Yikes the flashes & sweats & hormones


[00:00:00] Hi Dame. Um, okay, it's Tuesday, so get to do a video less rushed and less early in the morning. And today we're gonna talk about. Menopause. We're not talking about the P word cuz I've done that before and I'll do it again cuz it's like one of my favorite things to talk about. But we're gonna talk about menopause apropo because last night I got to speak to a divine group of women through the ever well, which is this great shared office space here. 

In our area that has all these virtual, um, classes that I love, I shouldn't call them classes, virtual discussions. So we talked about perimenopause and menopause. Today we're gonna talk about menopause specifically about hormones. There's a lot of aspects of menopause we can talk about, including. The dry vagina, as you guys call it. 

What I like to remind you guys is really just inelastic tissue in your vagina and Volvo. That is for another day. I will do another post about it. I have posted about it before and it is on my like repetitive roster to talk about cuz that's an important one. But today we'll talk about hormone replacement and whether or not you can should, [00:01:00] how should you do it? 

So hormone replacement was widely used until 2001 ish when this huge. Came out that basically maligned hormones. So up until then, in fact, when I was first in training in 1999, we would say to women, here are your hormones. You're in menopause. Menopause, just to remind you, is defined as a year with no period. 

And regardless of whether or not you had symptoms back then, we would say, Here are your hormones. Take them because they will provide cardiovascular benefits among other things, right? So women took them and which might be why a lot of you don't know whether or not your mother went through like difficult menopause or not, and whether or not she did doesn't necessarily have any bearing on whether or not you will have challenging or less challenging symptoms when your mother or maybe your sister, if she's older, went through menopause, may have bearing on when you'll go through it, but how they went through it, we really don't necessarily think has any bear. 

First of all, as I say, because we just don't know how your mom went through it to your grandmother. People didn't necessarily talk about it [00:02:00] as much back then, and second of all, many women were just placed on hormones, so they didn't necessarily have a lot of the same symptoms. Now, unfortunately, when that study came out, It noted a significantly higher rate of breast cancer, but significant in our world, meaning statistically significant, was still a small amount of increased risk of breast cancer. 

But because of that, the study was halted and women were literally overnight taken off their hormones, which as you can guess, is not the greatest thing if you were on them. Um, and now we luckily in the last, I'd say decade or 15 years, come back to hormones are not bad. Hormones are not good. It depend. 

Which melds well with my little quote. Those of you who knew might not have heard me say Nothing is ever only everything is always. And so hormones are not good or bad. They are good and bad, right? So it depends on the woman. So should you take hormones? The answer is, it depends. So first, let's talk about why would you take hormones if you're having hot flashes, night sweats, trouble sleeping. 

Maybe mood changes, maybe headaches. Those are the really common common symptoms you would [00:03:00] have. What do hot flashes feel like? They're different for everyone, but for me and for many women, I describe them as anxiety. Running through my veins. They felt like this shrill, horrible feeling, and I'd get like a creepy crawly like. 

prickly feeling up my neck, and then I would get really hot. They were yucky. I say they were because I've managed them without taking hormones because of my ovarian cancer. I am in this kind of in between. Like some people would maybe let me, many people would not let me or encourage me. So I am right now not taking them to be determined in the future. 

Other than, again, vaginal hormones, which is different. So we're talking about systemic hormones. So hot flashes, night sweats, headaches, insomnia, sometimes mood, sometimes energy. Those are again, the systemic symptoms that you might feel. The flashes and sweats. We d we call vasomotor symptoms. Those are the most obvious reasons to take hormone replacement. 

I'm not gonna discuss all the alternatives right now, but in a nutshell, you could try acupuncture, you could. Over the counter herbs, you can certainly try things like just upping your vitamin D level. Um, so there are [00:04:00] other things you can try. You can try antidepressants. Low dose of antidepressants can actually help with vaso mo vasomotor symptoms, but today we're talking about hormones. 

So you've determined that you need the hormones because you feel horrible. Should you take estrogen and progesterone or only estrogen, that is determined by whether or not you still have your. If you have had your uterus removed, which is called a hysterectomy, we discussed it in a prior video a couple weeks ago, that has nothing to do with your ovaries. 

So if you had your uterus removed alone and your ovaries remain, or you had your ovaries removed, like me and you are in menopause again, regardless of whether or not you have your ovaries, but if your uterus was removed, then you need only estrogen. Okay? If you still have your U. Whether or not you have your ovaries, you need estrogen and progesterone because the estrogen, which is really the predominant hormone that's going to make you feel better, unfortunately, also has an effect on your uterine lining where it can thicken it and then it can cause it to do onerous things like. 

Turn [00:05:00] into something called hyperplasia, which is a precursor to uterine or endometrial cancer. So you cannot take unopposed estrogen if you have your uterus. You need the progesterone to oppose, oppose or thin out the uterine lining so that it does not turn into cancer. And that's actually the only reason in the western world. 

I say Western versus kind of integrative eastern naturopath world. But in the western world, we only give you the progesterone really for that reason. There are some vasomotor, um, sparing properties of the progesterone, but that's not our purpose in giving it to you. So again, if you've had a hysterectomy, You only take estrogen if you have had your uterus intact, then you use estrogen with progesterone. 

So that's one. Should you take pharmaceutical grade, estrogen and progesterone? That your doctor, your doctor, meaning your md, your do your nurse practitioner, your pa, so your practitioner, your female health practitioner, can prescribe and you would go to a pharmac. One of the big [00:06:00] pharmacies that you know, or one of the little pharmacies that you know, but pharmacy where your insurance should pay for it. 

Should you use those types of hormones or should you go to an alternative type of practitioner, maybe an integrative doctor, maybe an acupuncturist, maybe a chiropractor, a naturopath, or even some of the compounding pharmacists themselves, and go through these specialty pharmacies where they create the hormones in their own. 

which one should you use? First of all, the word bioidentical, which is really what the kind of eastern world that I described. Integrative doctors, naturopaths, compounding pharmacists, um, chiropractors, they will use what they call bioidentical hormones, implying that their hormones that are again, created in these pharmacies, either creams or pills or lozenges. 

that those are more closely mimicking the actual hormones that are in our system. For example, estradiol is the circulating hormone of estrogen that we believe is what is making us feel good or bad. Um, and they are using bioidentical forms, meaning identical [00:07:00] to the one that is in our actual biological system. 

It's a bit of a misnomer and it's largely a marketing concept because there are pharmaceutical. Hormones that use only estradiol as well, which means it's bioidentical, but because it was created through the pharmaceutical c. They have kind of maligned them as if they are, um, exogenously damaging hormones. 

The truth is they're the same hormones. It just depends on where they're made. Certainly, if you feel like you trust your compounding pharmacist and you'd rather use them, then that is absolutely your prerogative, but you need to be very clear. That those hormones are no more safe because they're touted as natural, because they're still not natural. 

They are being made somewhere and you're taking them at a time where you shouldn't be taking them naturally. You should be in menopause. You should not do anything about it. Right? But we've all agreed that we are willing to go against nature. So bioidenticals, I'm a little concerned about. As many of us in the Western medical world are because they are not studied, first of all, compounders, largely of whom are wonderful people who mean [00:08:00] well are still not having the same exact oversight. 

So you don't have kind of larger institutions like the fda who is making sure that everything is being done completely properly. So each compounder might. Not purposefully, but just change the amount of ingredients and that sometimes can have a concerning effect. And third, they're not covered by insurance, so you have to pay for them. 

So again, if that is your choice, I do not, um, disallow my patients. Is that a word? I allow my patients to use them if they want them. But I'm very clear to them that they are not necessarily safer. They're not what I would personally use. I would still use pharmaceutical grade, and by the way, it's not cuz I trust every big pharmacy or the FDA all the time, but I certainly believe a little bit in some oversight in that perspective. 

So that's where the bioidenticals come into place. So I'm gonna talk mostly about pharmaceutical grade. Again, I use bio identicals for my patients if they really choose to. I don't necessarily encourage it and I have a world of opinions about it in other ways. But we will focus now on the pharmaceutical. 

So you've gone to your practitioner, you've determined that you're having all these hot flashes and night sweats, and you're [00:09:00] gonna use estrogen and progesterone or progesterone along. There are a few different ways you can do it. You can use pills, you can use patch. You can use some topical things that actually get absorbed systemically. 

There's a topical mist, there's a topical gel, there's a topical, um, I believe a cream. I don't tend to use those as much just because I didn't train with them. I don't understand them as much. Um, and it just doesn't seem to be what my patients necessarily want, but that's probably directed by me, so I'm certainly open to it. 

There's also one particular formulation that is a vaginal ring that is meant to be systemic. Again, when I keep saying systemic, I specifically mean. Only for the purpose of treating your vaginal atrophy or your inelastic vagina. So if you take oral hormones or the hormones in the patch form, you can either do separate estrogen hormone and separate progesterone hormone, or you can do a combined formulation. 

Sometimes you'll do an estrogen patch and a progesterone pill. By and large. Right now most. Believe from some data that the safest form to take, at least [00:10:00] to start, is something that bypasses absorption through your GI tract in your liver, so that your liver doesn't happen to have to metabolize the estrogen. 

Meaning you would use ideally a patch to start, um, for the estrogen's purpose. And then there is unfortunately only one kind of bioidentical. More natural progesterone hormone that is micronized progesterone in a gel cap form that you would take orally. So typically if you were in my practice, I would say, okay, let's start with a patch. 

There's a bunch of different doses. There's a patch that's once a week and a patch that's twice a week. There's a ton of generics, so insurance often will cover it. In part they still suck, but that's the fact. Um, and then you would use separately an oral progesterone at night because it can make you. And that's how we start. 

And then we start, I typically start at like a middle dose or the second to lowest dose, and then we kind of titrate up from there if the patient needs it or titrate down if they don't. The purpose of the hormones being make you feel better for now and every couple years revisit it. So that you can ideally [00:11:00] wean off of it within three to five years. 

You don't have to. And some of my patients every year are like, please don't take me off my hormones. And some patients go, you know what? I forgot I didn't take my hormones this week. And I actually feel, okay. So again, you can start with ev, whatever your practitioner says, but typically many of us will do patch first. 

For the estrogen pill. I keep going patch, but most people put it on their stomach or buttocks and then pill for the pro. There are combined hormones that already come. In fact, one newer brand called um, by Juva is considered bioidentical in one combined gel cap form. I actually think it's pretty good. 

The con, the downside is that it does not have a multiple different doses yet. Hopefully it will. So if that one particular dose doesn't work for you, then you have to just switch again. But that's completely oral. You can use, for example, the estrogen topical. And again, the progesterone that is in the pill form. 

So these are all different ways you can do it, and your doctor can really help figure out what to use that's going to help you feel your best. And over [00:12:00] the course of a couple years, maybe ween off of it. But you have to remember, just like if you were starting a birth control pill, it's a trial period because during that trial period you may feel great, you may feel lousy. 

It takes sometimes several weeks, like three to six weeks for them to really kick in, though most women will notice almost overnight, immediate relief. And many women, if they forget to put on their patch or take off their patch or they forget their estrogen pill, will start to hot flash and night sweat immediately, and it will remind them there are a couple of their options that women can try. 

So you. I'm creative and strategic with your doctor, you can say, God, I don't wanna take the progesterone every night. So you might use an estrogen patch and use the hormone i u d, the ute, the i u d that has progesterone, that thins out the uterine lining. You may decide that you're going to do the progesterone in a way that's very cyclic so that you still get a withdrawal bleed. 

I don't personally encourage that from my patients, cuz who the hell wants their period? But apparently many women do and some practitioners just routinely do that where they'll do a cyclic version of the progesterone meaning. Two weeks of the month or one [00:13:00] week of the month, or they'll only just withdraw their patient's lining once every two or three months. 

Again, to me that's more complicated. My simple way is just patch that stays for once or twice a week and then pill every night for the progesterone. But again, talk to your doctor about the different ways. Bottom line is hormones can be amazing and make you feel great. Hormones can be concerning. The fact is that the con, the hormones can cause. 

Heart attack, blood clo stroke, and breast cancer. But the likelihood of those things is still small and from the protective benefit, again, it can decrease the risk of colon cancer. It can certainly improve your mood, it can help with osteoporosis, maybe even improve cognition to a degree. Okay, so many benefits. 

All right, people. It can also help with this gaggle. That I'm really starting to get not happy with when I'm watching myself on video. So I'm not gonna do Botox cuz I don't like it. Potato, potato. But I might do something to get rid of that gaggle at some point. Suggestions are welcome. Okay, happy Tuesday.