Choices for menopause

Rather than blog about melatonin I decided to write about respecting a woman's choice to not choose hormonal treatment for hypogonadism. This is fundamental. Like any illness, as long as a person is informed about having an illness, in this case hypogonadism, the choice to forgo a particular treatment option needs to be respected.

I know I can go on a on about hormonal treatment for hypogonadism and most of the time that is why a person will contact me. However, sometimes a person who wants to feel better using a non-hormonal approach will contact me. I completely respect this choice and try to be as helpful as possible.

Often the choice to forgo hormonal treatment is at the urging of a healthcare provider or due to a previous health issue. Regardless of the reason, if a person, woman or man, feels that hormonal treatment is not an option then other avenues, some of which I've listed below, should be pursued to try and stall some of the ill health of hypogonadism.

One of the illness's which most of us worry about is osteoporosis. This is a terrible disease. My mother has told me of women who became housebound and lost their jobs and sadly, within a few years, their lives after breaking a hip. Fortunately you can help keep your bones stronger by using a new class of medications called biphosphates. These include Fosamax, Boniva, and Actonel. Weight bearing exercise combined with taking Vitamin D can also help slow or stall bone loss.

Sleep is a real issue for many, many women. There are sleep aids such as Ambien and Sonata. Some people do use them for long periods of time but there can be problems like re-bound insomnia if you stop taking them. These medications were not developed for long term use and shouldn't be used for an extended period of time. Believe it or not many women have told me that they use Benadryl to sleep. There is another medication called Rozerem that will stimulate melatonin receptors in the brain. Is it a hormone? It stimulates a hormone receptor so it acts like a hormone. Based on what I have read I can't really say but I will find out.

Unfortunately, sexual response really can't be treated non-hormonally yet. There are medications that are currently being tested, but none are available yet. Until those medications are available a woman can and should use a vaginal lubricant for intercourse because her vagina has gotten smaller and has lost much of its elasticity.

There are other medications that can be used and I'll talk about them in future blogs.
5/29/2008 10:19:00 PM
Beth Rosenshein
Written by Beth Rosenshein
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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Dear tfw617, Try this approach. First of all think of the ovaries as an organ that mostly makes four basic ingredients Progesterone Testosterone Estradiol Dhea Replacing each to an adult level will help you minimize fibroids, extended bleeding, and acne. A good starting place is to start with the 1:10:100 rule: Try to make testosterone approximately 10 times higher than estradiol Try to make progesterone approximately 100 times higher than estradiol Here's how to do it using compounded creams because they are more effective than any other products. Progesterone 20-30 mg/daily at bedtime for two weeks and 30-40 mg/daily at bedtime for two weeks. You can replace progesterone cream with Prometrium 100 mg for two weeks a month and 200 mg for two weeks a month. You want your progesterone to get to about 2-5,000 pg/ml. Eventually, your periods will become very light, very short, or may stop completely. Remember that Prometrium contains peanut oil. Testosterone 1-2 mg/day. You can get testosterone in a patch called Intrinsa made specifically for women. It's a great product but not yet approved in the United States. You can find it on the web. Otherwise, compounded is your only option. Having normal levels of testosterone can reduce or completely reverse fibroids and is very important in lowering the risk of breast cancer. Try to get testosterone levels to about 400-600 pg/ml. Estradiol 1-2 mg/day. You can get estradiol in a patch, but only use the 0.1 mg dose so you don't under dose. Vivelle makes a good 0.1 mg estradiol patch. Any other dose and you'll get too little. You can always use compounded estradiol. Try to get estradiol levels to about 50-125 pg/ml. Remember to test all hormone levels approximately 12 hours from your last dose. If you take all of your creams before bedtime at 10 pm then get your levels checked at about 10 am the next morning. Recheck hormone levels every 2-4 weeks until you feel good and are where you want to be. Dhea 10 mg/day if your ovaries have not run out of eggs, 20 mg/day if they have. You can get dhea at a vitamin store. Try to get your levels between 300-500 ng/dl. Now look at the levels so you see the 1:10:100 rule Testosterone level of 500 pg/ml is 10 times higher than an estradiol level of 50 pg/ml Progesterone level of 5000 pg/ml is 100 times higher than an estradiol level of 50 pg/ml There you go. The reason behind replacing your ovarian hormones is that your ovaries have run out of eggs and can no longer produce these hormones themselves. It's not that your body doesn't need them anymore it just that the ovaries cannot produce them anymore and it is up to you to give your body what it needs to stay healthy. By replacing these hormones you will be lowering your risk of breast cancer, avoiding osteoporosis completely by maintaining strong bones, and allowing yourself to engage in meaningful sexual activity. In short, you are effectively treating profound hypogonadism. Take this information to your doctor and discuss it. Let me know how it goes. Thanks, Beth
Posted by Beth Rosenshein
Hi Beth, I have so many questions about HRT. I have been on HRT for several years now and can not seem to get to the right combinations or right levels. I am 44 years old, have Polycystic Ovarian Disease, Endometriosis, peri-menopause, Fibroids, and irregular menses. I know all these can go hand in hand. I have tried oral hormones, patches, and pellets. With all this I just can not seem to get the right mix. The pellets were very convenient, but I seemed to get too much Testosterone. My testosterone levels were always nil along with my progesterone levels. I had acne like a 16 year old and an over-the-top sex drive. I do not produce progesterone, so I know these are something I really need. But at times the progesterone causes severe menses lasting 1-2 weeks. My Estrogen level was usually pretty good. Now I am on a BCP for the estrogen and supposed to be taking Progesterone 100mg daily. My doctor is urging me to have a Hysterectomy so we can more control the irregular, heavy menses and we can "play more" with the hormones. I am MISERABLE. Every symptom of menopause imaginable, I have! I want to try something else. I have thout about using BHRT in cream form. Can you help me?
Posted by tfw617
Ambien CR is the extended release version of Ambien. The reason the extended release was developed was because Ambien is designed to help a person fall asleep not necessarily stay asleep all night. Some people will wake up 3-4 hours after taking their pill so this version was developed so they could fall asleep and stay asleep longer. Both Ambien and Ambien CR were designed to be taken for a short period of time, a week or less for occasional insomnia. Using Ambien CR for longer than a few weeks can build a person’s tolerance for the medication which means they will need more of it to work. Also, dependency can occur after a few weeks, and there is a greater chance of that if a person has a history of other kinds of addictions like alcohol or other medications. If your mom stops taking Ambien CR she may experience something called rebound insomnia, which means the first night she doesn’t use it she may not be able to fall asleep very easily or for many hours. This medication is really only designed for occasional use. An alternative for your mom could be melatonin. There is no risk of addiction because she would be adding back what her body is no longer making and it is not foreign to her body like other medications. Melatonin can be effective in helping to fall asleep and if she awakens again during the night, another small dose can help her fall asleep again. One of the most common mistakes with taking melatonin is that more is better. Taking too much can cause a very bad headache which can be treated with Advil or Aleve. A good starting dosage of melatonin is 0.2 to 1 mg just before bed. Melatonin is available in 1 mg tablets and liquid droppers. If you buy the liquid start with 4 drops under the tongue and see how that works. Insomnia due to hypogonadism (peri or complete menopause) can be effectively treated with gonadal hormone replacement. Gonadal replacement is replacing the ovarian hormones that the body is no longer producing. Here is a link to my website for more information: <url removed> Here is a link to a website that lists more of the side-effects: <url removed> Please feel free to ask any more questions. Beth
Posted by Beth Rosenshein
Hi Kathy, It is good to hear from you. I’m glad that you enjoyed my talk. Unfortunately, I can’t refer you to someone in the Seattle area who is accepting new patients right now. Those who are willing to replace gonadal hormones appropriately eventually close their practices to new patients because they become so busy. As more women go into their doctors and help them recognize that treating hypogonadism in women is as important as treating it in men, this will change. Here is the approach I would take. Make it clear to your doctor that you want treatment for hypogonadism. Every doctor has learned about hypogonadism in men and fully understands the importance of treatment. Bring the list of what you will need by going to my non-profit website at <url removed> and printing out suggested dosages of the gonadal hormones, estradiol, testosterone, progesterone, and dhea. If your doctor doesn’t see that your hypogonadism should be treated then you will have to move on. It’s not easy, I know. After we moved to Boulder, CO last year I went to 3 doctors before I found one that was on the same page as me. The first doctor made fun of me and said it was nice that I had a hobby by using big words like hypogonadism, the second doctor read me the riot act then added I was doing the right thing and wished more women would, and the third said that she didn’t know women could have hypogonadism and while it was probably true what I was saying she didn’t have the patience to work with me. By the time I got to my current doctor I was weary but still determined. When I told him I wanted treatment for hypogonadism, which most people refer to as peri-menopause or menopause he smiled at me and said, ‘ok, what do you need?”. As it turns out he was unfamiliar with what I needed but was quite willing to work with me. I explained to him that hypogonadism is the same illness in women as it is in men. It was clear that he was beginning to understand and ever since he has been very supportive. There are lots of smart doctors out there. It just may take a while to find one that is willing to treat this terrible ailment in women. The onset of your breast pain coincides with the time at which your levels of testosterone and progesterone begin to fall, which starts about age 30. As you grow older your levels continue to fall, leaving you with more and more of a deficit of testosterone and progesterone. The gonads produce a specific ratio of hormones and as you get older this ratio becomes more and more unhealthy. Some people call a normal estrogen level with very low levels of progesterone and testosterone estrogen dominance. Supplementing your testosterone and progesterone to normal levels will help restore your ratio of gonadal hormones back to normal and may help alleviate your breast pain. Please let me know how you are doing. You can always reach me at: Thanks, Beth
Posted by Beth Rosenshein
Hi Beth, I first heard you speak at Whole Foods in Bellevue a couple of years ago. That really opened my eyes to a whole new way of thinking about this topic. At 46, I'm going through some changes, including minor hot flashes, foggy thinking/memory, weight gain, etc. I live in Kirkland, but I don't feel confident in my current medical practice to treat this hypogonadism, and I'm curious if you have specific recommendations for people in this area that I could seek out for assistance. In addition, I have suffered from excruciating breast pain for years (it feels like I'm always 4 days away from the commencement of my period), yet my breasts are consistnetly sore and painful to the touch 24x7. I sleep with my bra on. It's awful, yet no doctor I've seen can assist me with this. My thyroid doctor suggested Thyroxizine (the breast cancer medication)(?) I was appaled at that, as I really don't want to have to take anything like that and truly believe it's a hormonal condition. Have you ever heard of something like this, and if so, could it be related to the hypogonadism? I've suffered from breast pain since my early 30s, but it has increased in severity and duration over the years. Any help would be greatly appreciated! Thanks for forming your organization! Hopefully, Oprah will wake up one day to the facts you so clearly highlight. Take care, Kathy in Kirkland
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