How to Properly Manage Menopause
At my practice, Optimal Wellness MD, about 60% of my patients are women seeking relief of menopausal symptoms. I commonly see women complaining of:
Can't Lose Weight
Increased belly fat
Anxiety & Depression
"Brain Fog" or problems with focus and memory
Fibrocystic Breast Lumps
Sometimes these symptoms are abrupt, such as after a total hysterectomy and sometimes they creep up one by one. In some cases these symptoms are intermittent with normal cycles for a few months, then a month or two of symptoms.
My approach to this is fairly straightforward and in nearly every case, I can balance the woman's hormones so she feel like herself again.
First I take a good history; this takes time and I will spend about 60-90 minutes during a first visit to be sure I know all the details. Symptoms of hypothyroidism, menopause, perimenopause, adrenal insufficiency and other conditions overlap, so it's important to be sure which condition you are dealing with. I have my patient fill out a "hormone questionnaire" that helps clarify which are the major symptoms and which are not so important. Once I have a good understanding of the problem and how it started and progressed, I do an extensive panel of blood tests and a saliva test to confirm my diagnosis.
Then I work on restoring a woman's hormonal balance, taking into concern what she feels are the most important symptoms or reasons for seeking help. For a perimenopausal (not yet in menopause) woman, the usual problem is a lack of progesterone and testosterone. Often a combination of an oral progesterone pill taken at night with a testosterone booster will do the trick. Progesterone can be delivered as a cream or a tablet, but the tablet has the benefit of giving a restful and rejuvenating sleep. Testosterone can also be given as a cream, but when delivered with a tiny implant under the skin, it boosts estrogen as well as testosterone and greatly improves low libido. A hormone pellet is hands down the best way to restore a woman libido. Some perimenopausal women also need supplemental estrogens, and these can be provided as a cream or a patch, or even as a hormone pellet.
For women in menopause (no period for at least 1 year or who have had a total hysterectomy), there are many options. The most effective method of hormonal replacement is a tiny implant under the skin that contains testosterone or testosterone and estrogen. These implants last 4-5 months. These are balanced with a progesterone pill taken at night. For women who may not want an implant, I can create a custom hormone cream that contains estrogens, progesterone, testosterone and even DHEA. I can adjust the dose of each hormone to be sure she gets exactly what she needs and no more. I can also design hormone vaginal creams that can rejuvenate atrophy and dryness. Creams can be combined with progesterone pills to give a good nights sleep. If a woman wishes to stay with brand name products instead of customized compounded hormones, we can prescribe estrogen patches and progesterone pills.
Every choice is made in conjunction with my patient. I take into account what her specifics symptoms and concerns are. If her concern is financial then I choose options that are covered by insurance or are less costly. If she is more concerned with convenience, then we can use pellets or patches. If she is concerned about libido, I will recommend hormone pellet implants. If she has migraines, progesterone and testosterone pellets are excellent treatments for this condition.
In summary, there is no reason to suffer from menopause symptoms. Recent studies have clearly shown that natural bioidentical hormones, when properly prescribed, do not increase the risks for breast cancer and may even lower the woman's risks.
If you have any of these symptoms, I encourage you to give my office a call and speak to me or my assistants about how we may be able to help.
Dr. Joseph Kaye