During Your First Visit
Your first visit with us will involve meeting with Dr. Kaye for 90 minutes. During that visit, he will review and discuss with you the medical information you provided in our intake forms. He will check your vital signs and do a brief exam, and check your body composition. We will then look at all the data, combined with your physical exam findings and discuss healthy diet and lifestyle and options for treatment. Usually we will need to do some blood testing and this will be ordered at your visit. You will have the opportunity to meet with our nutritionist to start a weight-loss program or further discuss diet.
Many of our patients have co-existing health issues and we put all the pieces together and come up with a plan of treatment. We want to prioritize what YOU feel is most important. For some women it may be getting rid of menopausal symptoms and getting a good night’s sleep. For others it may be a better libido and relief of vaginal dryness and a better sex life. Others may be focused on losing weight and improving their hair and skin. Be assured, we will address all your concerns relating to hormones and even address your non-hormonal issues such as Lichen Sclerosis, IBS, food and environmental allergies, thyroid and adrenal disorders, chronic fatigue/fibromyalgia, autoimmune diseases, osteoporosis, cholesterol and heart-disease prevention, nutritional deficiencies and supplements, and mood disorders.
Menopause and Hormone Replacement
What is menopause?
Menopause is usually defined as the absence of menstrual cycles for at least a year due to the ovaries no longer producing the sex hormones (estradiol, progesterone, and testosterone). This can occur because of a total hysterectomy, where the uterus and ovaries are removed, it can happen due to age, usually in a woman’s 50s, but it can happen as early as her 30s, or it can be the result of chemotherapy or radiation to the pelvic area.
Regardless of the cause, many women experience debilitating symptoms and rightfully seek relief. The ideal treatment for menopausal symptoms is the replacement of the natural missing hormones at the correct levels to relieve those symptoms and also prevent the diseases associated with the lack of the sex hormones.
After menopause, women typically experience hair loss, skin wrinkling/thinning saggy skin, loss of memory and cognitive ability, bone loss and osteoporosis, accelerated cardiovascular disease, overweight (increased belly fat), higher cholesterol, loss of muscle tone, low libido, anxiety, insomnia, mood changes, fatigue, and of course hot flashes and night sweats. The good news is that all these diseases and symptoms can be prevented and often reversed with the proper use of bioidentical hormone replacement.
So, congratulations on taking a big step toward feeling better, more like the former "you." Get ready to say goodbye to hot flashes, night sweats, sleepless nights, bad moods, irritability, that stubborn weight gain, hair loss, and that "brain fog." Say hello to better skin and hair, a sharper memory, better moods, relief of those menopausal symptoms, a leaner and firmer body, and those extra pounds finally going away.
At Optimal Wellness MD, we have treated thousands of women just like you with safe, natural, bioidentical hormones. We are expert at all the variations of this type of treatment and can ensure you get the best results.
Peri-Menopause and Hormone Balancing
What do we mean by peri-menopause?
Peri-menopause is a less well recognized condition than menopause because, while a woman will still be having menstrual cycles (and thus is not in menopause), she will still experience some symptoms. Peri-menopause symptoms may begin 5-10 years before actual menopause.
Symptoms commonly associated with peri-menopause are a result of a relative deficiency of progesterone and often testosterone or DHEA, while estrogen levels remain fairly normal.
What are Symptoms of Peri-Menopause?
Typical symptoms of peri-menopause are anxiety, insomnia, irritability, mood-swings, heart palpitations, breast tenderness and lumpiness, heavy and painful periods, irregular periods, migraine headaches, PMS, low libido, unexplained weight gain and obesity.
For women who are in the peri-menopause age, we can help to relieve all those unwanted symptoms with proper hormonal balancing using natural bioidentical hormones. Even migraine headaches and osteopenia or osteoporosis can be improved with proper hormone balance.
Testosterone and DHEA Deficiency in Women
Do women have testosterone?
Yes, women have testosterone, and they need it just as much as men! Testosterone levels are lower in women, but they are very important for energy, motivation, libido, muscle tone, bone health and memory. If a woman is deficient in testosterone and DHEA, it is often unrecognized by conventional doctors who rarely even measure testosterone levels in women.
What are symptoms of low testosterone in women?
Symptoms that suggest low testosterone are: Fatigue, depression, low libido, sore joints, weak muscles, obesity.
How do we restore testosterone levels in women?
We restore testosterone to optimal levels with either DHEA or by using actual testosterone using only natural, bioidentical testosterone in the form of creams, pellets, or even injections.
Hormone Replacement Options for Treatment of Menopause
How do we use hormones for women and how much do bioidentical hormones cost?
The HRT options we offer include the following bioidentical products:
Compounded bioidentical skin creams containing a mix of estrogens (usually Bi-Est), progesterone, and testosterone and in some cases DHEA. These are easy to apply to the skin, usually once or twice per day, and are very effective. The doses are individualized to each patient based on lab testing and evaluation of your symptoms. The cost of these creams are about $50-$75/month depending on the ingredients if purchased in a 90-day supply.
Hormone Implants or Pellets are an excellent way to do hormone replacement in menopausal or perimenopausal women. Typically we use testosterone and estradiol and the dose varies with each patient depending on her symptoms and blood testing. We combine these pellets with oral progesterone. The cost of pellet therapy for women is about $125/month including the office visits every 4 months to install new pellets since the old ones dissolve. Pellets are great for convenience as all you need to do is remember to take your progesterone capsule at night.
Testosterone Injections. This option may be helpful for women who are using commercial estradiol patches and oral progesterone but still need a source of testosterone. This is inexpensive, less than $10/month for the medication.
DHEA capsules. These are very inexpensive and, in some women, can be used to boost testosterone as DHEA is converted to testosterone by the body. It doesn't work for everyone; I find most women need real testosterone.
We offer vaginal creams or suppositories containing an individualized mix of estrogens, testosterone or DHEA (particularly helpful for vaginal dryness and Lichen Sclerosis).
We can prescribe commercial bioidentical estrogen skin patches which are sold from any commercial pharmacy. Examples are Vivelle or Minivelle. The cost of these depends on your insurance co-pay.
Progesterone as an oral capsule is also available from conventional pharmacies or from compounding pharmacies if we want a specific dose or type of capsule not available commercially. Progesterone capsules are typically covered by insurance, but if not, are reasonably priced, about $50/month if purchased in 90-day quantity.
Personalized Approach
All BHRT prescriptions are individualized for each patient and we monitor your symptoms and blood testing carefully to make sure you are taking exactly the right dose for you - this is not a one size fits all approach.
Women who have had a hysterectomy are perfect candidates for BHRT, especially our pellet implants.
Weight Loss
For weight loss, we offer several options: For very rapid results we offer a ketogenic diet program combined with medications such as semaglutide or tirzepatide and a medical food program called Ideal Protein. If that is not for you, we offer the diet programs without medications and also offer coaching on low fat and low carb diets or more vegan options.
We will usually meet with you 2 or 3 times per year to make sure you are doing well and we will check labs as necessary.
To learn more about our weight loss program, click here.
Risks?
What about risks from using bioidentical HRT? The conventional HRT you may have heard of such as Premarin and Provera does increase your risks for breast cancer, stroke, and heart disease according to the WHI study of 2009. However, the good news is that recent studies (KEEPS and others) show no increased risk of breast cancer or other cancer with the types of BHRT we prescribe.
Benefits
Bioidentical Hormone benefits can be significant. Our long-standing patients comment on how much younger they look compared to their friends; their hair is fuller, they have less wrinkling and better skin tone. They have stronger muscles and bones and can lose weight more easily. They have better sex lives and much improved libido. They have sharp minds and a good memory again, so they can do better at work and in life. Of course, all of our patients have improvement in their menopausal symptoms. Our patients with osteoporosis have improvement in their bone density tests and the patients with prediabetes or high cholesterol can often correct these problems with our diet programs. To learn more about recent research on estrogen and progesterone, please read more on our blog page here.
We look forward to working with you!
Frequently Asked Questions about Menopause
Do I need treatment for menopause?
Whether to treat menopausal symptoms is always an individual choice; however, it is important to understand that these symptoms are due to the lack of important hormones. The lack of these hormones may lead to adverse health results over the long term such as osteopenia (bone loss), increased cardiovascular disease, memory impairment and a higher risk of dementia, fatigue, and depression. While drugs are available to help manage each of these conditions, many women elect to simply replace the missing hormones and thus not only relieve menopausal symptoms, but also reduce the risk of diseases developing as they age.
Do hormones increase my risk of developing cancer? Some types of hormone replacement such as the synthetic progestin hormones and conjugated horse estrogen pills have been linked to a small increased risk of breast cancer; other types of natural bioidentical estrogens and natural progesterone do not appear to have the same risk. It is important to understand that hormones must be prescribed in a balanced manner at the proper dose to avoid health risks; even natural bioidentical hormones must be balanced to avoid increased risk and annual mammograms or thermograms must be done to screen for breast cancer. However, recent studies indicate no increased risk over usual background risk for women choosing natural bioidentical hormones when prescribed correctly.
Are there certain conditions where hormones are risky to use? As with any medicine, some people have higher risks of adverse effects. For example, women with a history of being overweight, smokers, history of blood clots, heavy alcohol use, have never been pregnant, had previous breast cancer are potentially at higher risk. However, there are no absolute contraindications to the use of bioidentical hormones. Each case is individualized and the risks and benefits must be explored by the patient and her doctor. There are many ways to replace hormones and certain types of hormones may have more or less of a risk than others. For example, estrogen-containing pills may increase the risk of blood clots, where creams and pellets do not. In general, we avoid prescribing estrogen to women with a history of estrogen-responsive breast cancer, but she may be able to use testosterone and progesterone with no increased risk.
Is there a certain age I should consider hormone replacement? Some studies suggest that the earlier a woman starts hormone replacement, the better off she is with less risk of adverse cardiovascular disease developing later if hormone replacement is started early. I suggest starting HRT as soon as menopausal symptoms begin to develop or when menses become irregular or perimenopausal symptoms begin.
Are there natural treatments for menopause? Certainly eating a healthy diet, exercise, maintaining a healthy weight can make the menopausal years healthier, but nothing is a substitute for those missing hormones. There are herbs that may reduce the symptoms of night sweats and hot flashes, but they are not an exact match for your missing hormones and do not reduce the risks of disease due to menopause.
Why is sex painful after menopause? The lack of estrogen due to menopause causes the vaginal lining to atrophy, leading to dryness and pain during sex. This can be easily reversed with vaginal hormone treatments such as vaginal estriol cream or suppositories or by replacing the missing hormones throughout your entire body with creams, pellets, or other methods.
Why do I have a low libido after menopause? This is due to the loss of estrogen and testosterone after menopause, poor sleep and fatigue due to menopause, vaginal atrophy which causes pain during sex, and the changes in the brain after menopause. Replacing the missing estrogen, progesterone and testosterone hormones can restore a normal libido.
Why am I fatigued after menopause? Fatigue has many causes, but if due only to menopause, it is likely due to a lack of testosterone and estrogen which both boost energy and mood and a lack of progesterone, which is needed for deep sleep and feeling rested. When hormones are in balance, sleep is restful and deep, and women have plenty of energy.
I am losing hair after menopause. What can I do about it? Hair loss is very common due to menopause and can be stopped and often reversed with hormonal replacement. In addition, in our practice, treatments such PRP scalp treatments with micro needling and medications such as minoxidil and finasteride have shown great results in growing back lost scalp hair.
Why am I gaining weight since menopause? This is due to several reasons. First, many women have an imbalance between estrogen and progesterone and become “estrogen dominant” during perimenopause and even after menopause. This excess of estrogen causes fat storage. Next, due to feeling depressed or anxious, many women tend to overeat or eat sweets or carbohydrates to excess, leading to weight gain. Third, the stress of not sleeping, and the anxiety associated with menopause raises cortisol levels, tending to cause fat to grow on the belly area. Hormone replacement alleviates all of these causes and can help a woman lose weight with a proper diet plan and exercise.
"I consulted Dr. Kaye recently and was impressed with his evidence based approach in diagnosis and treatment. The tests he recommended were comprehensive which included parameters not covered by my previous annual medicals. His consultation meeting was also thorough in that he took a holistic approach and provided specific science supported recommendations on diet."
"Cheers and thank you again. (This is such a more comprehensive approach to health care than anything I’ve experienced previously.)"
"Feel absolutely amazing and in the shape of my life – you are a god among men!"
Schedule Your Consultation Today!
Interested in learning more about Female Hormone Optimization? Call 781-933-4200 to schedule your consultation with Dr. Joseph Kaye today! Our practice serves Woburn, WA & all nearby areas.
