Menopause and Hormones: Are They For Me?

hello everyone

my name is luanne lavin and i’m a board certified family nurse practitioner at the maxwell clinic

and i am excited to talk to you today about menopause and hormone therapy and is it a therapy for you

okay first slide this is a quote from one of my patients and um she states i

am not the energetic outgoing person that i used to be i’ve lost my fun side i’m moody

irritable angry and sad and on certain days i have all of those

emotions within 10 minutes so i thought this quote was really um

very pertinent to share with you today um i do hear comments like this quite

often and when you’re a patient at the maxwell you share your insights with your clinician and when you’re a

clinician at the maxwell we know that there are very many things that we can do to address these feelings

so these can be the feelings you experience in menopause and all within

10 minutes here’s the next quote my mind is not

sharp like it was i feel like i’m in a brain fog focusing is nearly impossible other

people remember things so much better than i do well brain fog is very real to a woman

who’s going through menopause when your hormones are steadily declining some of you may also have noticed brain fog when

you overeat or when you eat a high sugar food and this can be from insulin

resistance or when your metabolism is not as stable as it was maybe when you

were younger it can also occur when your hormones become low in your body and they are not

available like they used to be to support your other systems as well as they did before

so the next quote i don’t hate sex but i don’t care if it ever happens

again it makes me sad to realize that i might feel that way for the rest of my

life i’m not sure i’m ready to give up intimacy forever

and i love this quote and i love being able to share it on this webinar intimacy is a very important part of our

human lives it is how we make offspring and it creates a unique partnership with

those we love sadly when going through menopause women may have these thoughts bottled up

inside which can be an underlying cause for changes in their relationships that

are most important to them so let’s talk about menopause what is

menopause well menopause is a point in time 12 months after a woman’s last period okay

the years leading up to that point i want to just make sure everybody’s on the same page here

when women may have changes in their monthly cycles they might have hot flashes or other symptoms and that time

period is called perimenopause when all these things start to happen it most often menopause happens between

ages 45 and 55. we are seeing it happening earlier and

earlier these days in young women menopause usually lasts about seven

years but it can last longer in as long as 14 years

during menopause the body’s production of estrogen and progesterone which are two hormones made by the ovaries varies

greatly the body begins to use energy differently and fat cells change

and women may gain weight more easily you may experience changes in your bone

your heart your brain health and your body shape and composition or your physical function

so these are the things we’re going to talk about today what is hormone therapy okay well this

is hormone therapy today hormone therapy today is different than

it was in the past and we’re going to talk about that hormone therapy today is called bioidentical hormone replacement therapy

and we refer to that as bhrt

and that’s the acronym i’m going to use during our presentation today

so bioidentical hormone replacement therapy otherwise known as bhrt

are at one time we didn’t used to use them

we used to use synthetic hormones and we have studies that concluded that this was not the best option

one very popular study you may have heard of was called the women’s health initiative many women participated and experienced

negative outcomes and so we’re no longer recommending synthetic hormones today

so br bhrt today comes in all shapes and sizes it can be in an oral pill that you

take it can be in a underneath the tongue kind of a trochy that dissolves it can

be a topical cream it can be a pellet that’s inserted underneath your skin

it can be cream going intravaginally or it can even be an injection type of a

form bhrt can be purchased from your regular pharmacy or you can use a compounding

pharmacy if we want to calculate your dose more exactly so the specific bioidentical hormones

that we will be talking about today are estrogen progesterone and testosterone

and these are also known as the corticosteroid hormones they are the downstream hormones and by

this i mean that they there are many hormones in your body and enzymes and cofactors

that all flow through the body to make these hormones but these are the hormones that we have extensively

studied and that we now can supplement directly if they are low

okay just moving through there’s the button there so i love this slide because we know

that menopause is or should be the best time in a woman’s life

if her hormones are balanced we also know that

hormone response is as unique to each person as their own fingerprint

so if you have friends that are telling you about their experiences yours can be absolutely totally 100 different

hormone testing is something we need to discuss when we’re talking about hormones just so you know that serum or

blood testing is quite often the starting place where we be where we begin by checking your hormone levels

urine testing has recently become the new favorite testing for hormones

the reason for this is because we can check for hormone metabolites and cortisol metabolites okay so what are

metabolites metabolites or metabolism simply means how your hormones are being

utilized in your body and then being removed from your body so this testing is super important in

order to be comprehensive with our treatment hormones that are not being used

properly or not removed from the body can cause a decline in health and this

is another reason why we are able to provide hormone therapy much more safely

than ever in the past since we have urine metabolite testing now available

saliva testing may also be used for convenience certainly not having to get stuck by

your blood and testing can provide hormone levels with

saliva it also can provide information about your cortisol which is another hormone and you’re going to learn here

shortly how cortisol can really um displace your corticosteroid or your

hormones of estrogen progesterone and testosterone so

most frequently more than one testing modality is indicated personally

i like to see both serum through the blood and urine testing at different

times so that i can be able to know that my patients are really utilizing and removing their hormones correctly from

the body so now we’re just going to talk about prevention and i think this is a really

great time to interject and talk about that we absolutely have no studies to

date that bioidentical hormones can cause cancer however you are about to learn that

hormones do contribute to continued growth as they support the

continued growth of our cells so hormones will not cause a cancer

however if you already have a cancer in your body they may grow a cancer more quickly just like back in the day when

you had a lot more hormones that were circulating around in your body this is why we insist on doing

preventative testing before we begin the use of bhrt and this is why we talk

about any cancer concerns or family traits before we begin therapy

there is a wonderful book it’s looking to see it is sitting on my shelf back there i mean it is called

estrogen matters it is by authors avram bluming who is an

oncologist medical doctor and carol tavris ph.d in biochemistry

they discuss the importance of estrogen and how we can best use it and how we need it from

an oncological perspective so for any of our patients at the maxwell who are

concerned about cancer or may have cancer risks we go through this book and

we make a plan so the united states health preventative task force recommends a mammogram that

should be done annually okay and a pap that should be done every three years for women who are ages 21

through 65 so depending on your individual risk factor we may want to do a pap more

frequently if you’re having issues down below when you’re using bhrt or thinking about

using bhrt this risk stratification can be personalized for each woman and for

women over 65 who choose to use bhrt i recommend continuing annual mammograms

and depending on each person’s pap history or health factors then we have a

discussion on best prevention for them keeping up with your colonoscopy

is also very important and also you can use the cola guard testing

as long as your gastroenterologist is okay with that sometimes

they might want you to have a colonoscopy instead and that’s fine but doing one or the other very important

also having a dexa scan for your bones can allow you to see a baseline if

you’re choosing to use bhrt and also

a mocha or a montreal cognitive assessment test can allow you to see a

baseline so that when we’re working with bhrt you can see improvements in brain fog

and these are up and coming but we do offer them here at the maxwell and encouraging encourage them depending

on what we’re trying to accomplish with our different patients so

how do we move forward and how do we best balance

our hormones how do we help our hormone system to be balanced

well we are a complex system of systems so hormones are influenced by all the

imbalances in our system and you really can never just look at hormones by themselves they are so

intertwined into your body this slide here i want to just explain a

little bit because hormones are heavily affected by your gut your detoxification system your

adrenal glands and your neurological system just to mention four things um

but i chose them to be the most important ones to talk about today um the sl the picture of the woman

on uh your left is basically just showing

she’s focusing on her gut health um and the one in the middle with all the

smoky stuff around it and the skull guy is having problems with detoxification obviously um the little guy in the

middle who’s got his hands over his back um that’s where your adrenal glands are

located a little glance on top of your kidneys and the woman all the way to the right is really experiencing some

neurological um mental kind of blocks and

so these are the four systems i just want to talk to a little briefly here and how they’re making a big impact on

your hormones so if your gut and your gut bacteria are not balanced or if you

have inflammation in that gut area you’re not going to have good signaling for your hormones

and they’re also going to have difficulty getting removed from your body most people most women have no idea that

the bacteria that lives in your gut is hugely responsible for signaling your hormones

do you have a healthy gut bacteria do you know many of us have no idea until menopause

can come along and it can be very difficult at times and that lets us know

your detoxification system does include liver lymph

colon kidneys your micronutrient balance and your genetic makeup

so these areas are not functioning properly if they’re not functioning properly you won’t be able to correctly

break down and remove the hormones from your system so this can create some serious problems

excess hormone accumulation can cause inflammation and contribute to further disease

so we want to pay attention to this and then your adrenal glands they probably are the most notable imbalance of all

upon entering into menopause these are these tiny little glands on top of your kidneys and these adrenal glands are

responsible for making cortisol and that’s your stress hormone you need cortisol to live

when you go through menopause your ovaries shut down and stop making estrogen progesterone

and testosterone so your adrenal glands take over and they try to do their best to continue

making estrogen progesterone and testosterone while they’re continuing to make cortisol for you to live

and if you’re having some heavy exercise routine if you are excessively stressing

lack of sleep um you’re going to need your adrenal glands to make more cortisol and so they’re not

going to be able to help you out as much and help you out during this transitional time

so um some people look at your adrenal glands as being like a little savings account and if you save or you don’t

overwork your adrenal glands by forcing them to make too much cortisol over the years and years of

your life leading up to menopause then you can give they can give you plenty of support when it’s your time to

go through menopause but unfortunately women who are constantly stressed and

need to constantly be making additional cortisol we typically have more difficult time

with this transition so i hope that’s uh giving you a little explanation here uh the

neurologically when you are anxious when you’re going through depression hyper vigilance ocdc

excessive obsessive-compulsive disease then you’re typically really working your adrenal glands hard

so the next screen i’m going to show you is just allowing you to see the complexity here that we look at as

providers oh please don’t think you have to take a picture of this screen but i

just want to show you here um that hormones are very busy and specifically i wanted to show you

about your testosterones and your estrogens they’re over here on the right side i can show you with my cursor i’m not

sure if it’s showing up here’s your testosterone down below is your estrogens they’re on the right side and

coming down here is your dhea and it will go right down the middle and over

here is your cortisol now if you’re really really over exercising over stressing

this is something that must happen you must have cortisol to live and so all the cofactors all the enzymes will make

you cortisol and instead of coming over here and making you nice and relaxing progesterone or coming over here giving

you good testosterone good estrogens it will not and this pathway will be

defaulted to making cortisol and so you’ll have less testosterone less

estrogens less progesterones which doesn’t always make for a pretty picture

next slide this is what we’re all here to talk about today is why might you want to use bioidentical hormones

actually this particular slide says why might you not want to use bioidentical hormones well you may have no symptoms

hooray right no hot flashes no insomnia no irritability you’re doing great and

it’s menopause and you are a year out not having any menstrual cycles and

everything is good well you also might not have any brain issues

you’re not having any brain fog you’re not having any heart issues you might not have any bone concerns as well and

as you’re about to learn bhrt can be very supportive of all three of those areas but if you don’t have anything

going on there you might not need to use bhrt you might not want to

you may also have a sluggish detoxification system and you might look like that little guy

back there on the slide before us with just illness and if you have a sluggish

detoxification or a cancer in your body or a history of cancer in your family

then we’re going to want to have discussions about what we can do to clean that up

so sluggish detoxification systems and poor gut health

we always want to address no matter which choice we make to use bhrt or not

to use bhrt but i’m here to tell you that these two areas are the big take-home points for

today identifying and correcting issues in these systems

detoxification in your gut will support longer and healthier life

period quite often these areas become more noticeable during menopause or

perimenopause this is a wake-up call for us as women to address it

so please pay attention to these discoveries they are very important

whether or not you choose yes bhrt are not bhrt the changes that you may notice

in your sys in these two systems during this time period are important to fix

so next slide is why would you want to consider bhrt well you have symptoms

you’re having hot flashes you’re having brain fog night sweats anxiety irritability

insomnia and depression and we do know that using bhrt is the fastest

most direct and fairly always works

strategy to eradicate these symptoms we also know as i alluded to before

brain health it can help with prevention and improvement of memory loss

this is a really big deal and um we’re going to talk a little bit more about this heart health atlas sclerosis

hypertension so plaque and high blood pressure bone production

anybody who has osteoporosis or osteopenia or has had to use medications

that may cause this at an earlier age bhrt is really really effective also

growth and repair for the entire body and just basic vitality and supporting

energy this is why we consider bhrt

so just to talk a little bit about more about the research that we have behind this

um and we’re going to talk a little bit about estrogen specifically and the effects on the brain and the heart and

the bone so we know that estrogen can increase blood flow okay

just to all of your vascularity throughout your entire body we also know that it keeps that blood

brain barrier working well it increases the glucose and oxygen to

the neurons all over your body and we also know that it increases

sensitivity to nerve growth factor which is going to help with your

neurotransmitters these are the things that are problematic when you’re dealing with

depression um anxiety so we also know and this is such a big

deal that it decreases estrogen decreases generation of alzheimer’s beta amyloid

peptides if you haven’t heard beta amyloid peptides or things that we are seeing

accumulating around the blood-brain barrier that are significant in alzheimer’s

patients so additional benefits from estrogen in

the heart these are specific studies stating that within the first five years of menopause using estrogen will cause

significant benefits this was the elite study in 2016. i’m going to talk about that a little

bit more um also decreasing in atherosclerosis or plaque for all age

groups this is estrogen it also can protect against hypertension

which is your high blood pressure and this study was done with transdermal or topical estrogens for helping with blood

pressure issues and we know that estrogen helps by activating the vasodilation which is when your arteries

can dilate you’re getting more blood flow to the area

here’s the study about reducing atherosclerosis it was done in 2020 so that’s really recent

um i just wanted to share that with you so you don’t think i’m just making all this stuff up there’s lots of studies

this is a study on estrogen in the heart and this was the study that took from five to ten years they found that it was

really a great time period to consider working with bioidentical hormones this

was partially recognized in the women’s health initiative study as well as the trial elite study

looking at cardio protection in post-menopausal women

also here’s the study about the hypertension and this was done in 2006

um and then we talk about estrogen and bone and i’m going to show you some studies

there too i think it’s remarkable when you look at this take-home

slot up here talking about 93 of women who do not use estrogen

93 who do not use estrogen have fractures of some sort by age 85.

we do know that cortisol levels if they are abnormal

so if you’re stressing a lot even though you may be using

estrogen we still may see bone breakdown so quite often it may not be about just

using estrogen if you’re still stressing and we haven’t been able to address that

we will still see bone breakdown even with estrogen nutrients alone are not enough to

prevent osteoporosis we do have studies that are showing that to us

we also know that estrogens have been shown to help build bone structure

and they have been proven to be equal to the bone supportive medications that we

are using for osteoporosis

so here’s a study on estrogen and bone health this one was put out in 2007

basically showing about bone structure and improving and helping to build bone structure

here are two studies that were the studies that they used to

use estrogen as well as alendronate which is one of the osteoporosis

medications that we use and showing how they benefited equally

a lot of people have side effects with those medications so what about progesterone and testosterone those are the other two

hormones that we really want to discuss today as well with bhrt uh we do know that benefits of

progesterone and testosterone both of these together help to lower blood pressure and cholesterol

we do know that low testosterone in men is associated with hip fractures

and we also know that a lot of the studies were done on men it’s difficult to do studies on women

because our hormones are always changing we do know also that progesterone and testosterone help to build bone and

testosterone specifically will strengthen bone we also know that both of them together

help to maintain bladder function and we also know that they are also

proven to be equal to bone supportive medications that are approved for osteoporosis just like estrogen

so you might want to take a picture of this slide this is progesterone and all the wonderful things that it can do for

you i would say i want to just hit on the very first one and the last one

progesterone helps prevent anxiety irritability and mood swings and this

can be really evident when you’re first working on the first signs of menopause

and really fearing feeling irritable we know that progesterone is typically the

first hormone to decrease and so those of you are out there who

might be feeling it this is why also the very last thing on this slide

that estrogen has a positive effect on sleep i can’t tell you how huge this is

i absolutely love helping women who are in perimenopausal stages or

post-menopausal stages not being able to sleep have tried everything and

progesterone really makes a big difference here’s a slide on testosterone support

also feel very free to take a picture of this as well sexual interest and this

kind of makes me go back to the initial quote about the woman who was really sad

about not having sexual interest anymore and certainly testosterone can be a big part of that it is

multifactorial but testosterone is a big part of that as well and it also helps with depression it can

help with decreased body fat and so it also plays a part in memory as

well there are just a whole lot of different studies that were done on this and i

just want you to know that when you come to the maxwell we can go over these studies with you depending on what’s

pertinent to your specific issues this is bhrt and the heart

and the atherosclerosis study as well i did throw a couple of other slides in

here and now i’m talking about some autoimmune disease connections that we’re just beginning to make

with bhrt support here’s one with multiple sclerosis showing that a first

pilot trial of showed encouraging results we want to do

more studies especially for the treatment of autoimmune diseases like multiple

sclerosis here’s a second study that was with multiple sclerosis as well looking at transdermal or on the skin

testosterone they also looked at that in male patients and estrogen for the female

patients and it definitely did some positive results for this disease process

this study right here is my absolute favorite this is the women’s alzheimer’s translation research board study

this looked at 400 000 patients that were studied for 10 years showing a 60

decrease in alzheimer’s disease the big take home with patients over 65

years of age had the greatest success this speaks to the vitality that you can

receive by using bhrt and the brain support that we’ve gone

over and talking about estrogen and progesterone and testosterone this data is simply impossible to ignore

other neurodegenerative diseases were looked at as well in this study such as parkinson’s disease and multiple

sclerosis and they were also significantly improved on bhrt again my absolute favorite study

so is hormone therapy right for me well

everyone deserves an opportunity for an evaluation and i feel passionately about

this and i know the providers here at the maxwell do the same

so much of what we see out there in traditional medicine is that

we don’t have talking points about this your traditional primary care providers often don’t have the education to really

discuss this the pros and the cons and personalize it for you

so um let’s see my slide seems to be stuck there we go what is involved in a bhrt

evaluation this is the slide i encourage you to take a picture of

so lots of things can be involved in a bhrt evaluation and i encourage everyone

who’s watching today to do this with your maxwell clinician we are going to be looking at all of

these points for you and especially the ones that are specifically

um pertinent for you i have highlighted two of these pathways that i discussed

with you earlier that we absolutely want to make sure whether you’re deciding yes with bhrt or no with bhrt these pathways

need to be optimized and we like to look and see where you’re at with detoxification and where you are at with

your gut health right now during this perimenopausal and post-menopausal phase

well no question is too small so if bioidentical hormones are not for you

optimize your gut and your detoxification systems in order to best support your natural hormones

if bioidentical hormones are for you then optimize your systems all of your

systems so that you can best support your bioidentical hormones address your imbalances and

that is my message for you today so a couple more quotes whether or not

you’re deciding to use bhrt here’s a quote specifically from someone who decided yes

that hrt or hormone replacement therapy opened my eyes and gave me my life back

post-menopausal quote from someone who didn’t use bioidentical hormones but yet

we’re able to optimize systems i am creating the life of my dream

this is what we want to hear this is what we want all of our patients to do at the maxwell

the same light that i see in others is now shiny inside of me and this is my wish that all of you who are watching

this today and who are working hard here to do the work that we do at the maxwell

can accomplish so take advantage of the opportunity to learn about yourself through hormones

schedule a bhrt evaluation and utilize us for all the information

that we can provide insight into your bodies questions

this is the time i don’t know if i have any questions here i think i need to push this little

button that tells me wonderful so i’m going to read the first

question i am not currently a maxwell member is there a membership specific to menopause

hormone testing support in signing up would i be working

directly with luanne thank you well this is an excellent question and i’m so grateful for you to

ask certainly here at the maxwell we make things happen so i would encourage you to go on the

maxwell clinic website maxwellclinic.com

and go and click into becoming a patient and you will be hooked up with our wonderful

um patient intake advisor and kelly will talk to you about all the

things that we can do for you here so the answer is yes yes yes and yes

we at the max will figure out ways to help people and certainly the first step

is becoming a patient at the maxwell and getting out of your visits what you want and what you need

so i hope that answers a question for many of you out there and um thank you

for listening and taking the time i hope that i honored your time by sticking to my 30 minutes

i know it can get mind-boggling to listen to research and information

for a little bit more time than that so i don’t see any more questions and i

know that there certainly may be plenty so please everybody feel free to

reach out to your maxwell clinician and ask the hard questions

find out what works best for you and optimize your hormones whether or not you choose to use bhrt and move

forward okay thank you very much all the best to you all and

we’ll see you next time at our group visits bye for now

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