only become more effective. The retirement of the ovaries is so much more than just lost of fertility. It is about the quality of life changes that can be quite debilitating for some women. Although most would agree that hormone replacement for women has value in the treatment of these deficiency symptoms, the real controversy is centered around the health risk associated with the treatments, especially for cardiovascular disease and cancer. Medical experts use evidence based studies to answer these questions, and unfortunately, the conclusions have not been consistent over the past 50 years. The best information is based on the design of the studies (largest number of patients over the longest period of time, removing bias by “blinding” the medication details from both the patient and the investigator). The pharmaceutical companies that host these studies use their medications and the conclusions may not be the same for similar medications i.e. Premarin (a brand conjugated estrogen) vs. Estradiol (a pure estrogen). Remember, drug studies have an enormous cost and pose a significant risk, especially if the conclusions are not favorable for the company. This is what happened in the last big study resulting in the pendulum swinging into the arena of caution. (See below for details of the WHI study conducted by Wyeth Pharmaceuticals.) Studies have not been done nor will they probably ever be done with bioidential hormones because there is no one to underwrite the cost. Outlined below is the real data that has created most of the concerns of physicians and patients. Keep in mind that bioidential hormones that “bypass” the liver (medications taken by routes other than the mouth) would be expected to have different effects. We know these delivery systems don’t have the same effects on blood clotting factors and lipids, because they bypass the liver. One might expect them consequently to have less cardiovascular risk. It is our goal at Pensacola Wellness Solutions to provide a good and true understanding of the risks and benefits of hormone replacement therapy for women. Read more on the WHI study under Risks & Benefits for Women LABORATORY measurements of estrogen and testosterone levels are crucial, along with other blood tests, to evaluate blood count, thyroid function and kidney function. The FSH level from the pituitary gland provides an additional measurement of how low estrogen levels are interpreted in the brain and/or how effective current therapies are working. Many women currently taking hormone replacement therapy continue to have hot flashes, because the signals are not getting back to the hypothalamus in the brain. Blood work takes the guess work out of the process. Women clearly have an estrogen dominant hormone environment. Women do make some testosterone from the ovary and the adrenal gland, which has an effect on muscle mass, energy and especially libido… just like in men, but much lower levels. FOR MORE INFORMATION ON LABS (SEE DIAGNOSTIC TESTING) DISCUSSION of replacement strategies is important in any thorough evaluation. Especially challenging with sex hormone (testosterone and estrogen) replacement is the fact that oral medications (pills that you swallow) are degraded by the gut and liver breaking down the hormone considerably before it can reach the target areas, affecting the overall potency and purity of the hormone. The normal gonad (ovary) releases the hormone directly into the blood stream at a fairly steady rate. “Bypassing the liver” is thought to be the most natural delivery system. See more discussion under the specific options section.