If your doctor refuses to treat menopause

I am contacted by women daily who say that their doctor refuses to treat menopause citing it as normal and that they must accept it. It is very frustrating for the woman who is seeking treatment and, believe it or not, frustrating for the doctor who sends them away.

Doctors are in the business to help people restore their health. In order to do that they have to know what they are treating and have a plan (protocol) and medications to treat it. Here are the obstacles your doctor faces and what you can do about it:

Obstacles:

1. Your doctor wants to treat it but may simply not know how because in medical school it was discussed very little and then only to say that it was normal.
2. Your doctor has very few products to use and may not know how to combine them for your optimal health.
3. Your doctor may think that treatment may not be in your best interest because clinical trials like the Women's Health Initiative proved that Premarin is not an effective treatment for hypogonadism. Premarin, the primary treatment since 1942, has never been associated with restoring sexual response and in no way represents ovarian hormone replacement. Premarin is neither replacement nor therapy for hypogonadism and should never be referred to as HRT, HT (hormone therapy) or MHT (menopausal hormone therapy).

What you can do:

1. Agree with your doctor that hypogonadism (menopause) merits treatment.
2. Agree with your doctor that the use of ovarian hormones is what you need to regain your health and sexual function following ovarian failure, which is what caused menopause in the first place.
3. Agree to use ovarian hormones, estradiol, testosterone, progesterone and dhea. You don't have to use a compounding pharmacy. You can use a patch for estradiol, Androgel for testosterone, a pill called Prometrium for progesterone, and you can buy dhea from a store. To make it easier to use the Androgel you can pay a compounding pharmacist to put it into a more convenient dispenser.
You deserve treatment for organ failure and your doctor wants to help you. Decide together that treatment for menopause (organ failure) is in your best interest. Be patient as you start on your regimen and give your doctor feedback on how you feel to adjust your dosages to restore your health and sexual response. It may take some time and several adjustments, but it is worth it.

Untreated menopause is untreated hypogonadism!

You are never too old or too young to benefit from treatment for hypogonadism.

11/4/2007 7:00:00 AM
Beth Rosenshein
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Beth Rosenshein is an electrical/bio-medical engineer and is very familiar with medical research. She holds two United States patents, one for a unique design of a vaginal speculum, and one for a clever urinary collection device specifically designed for women. Beth discovered and documented an important drug interaction...
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Comments
Dear Trillia, I am glad to hear that you realize the importance of treating hypogonadism (peri-menopause) before it progresses to profound hypogonadism (menopause). Don’t be discouraged by your doctor’s reaction because there are doctors who understand the immense health benefits of treating these illnesses in women and men. Since your doctor is unwilling to treat these very treatable illnesses you must find another doctor. Here is a link to a website that can help you find a doctor. <url removed>/ If you can’t find a doctor in your area with this website there are a couple of things you can do right away. First, ask friends and relatives for referrals to open minded healthcare providers. If you don’t have any referrals do a Google search of bio-identical hormones and doctors in your area. Second, call the referred doctor and ask if he or she prescribes bio-identical hormones, estradiol, testosterone, and progesterone for the treatment of peri-menopause and menopause. Once you are in the doctor’s office refer to your illness by name, peri-menopause is hypogonadism and menopause is profound hypogonadism. By doing this you are reminding your doctor that you are requesting treatment for an illness to improve your health. This empowers the doctor to do his or her job better. One last thing. If your doctor says that hormone replacement is bad for you then gently remind your doctor that there is no proof that treating hypogonadism is bad for you. The studies that, like the Women’s Health Initiative, say that hormone replacement is bad for you did not use replacement at all. The WHI, like all other ‘hormone’ trials, never measured hormone levels before or after giving ‘HRT’ because it would have proven no replacement was being given at all. There is no controversy about this, it is fact. Good luck and let me know if I can help further. Beth
Posted by Beth Rosenshein
Hi Beth, Is there any thought to having a network of doctors who are open to this protocol or who are willing to help us with this treatment? My doctor seemed open minded about it until I actually asked her to prescribe and start the bloodwork. Then she totally balked and I am heartbroken and frustrated. I'd be happy to travel rather than keep going to doctors sounding like I don't know what I'm talking about (I don't express myself very clearly) and trying to hand them your book and getting rejected. I'm 48, and I have to get on this pronto. I'm really grateful for you and your book and research and have bought copies for sisters, friends, neighbors... THANK YOU!!!
Posted by Trillia
Dear cbsmith259, Congratulations on the birth of your son. I love hearing about success stories when ovarian hormones are used appropriately. If you feel that you need supplemental progesterone you can purchase it yourself and try it again. A good starting dose is 20 mg/day. If you find yourself feeling down or weepy than you can reduce it to 10-15 mg/day. You can go on the internet and find a bio-identical brand of progesterone to use. If you find that the progesterone is not the answer this time then I would encourage you to go to your primary care physician and ask for a referral to an internist or gynecologist who understands the use of bio-identical hormones and the importance of eugonadal (pronounced U-go-nay-dal) hormone levels to your overall well being. Eugonadal levels are normal levels of all of your gonadal hormones, which includes estradiol, progesterone, testosterone and dhea. Another alternative is to call a doctor’s office and simply ask if the doctor supplements hormones with bio-identical hormones for pre-menopausal women. If the answer is yes than see how it goes. If the appointment doesn’t go well don’t get too disappointed and simply continue on and ask another doctor. There are no training programs to help doctors really understand and replace ovarian hormones up to eugonadal levels. The most important thing is that you do not give up. Keep going to doctors until you find one that is helpful and understands the importance of healthy, eugonadal, ovarian hormones levels at any age. Thanks, Beth
Posted by Beth Rosenshein
Hi Beth, I just read this and was hoping you could give me your advice. I am 32 years old. A few years ago after feeling depressed, short fuse, scatter brained and feeling fatigued all the time I went to my primary physician who diagnosed me w/ adult ADD. After taking the medication prescribed, I just knew that wasn't it. I went to another physician who informed me that she believed I was low on Progesterone. After a workup she was right, actually my progesterone level was 0. Which could have also explained why I had two miscarriages. After taking the prescribed progesterone I felt like I was on the right track, feeling better and just thankful to have a physician that gave me answers. Shortly after taking the progesterone I got pregnant and now have a beautiful 15 month old boy. I was told to quit taking the progesterone while pregnant and haven't taken any since but am now beginning to feel the same way. With all that said, sorry so long, I have since then moved and have seen an OBGYN in my new location who after listening to my story really didn't make it seem of that importance and recommended just prescribing me birth control that contains progesterone in it and after I requested I get blood work done he kind of explained that one blood test wouldn't really give me an accurate level as they fluctuate daily. He made me feel like I was previuosly mislead by my other physician. I feel like my previous doctor was right and took your hormone levels seriously. Is there a way to find a physician who specializes in this?
Posted by cbsmith259
Dear Micah, Perhaps. The maturation process of the egg involves a closely regulated feedback loop between the ovaries and the brain. No matter your age, the tighter this feedback loop, the better the chance that the egg will mature properly so fertilization can occur. As I outlined in my book, you will have to replace your testosterone up to normal youthful levels. You will also want to supplement your other ovarian hormone levels (progesterone and dhea) up to normal youthful levels. The progesterone supplementation would only be for the first two weeks of your cycle. Bringing all of your ovarian hormones up to normal is called replacing to eugonadal (pronounced as U-go-nay-dul) levels. Eugonadal levels will help your ovaries work their best. If you or your endocrinologist are interested in learning more please contact me at 303-665-5215, MST. I wish you the best, Beth
Posted by Beth Rosenshein
Dear Beth, I am 53 and want to have a baby. Yes, we've thought this through! We are seeing an IVF specialist. He said that although I still have regular menstral cycles, and I am in good health; I am experiencing "cell death". Therefore, my eggs are not in good shape, and it is better to use donated eggs. We want to use my eggs. My question: Can I use the processes outlined in your book to help make my eggs healthier/usable eggs? Please help. Micah
Posted by Micah
Dear 53patrice, Thanks for contacting me. It is so unfortunate that you are unable to walk into your doctor’s office and expect him to understand that you have an illness that is treatable. Every doctor learns about the endocrine system yet when it comes to the gonads treatment is usually only extended to men. You are doing all of the right things. You are taking your medication and since you know that it needs to be adjusted you are going back to your doctor to adjust it. It is good that you are on a transdermal form of estradiol. I think that you would feel better on a daily progesterone cream and a daily testosterone cream and a daily dhea pill. Remember that you are taking all of these medications to treat an illness and its name is profound hypogonadism. Go back to your doctor and remind him that you are taking these medications for more than just symptom relief. You are taking them to treat an illness. Gently request a progesterone cream and a testosterone cream. You can purchase dhea from a vitamin store. Here is a suggested regime: .01 Vivelle or Climara patch changed twice weekly or 2-3 mg estradiol cream applied nightly 2-6 mg testosterone cream applied nightly 20-40 mg progesterone cream applied nightly 10-25 mg dhea pill, taken every morning Always start with the lowest dosage and increase every month or two until you feel better. Look for signs of too much. For instance if you are getting weepy or feeling sad reduce your progesterone by 5 mg and see how you feel after about a week. If you find that you are getting a bit jittery reduce your estradiol by ½ mg and see how you feel in a week. If you feel like you are a bit snappy and curt then reduce testosterone by ½ mg and see how you feel in a week. Only adjust one hormone at a time. This can be a lengthy process but it is well worth it. Also, keep in mind that you may not feel as good as when your ovaries were still working. The reason is that these products are only replacing a few of the many gonadal hormones. In time more products will become available but for now this is what’s available. I encourage you to use the medical name for your illness, profound hypogonadism, for two reasons. Giving your illness a name validates your need for treatment, and it also allows your doctor to know that a real illness is being treated. If you go to another doctor be sure to continue using the medical name of your illness. That way your doctor will understand that you are expecting treatment for a real illness. Also consider taking a timed released (TR) melatonin pill before bedtime. I would suggest starting with 1 mg TR, taken nightly, and see how you do. You can increase the dosage to 2 mg TR and again to 3 mg TR as needed. Let me know how it goes, Beth
Posted by Beth Rosenshein
I just found your blog. My dr of more than 20 years was slow to respond to my symptoms...when I reached the age of 45 and hot flashes began, again, I appeared to be a normal, healthy person with regular periods. Basically my sleep issues, fogginess, changing memory issues, now with hot flashes were brushed off. I turned to an endrocronologist, convinced it must be a thyroid problem. The blood tests revealed that there were no detectable amounts of estrogen. My gyn dr was not too thrilled with my report. I did receive a patch climara pro...which helped with daytime hot flashes and lifted a bit of the fogginess. Five years later, the hot flashes increased. I had become aware there were other treatments via HRT...I returned. I was put on Clamara 0.01 mg patch daily for three months. What a difference..but I was jittery and a bit jumpy. Promethium was added (taken 10 days per month) at night. I did not fare well (mood swings, unpredictable tears flowing, anger). I was switched to a daily pill (progesterone). It leveled some thing out...but not enough. By the end of the 4th month, my hair fell out. I was told it had nothing to do with the treatments (others told me it was most likely an inbalance between the progesterone and estradiol ). A dermatologist confirmed I didn't have any scalp issues. My sleep issues continued, but now I am waking up suddenly and can't seem to fall asleep for long. (Ironically, I did notice my body was more relaxed...the muscle tension was gone...but my mind was active..and I now have hotflashes and my scalp started to get sweaty at night). I've gone back three more times, twice told to see it through another month. It's been 7 months, I went back and now have some breast pain, crying jags, hair loss and some other issues. I gave a list of my symptoms. I was told to increase the Clamara (two patches per week). And basically that I had achieved some improvement, so I did have a better quality of life than before. OK, so I am disappointed and a bit angry. I was scheduled to come back in 6 months! I read your comments to a woman, almost the same regime, but with a vivelle patch (same mg), promethriem -- don't know if it was taken daily or for a set number of days... Plus it said to increase the patch to twice a week. I realize my dr. has reached the end of his comfort zone in this treatment. And I realize that even though I have some side affects, the treatment has some positive affects...but I know there has to be some balancing between what I am taking and over time, could find the right combination for me. This is not in my current drs course of treatment. What he offers is what is effective and followed by many. How do I find a doctor who is a bit more versed, comfortble with individualized treatments? The highly publized clinics are expensive and according to some, not all are equally "manned" with medical professionals of the same level of expertise than the ones seen on TV (so I have heard). It's a bit undaunting to find a new dr. while the topic is discussed, there's not a lot of recommendations from people in my community. And most offices won't schedule a consult...but want a totally "new" patient visit ($400+ vs $100/150 for a consult.). When I call, I have learned to ask if the dr. treats with RX and also uses compounding pharmacies (that weeds out some doctors who only use one or two treatment plans). Any suggestions?
Posted by 53patrice
When we think of HRT we expect that what we are given replaces what our body no longer makes and it will make us healthier. It is a reasonable expectation given the success of HRT in the treatment of diabetes, thyroid replacement, growth hormone replacement, etc. Our ovaries help us stay healthy and when they fail our bodies begin to suffer ill health. So our expectation is that if we take HRT for ovarian failure (menopause) we will regain our health. However this is not what happens. So we are left to think that HRT is not good for the treatment of hypogonadism (menopause) in women. But we also know that HRT is extremely beneficial, using insulin replacement for diabetics and thyroid replacement for hypothyroidism, and for the treatment of hypogonadism (equivalent to menopause) in men. Why would HRT not be beneficial for hypogonadism in women? What is called HRT for menopause is not healthy because it is not really HRT. It has been know since 1942 that Premarin is not HRT for ovarian hormones. In fact, there were no hormone tests of any kind done before, during or after the Women’s Health Initiative. Premarin is not replacement nor is it therapy. Premarin contains over 200 different hormones, the vast majority of which are native to the pregnant horse. Premarin creates unnaturally high levels of estrogens and pushes the already very low levels of testosterone and progesterone even lower. Clinical trials are supposed to find healthy regimens for hormone replacement. In every area of medicine this approach has been successful, except for the treatment of hypogonadism (menopause) in women. Extending the success of physiologic, bioidentical replacement for hypogonadism in women would mean that treatment for hypogonadism (menopause) would then be a healthy thing to do. To see that this happens my husband and I have formed Diamond Research Foundation. Our goal is to extend the success of HRT in every other area of medicine to menopause in women.
Posted by Beth Rosenshein
Thank you for this information. I guess it is hard to think of menopause as something that we need to treat. Menapause is something that happens to women at the end of their reproductive cycle. It's hard to make the connection since I don't see diabetes and menopause the same way. Menopause is something that I am expecting to happen to me, I don't expect become a diabetic at any point in my life. But I do expect to grow older and go through menopause. I don't want to. I'm not looking forward it to. Is there any truth that treating menopause will pose a threat to a woman's health? I don't know why I think this but I have heard, that we can be doing more harm than good by treating menopause.
Posted by Charlotte
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