Lifestyle Change and Hormone Therapy: Two Important Pieces of Your Menopause Treatment Plan
Your body is an amazing machine. When things are not right, your body will give you subtle messages that it might need your attention. Messages such as feeling a little run down, minor aches and pains, increased gas and bloating and mood and sleep disturbances. If you fail to listen to these messages, they will continue to get louder until you are eventually forced to listen.
The way to hormone balance is different for every woman. Nothing clarifies this more than the findings of the Women’s Health Initiative: You cannot put all women on the same dose of the same medicine and expect everyone to feel well. The one- size-fits-all synthetic hormone therapy of the 1990s proved to be both ineffective and unsafe.
Diet and Exercise
Typically, when talking with women about hormone balance, it’s about a continuum of options. The continuum starts with doing nothing, which is always an option. Hormone imbalance for some women is tolerable. Whether tolerable or not, nutrition and exercise should always be discussed at length. Eating lots of vegetables, limiting simple carbohydrates like bread, cereal, and pasta, and getting adequate protein, either from organic animal or plant sources, promotes hormone balance.
Managing Stress
Managing stress in healthy ways, i.e. without alcohol and drugs and other addictive substances and behaviors, has a direct effect on hormone balance. Ovaries are the primary production site of hormones. The adrenals, small glands right above the kidneys, primarily make cortisol and other stress hormones. However, the adrenals secondary job is to make sex hormones. Therefore, women who have had complete hysterectomies and postmenopausal women still have some hormone production. If our adrenals are burdened by stress and are consumed with full-on, 24/7 stress hormone production, they can’t efficiently make the sex hormones. When the adrenals aren’t focused on making stress hormones, they can efficiently make the sex hormones and thereby minimize the symptoms of hormonal imbalance. So, take a walk, pray, meditate, see a friend, have a nap. Your adrenals will thank you and you will help your hormones balance.
Alternative Modalities
Once nutrition, exercise, and healthy stress management strategies have been addressed, there are a variety of other modalities that offer women relief from symptoms of hormone imbalance. Among the options are acupuncture and Chinese herbs. There are also many botanical remedies and supplements for hormone balance. Some remedies and supplements are supported by clinical data. Nutrients that have clinical data supporting their efficacy in balancing hormones include indol-3-carbinol, omega-3-fatty acids, resveratrol, and probiotics.
Pharmaceutical Intervention
If the latter interventions miss the mark and a woman is still struggling with her quality-of-life, then oral contraceptive pills or bio-identical hormone therapy (BHT) are an option. Research supports the safety of bio-identical hormone therapy that is given through the skin, for the shortest duration of time necessary, and at the lowest therapeutic dose.
Individualized Hormone Therapy
Hormone therapy should not be approached with a “one size fits all” mentality. Pharmaceutical compounding* with bio-identical hormones is a great way to break free from traditional hormone therapy and tailor medication to your specific needs. Dosage form, strength, allergies, and even flavor preferences can be adjusted to provide you the best medication experience possible. Compounding allows for greater control of delivery to specific target areas and the rate your body receives therapy. It also provides alternatives to less irritating options through hypoallergenic bases and dye-free formulations.
Choosing an appropriate dosage form is as important as choosing the correct hormone. As previously stated, topical BHT has been shown as the safest method of delivery. Creams, ointments, and gels are all common forms of topical delivery. Topical application minimizes negative systemic effects of oral medication and reduces the likelihood of adverse skin reactions through the options of hypoallergenic or natural bases.
One example of the effectiveness of targeted BHT is the use of vaginal creams and suppositories for vaginal atrophy. By introducing hormone therapy directly to the problem areas, you apply medication where it is required and avoid distribution of hormones to areas where it is not needed. Research has advocated for the use of local estrogen therapy, with reported improvement of symptoms such as vaginal dryness, pain, and overall quality of life.
When the overall levels of systemic hormones need to be improved, we typically turn to oral formulations. Capsules allow for greater control and release for hormone therapy though various ingredients. Liquid solutions and suspensions also provide alternative routes for patients who cannot swallow comfortably. Oral dissolving tablets and lozenges allow our body to absorb hormones, while avoiding partial destruction through the inhospitably acidic environment of our stomach and metabolism from the liver.
In a study published in the International Journal of Pharmaceutical Compounding, women using compounded BHT reported significant improvement of post-menopausal symptoms when compared to synthetic equine hormone therapy. These women on BHT also reported a lower incidence of adverse side effects, such as weight gain, difficulty sleeping, and bloating.
Compounding also allows for creating combination hormone therapy. Combining various hormone treatments into a single medication can provide a multitude of benefits. Advantages of combination therapy include reduction in waiting time and money spent.
Education is Key to a Successful Treatment Plan
Hormone levels decline as we age. This is the natural order of things. Some women cannot, or do not want to, accept that. Working with a licensed practitioner and pharmacist who deal with each woman’s biochemical individuality is key to achieving successful hormone balance. With education, guidance, and comprehensive health care, women can achieve the hormone balance they desire in a way that feels good to them.
*Pharmaceutical compounding is the process of creating personalized formulations for individual patients.
Carrie Levine, CNM, MSN specializes in women’s health, hormone therapy, and Function Medicine. Her practice is Whole Woman Health in Portland and Newcastle. Find her at: www.wholewomanhealthcare.com.
Dylan Lim holds a Bachelor of Science Degree in Chemistry from Rochester Institute of Technology and is in his 3rd year as pharmacy intern at Coastal Pharmacy & Wellness in Portland. He is currently a PharmD candidate at University of New England, expecting to graduate in 2018. Learn more about Coastal Pharmacy & Wellness at:
www.coastalpharmacyandwellness.com.
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