Fake news flourishes everywhere, in politics and in health news. The latest in healthcare “fake” news is really based on misunderstandings, especially of bioidentical hormone therapy, otherwise called BHT. In the October issue of Contemporary OB/GYN magazine, the author suggests two topics of fake news: 1) that implantation of ovaries can delay menopause, and 2) that BHT benefits are just a marketing scam. (more…)
What happens when you go into menopause early? Menopause is that time in a woman’s life when her ovaries stop working and produce no more hormones. Usually this is around 50 years old. However, now studies are showing that if you go through menopause in your late 30’s or early 40’s, you have an increased risk of cardiovascular disease if you don’t supplement your hormone levels. (more…)
Part 1: Breast Cancer and Hormone Therapy
“Five minutes of communication can save your life and years’ worth of pain and suffering.” — Robert True, MD
Seems like everyone’s an expert these days regarding your hormones. From your doctors, your hairdresser, or your fitness instructor, conflicting views just mess-up your mind and contribute to a lot of myths and misunderstandings about hormone therapy. Even doctors in different fields or the same fields can’t seem to agree on what’s best for you. (more…)
Hormone therapy has been shown by many studies to be very beneficial for improving a woman’s and a man’s sexual performance, libido, and satisfaction. In my practice, I have many women who complain, that they have concerns about sex or libido, i.e. a decrease in sexual desire. Many have very low levels of sex hormones. Without hormones, sex goes out the door and is noticeably decreased most of the time. (more…)
There is much confusion about hormone therapy in the media and a lot of this comes from the definitions that have been used and what exactly do these terms mean. BHRT is short for Bioidentical Hormone Replacement Therapy and HRT is short for Hormone Replacement Therapy. Their definitions and the connotations of their meanings vary, so I would like to describe these to clear the air. (more…)
Oestregen (also spelled Estrogen) is a group of compounds, that act as the primary female sex hormone. The name oestrogen is derived from ‘oistros’ meaning the fertility period of female and ‘gonos’ means to generate.Natural oestrogens are steroid hormones. The main function of Oestrogen is to mantain and regulate menstruation cycle and oestrous or reproductive cycle in woman. Oestrogen also helps in other physiological functions like temperature regulations, controlling bone density etc. Oestrogens are synthesized in the theca interna cells present in the ovary and are released by the follicles on the ovaries by the stimulation of Luteinizing hormone (LH), that is secreted from anterior pituitary gland. Oestrogen is secreted by the corpus luteum after the egg has been released from the follicle. Besides ovary some estrogens are also produced in smaller amounts by liver, adrenal glands, and the breasts.
Biosynthesis of oestrogen : As stated above, biosynthesis of oestrogen starts in theca interna cells in the ovary. The first step of oestrogen synthesis is the synthesis of androstenedione from cholesterol. Androstenedione is the precursor of testosterone and estrogen. While crossing the basal membrane into the surrounding granulosa cells, androstenedione either immediately convert into estrone (catalyzed by the enzyme aromatase), or into testosterone and then estradiol. Androstenedione is converted to testosterone in presence of the enzyme 17β-hydroxysteroid dehydrogenase, testosterone then further converted into estradiol in presence of aromatase.
Types of oestrogen : There are three natural oestrogens namely estrone (E1), estradiol (E2), and estriol (E3).
Oestrone : Oestrone is the least abundant oestrogen and it is predominant during menopause. The molecular formula of estrone is C18H22O2 and the structural formula is
Oestradiol : Oestradiol is the predominant estrogen during reproductive years i.e. non-pregnant females who are between the menarche and menopause and it is strongest among the three oestrogens. Oestradiol is about 80 times as potent as estriol and 10 times as potent as estrone. The molecular formula of Oestradiol is C18H24O2 and the structural formula is
Oestriol : Oestriol remain predominant during pregnancy. The molecular formula of oestriol is C18H24O3 and the structural formula is
Another kind of oestrogen called Estetrol (E4) found in maternal serum at around 20 week of pregnancy.
There are some non steroidal compounds that also possess estrogenic activity. These are xenoestrogens (artificial oestrogen ), phytoestrogens (produced by plants ), mycoestrogens (produced by fungi).
Functions of oestrogen : Oestrogen enters all cells but the response of oestrogen depends on the presence of oestrogen receptor (dimeric nuclear protein ) in the particular cell. Generally ER is expressed in female sex organs like ovary, uterus and breasts. Oestrogen enters passively in the target cells and bind with the estrogen receptor and then activate the transcription of target genes.
The primary functions of oestrogen are development of female secondary sex characteristics (development of breasts, growth of underarm and pubic hair, widening of hips and distribution of fats around buttocks and thigh) maintaining menstruation cycle and oestrous cycle (thickening of the endometrium, thickening of the vaginal wall, increased uterine growth and increased vaginal lubrication). Oestrogen with Progesteron prepare uterus for pregnancy and the development of the foetus. Hike in oestrogen level induce the release of Lutenising hormone, that triggers the release of ovum from Graafian follicle in the ovary.
Other functions of oestrogen include as follows:
- Increase or preservation of bone formation
- Increase vaginal lubrication and estrogenization of vaginal mucosa
- Increase adhesiveness of the platelates
- Increase in the level of High Density lipoproteins and triglyceride and decrease Low Density Lipoproteins
- Reduce bowel movement
- Increase of cholesterol in bile
- Maintaining maintain healthy libido
- Stimulating collagen in the skin
It is found that oestrogen plays an important role in mental health of women. Withdrawal of oestrogen or fluctuation in oestrogen level or menopause (decrease in oestrogen level) may cause depression, mood swing and anxiety.
Medical Application of oestrogen :
Contraceptives : Synthetic oestrogen with synthetic progestin used as oral contraceptives. These hormones togather gave negetive feedback to supress the release of luteinizing hormone and follicle stimulating hormone, the gonadotrophins that are necessary for ovulation thus preventing pregnancy. Moreover progestin inhibits the penetration of sperm through the cervix into uterus and fallopian tubes.
Hormone Replacement Therapy : The production of oestrogen drop significantly after menopause or hysterectomy. Due to the decreased level of oestrogen many women suffers from various physical and mental problems like hot flushes, night sweat, vaginal dryness, mood swing, depression etc. To mange this problem oestrogen is given externally to restore normal level of the said hormone. Oestrogen may given as tablets, skin patches or gels.
Menopause literally means the end of monthly menstruation cycle. More accurately menopause is the cessation of the primary function of the ovaries, i.e. when women no longer ovulate, signaling the end of the fertile phase in women’s life cycle. Menopause usually begins around the age range of 42–58. The transition from reproductive to non-reproductive phase occur due to the reduction in the production of female hormones (estrogen, testosterone and progesterone ) by the ovaries. In many women this transition may be accompanied with various mental and physical signs and symptoms (menopausal syndromes), that in some cases may disrupt their daily activities and sense of well-being.
Menopausal Syndrome : The cause of menopausal syndrome is the body’s response to falling natural hormonal levels. Some common menopausal syndromes are given below :
- Vaginal atrophy or Atrophic vaginitis : The cause of vaginal atrophy is the decrease in the level of estrogen. The common symptoms are due to thinning and shrinking of vaginal tissue, inflammation and itching in vagina and outer urinary tract, overall dryness and decreased lubrication of the said area. This can cause abnormal vaginal discharge, pain with intercourse, dry vagina, itching, irritation, urinary incontinence, increased susceptibility to infection like vaginal candidiasis and urinary tract infections.
- Hot flashes : Another most common symptoms are hot flashes. The symptoms of hot flashes are feeling of intense heat with sweating and rapid heartbeat. The condition aggravated during hot weather or in an overheated room. The main cause of hot flash is lower level of oestrogen. Hot flashes may also happen due to a change in the temperature controlling process, that regulated by hypothalamus.
- Night sweats : Excessive sweating in night or during sleep.
- Decreased cognition; foggy thinking
- Fatigue; lack of motivation
- Decreased libido, or sexual drive/desire
- Decreased ability for orgasm
- Migraine or headaches
- Back pains, joint pains, muscle pains
- Breast tenderness and swelling
- Overall thinning of the skin with drier less elastic skin
- Skin itching, burning or prickling sensations
- Psychological problems like anxiety, depression, mood swing and memory loss.
- Insomnia or sleepiness
- Painful intercourse
Some medical problems that can occur due to lack of these hormones include:
- Atherosclerosis or gradual thickening of arterial wall due to the deposition of cholesterol and triglycerides.
- Osteopenia and increased risk of osteoporosis
- Increased risk of developing Alzheimer’s disease and dementia
- Arthritis and degenerative joint disease.
- Decreased risk of colon cancer
Hormone replacement therapy : The most effective treatment of menopausal syndrome is hormone replacement therapy (HRT). HRT can improve the quality of life in the women suffering from menopausal syndrome.The aim of HRT is to reduce the discomfort associates with menopause due the diminished circulation of estrogen and progesterone hormones. Generally estrogen, and progesterone are given but testosterone may be added for further enhanced therapy.
Estrogen is the most important female sex hormone. During premenopause, estrogen is responsible for improving the lining of the uterus for receiving a fertilized ovum. If no conception occurs, menstruation occurs and the cycle repeats itself. Some other functions are controlling bone density, skin temperature and keeping the vagina moist. The decrease in estrogen levels with menopause causes hot flashes, vaginal dryness, osteopenis or osteoporosis and decreased libido.
Progestorone is also a female sex hormone, that helps to prepare the uterus for pregnancy and supports the pregnancy. It also helps to protect the endometrium or lining of the uterus when estrogen is given potsmenopausally and thus decreases the risk of developing endometrial cancer. Progesterone may not be given if the woman had a hysterectomy, i.e. surgical removal of the uterus.
Progestin is a synthetic progestogen (a groups of steroid hormones similar to progestorone). The two main functions of progestin are hormonal contraception (birth control methods that act on the endocrine system) and to prevent the excessive proliferation of the cells of the endometrium or endometrial hyperplasia, that caused due to the high level of oestrogen. It is given to oppose the excess estrogen in HRT.
Testosterone is a vital hormone that is sometimes forgotten for women. When women are young, they have quite high levels of testosterone. As they get older, the levels drop every year, and are almost none existant in menopause. However, this drop can be associated with fatigue, decreased libido (sexual drive), decreased motivation, depression, lack of muscle tone, and foggy thinking. Replacing testosterone to levels of a young woman can reverse these problems and improve women’s quality of life.
BioIdentical Hormone Therapy (BHT)
The concept of BioIdentical Hormone Therapy is to use hormones that are structurally the same as those hormones of young women, and in doses to provide the similar hormonal levels as young women. Also called “natural” hormone therapy, this is the best method to provide adequate postmenopausal hormone therapy since it has a multitude of the same benefits of HRT as noted above, but at the same time does not have the potential side effects of synthetic hormone therapy. Thus, there is no increased risk of breast cancer nor stroke as one gets older, making its use safer for women.
Generally there are four ways for taking HRT.
- Topical application as a cream or gel : Applied topically to the skin or vagina.
- Tablet : Taken orally (estrogen or progesterone).
- Implant : Small pellets of estrogen and testosterone are inserted under the skin of the tummy, flanks, buttock or thigh.
- Patch : A adhesive patch placed on the skin to give estrogen transdermally (through the skin to the blood stream).
Lack of lubrication is the most common problem during menopause. Application of vaginal gel may help to reduce the problem.
Antidepressants like as paroxetine, Fluoxetine hydrochloride and Venlafaxine hydrochloride may some time use to treat the hot flashes, depression and mood swing associated with menopause.
Gabapentin is also effective for the treatment of hot flashes.
Selective estrogen receptor modulators, also called SERMs, are a category of drugs used to reduce the some menopausal syndromes. However, they may increase other symptoms, such as hot flashes and night sweats. These drugs are either synthetically produced or derived botanically or from plant sources. Generally raloxifene and tamoxifen are prescribed.
Some studies suggests that phytoestrogen or the plant-derived xenoestrogens are useful for the treatment of menopausal syndromes but it is not yet proven.
Lifestyle measures such as drinking cold liquids, avoiding hot and crowded room, using fans, staying in cool rooms, wearing light and cotton clothing may help in managing hot flashes.
Cessation of smoking, regular intake of vitamin D and calcium help to lower the risk of developing osteoporosis after menopause.
It is important to remain well informed about menopause and menopausal syndromes and the effects lack of hormones have on the body. One should seek proper treatment and therapies to improve not only their health but their quality of life as they get older.
This month, Dr. Robert True held a seminar on nutritional aids and supplements to improve your health and potentially to increase your lifespan. Everyone wants to know, “What type of vitamins and supplements should I take?” Well, here’s a good start.
You should indeed practice “Anti-Aging” actions. These are actions you can do today to decrease the risk of developing degenerative processes within your body. Medical conditions such as heart disease, diabetes, cancer, arthritis, and many others can decrease your quality of life and shorten your lifespan. If there are simple solutions to preventing these, why not embrace them.
The leading causes of death were discussed, and these include heart disease, cancer, and a number of other processes. Most of all of these medical problems have inflammatory components to them. The biggest killer in the cancer group is lung cancer.
Smoking cessation is a top priority. It can reduce your risk of developing not only lung cancer, but also cancer of the colon, pancreas, and bladder. Heart disease is also decreased. This is a simple and sometimes easy fix, to improve your health. There are many options to quit smoking, but the ultimate decision must be in your mind.
Getting rid of extra weight, especially if you’re obese, is the next step. Obesity is now considered the leading cause of cancer, outnumbering those caused by smoking. It can increase your risk of cancers of the breast, prostate, colon, pancreas, ovary, uterus, liver, and bladder. It also increases your risk of developing heart disease, diabetes, and arthritic conditions. Weight loss to a normal weight is essential to become healthier.
Maintaining a good balance of hormones is also important for preventive health plus it can improve your quality of life. Hormone therapy and Weight loss concepts have been discussed in prior seminars and can be viewed on the web. Go to the links to learn about these concepts further.
There are several concepts of aging that enable us to utilize nutritional aids for better health, as was discussed during the nutritional aids seminar. Antioxidants, anti-inflammatory products, telomerase activators, and simply supplements with impressive preventive statistics have all been shown to improve your health. This improvement may be from decreases in cancers, heart disease, diabetes, Alzheimer’s disease, and many others.
There are laboratory tests available to you that can help you see if you are deficient in many of these compounds. You may want to get evaluated so that you know in what components your body is deficient. Taking supplements is essential since our American diet and food sources have become less healthy and less nutritious over time.
The latest concept of aging is telomere shortening. The telomere is the end part of each chromosome (DNA). Every time almost every cell in your body reproduces itself, its telomere shortens. After many replications, the telomere is so short it doesn’t work anymore and the cell dies. It has “aged” to its max. Science has discovered many ways to help prevent this shortening from occurring.
Longer telomeres have been associated with longevity and better health. Coincidentally, boosting your antioxidant level, improving your immunity, and taking new telomerase compounds, all prevent the shortening of your telomeres. If you want to live a healthier, happier, and longer life, you should consider supplementing your diet with these. Click here or the photo above to see the first part of this seminar.
A basic recommendation for supplements is to take high dose Omega 3 FFAs, Vitamin C, Vitamin D, Gamma Vitamin E, Calcium, DHEA, Melatonin, Cercumin, Resveratrol, Coenzyme Q-10, and TA65. Each nutritional aid is discussed in the seminar and this discussion can be viewed on the web, just click here or click on the Part 2 photo above.
We all want to live longer but with quality of life. Embracing anti-aging concepts helps us to maximize our health while improving our lifespan. If you are interested in further information regarding these concepts, make an appointment to see Dr. True at 817-399-8786.
At one time, in the 1990s, Hormone Replacement Therapy (HRT) was a standard treatment prescribed for women’s severe menopausal symptoms of hot flashes, night sweats, headaches, incontinence and others. The treatment improved quality of life of the women over several years between the pre-menopause and post-menopause phases.
But ten years ago in 2002, the first Women’s Health initiative (WHI) Report of the National Institute of Health came up with the finding that HRT might increase the incidence of breast cancer, heart disease and stroke among the patients and this led to a dramatic decline in HRT users.
But now things have changed. The conclusions of the WHI study were first questioned when the women under the WHI study were found to be well past their menopause, obese and smokers, thereby already at risk of heart disease and stroke. Dr. Robert L True, an Anti-Aging Specialist from Colleyville, TX, has confirmed, ” The bad press produced by the WHI has caused more harm than good for the risks are actually very low, while the benefits very high.”
Several years after the WHI, the findings of the WHI were re-evaluated and it was found that the risks of HRT had been overstated particularly with respect to its cancer causing potential. Moreover, HRT could have benefits depending on the time of onset of menopause, health condition and the family history of the patients. However, there is a need for assessment of health condition plus the family history of the patients before HRT is recommended.
It is also now seen that earlier formulations were less safe in their dosage, mix of hormones and delivery method that is, through pills which go to the liver and may cause clots.
Way forward for HRT:
All these and a wider variety of hormone treatments available now make HRT dependent on close consultation between the patient and the doctor.
For most American women menopause symptoms start around the age 50 and there could be degradations in quality of life for a period ranging from two to twelve years. HRT can give relief to these women if their health conditions and other details permit.
In HRT, dosages depend on the individual conditions and It is important that the women seeking HRT not only consult with their doctors but also educate themselves to the extent possible about HRT.
Dr. Marina Johnson, a Dallas endocrinologist and pharmacist and author of Outliving Your Ovaries: An Endocrinologist Weighs the Risks and Rewards of Treating Menopause Â With Hormone Replacement Therapy says “Some women need higher doses, some need lower doses. Once a woman is educated, then she knows what to go in and ask for. If a doctor won’t work with you, then find another doctor,”
According to Dr. Noushin A. Firouzbakht, an obstetrician-gynecologist at Texas Health Harris Methodist Hospital Fort Worth, despite the alarm caused by the Women’s Health Initiative study, much was learned, especially about the ideal candidate for hormone replacement.
Dr. True encourages women to embrace the benefits of HRT, “Women live well into their 80’s to 90’s now, why not live with a better quality of life using hormones.”
These opinions again underscore the need for self education and consultation with doctor by a potential HRT patient to determine if she is indeed an ideal or near ideal patient. This assessment is important as HRT is known to have risks for an individual who is not a good candidate.
Information for Potential HRT Patients:
Dr Firuzbakht says “We also learned that we see fewer strokes and heart attacks from non-oral methods like a patch or a cream.” The rule of thumb traditionally was that one should use it in the lowest dose for the shortest amount of time. Now, with this new data about transdermal estrogen, no longer do you need to stay away from hormone replacement therapy, but you do need to use it wisely.
This points to regular health appraisal including monitoring blood pressure, blood analyses, breast changes, side effects and finally if one is still a good HRT candidate. Women with breast cancer or at higher risk of the disease cannot take HRT.
On the other hand, despite the close surveillance that the HRT patients may suffer, there are certain positives, including getting a better quality of life post-menopausally, and other preventative actions that suitable patients gain from HRT. These are protections that HRT has been proven toÂ provide against heart disease, dementia, colon cancer and osteoporosis.
Bio-identical hormone therapy (BHT), which uses identical hormones to those that naturally occur in the body during youth, may be different than those hormones commonly prescribed. BHT is getting a lot of attention due to the benefits they provide, but this also leads to added confusion about HRT. But the HRT patients should learn about such hormones too.
Dr. True prefers to use BHT because of the improved benefits they provide for women, including a potentially better quality of life. “When women have hormones of a youthful woman, this gives them a fighting chance to feel that youthful vitality, enthusiasm, sexual libido and zest like one sees in young women.”
Dr. Johnson says that she has no objection to use plant based (BHT) or equine based hormones provided these are “quality-controlled, safety-tested formulations that are made by pharmaceutical companies and approved by the Food and Drug Administration.”
But both Dr Firouzbakht and Dr. True prescribe only pharmaceutical hormones through pharmacies that develop bio-identical hormone combinations for some patients. Such custom compounds are not FDA approved. Dr. True also uses custom hormone therapies, titrated to each woman’s metabolism. He prefers to use hormone pellet therapy because he finds that these provide the best results.
They both agree that “It doesn’t matter what formulation of the hormones you are using, it’s the surveillance of it all that is very important. We need to know about side effects, unwanted adverse effects; those risk factors don’t go away with bio-identical hormones. When you have a good relationship with your gynaecologist, you will get what you need.”
So, what do all these finally mean to women facing or going through menopause?
It is that they should surely, if the symptoms are severe, investigate by self education and consultations with their doctors, if they are fit to take up HRT. After all HRT can give significant relief to some women while it may be risky for some others.
Â [Source: This write up is sourced from the articleÂ Hormone replacement therapy regains popularityÂ By DAPHNE HOWLANDÂ The Dallas Morning News Published: 02 April 2012]
Hormone Replacement Therapy (HRT) is prescribed for women suffering from severe menopausal symptoms.
Ten years ago, the first Women’s Health Initiative (WHI) report gave rise to a widespread belief that HRT might increase the incidences of breast cancer, heart disease and stroke among the patients and led to a dramatic fall in the number of women opting for the therapy.
Now the findings of the WHI study and HRT”˜s risks and benefits have been re-appraised by some of the leading experts in the field including the clinicians who worked in the original WHI study.
The re-appraisal shows that the risks of HRT had been over-emphasized particularly with respect to a relatively small increase in incidence of cancer among women taking HRT and that HRT can have risks or benefits depending on the time of on-set of menopause, health condition and family history of the patients. In addition, all hormones were placed in the HRT group, and there is a difference between bioidendical hormone therapy and the use of synthetic hormones.
Dr Robert Langer who was the Principal Investigator of the WHI Clinical Center at the University of California in the US now says “Information that has emerged over the last decade, shows that for most women starting treatment near the menopause, the benefits [of HRT] outweigh the risks, not just for relief of hot [flushes], night sweats and vaginal dryness, but also for reducing the risks of heart disease and fractures.”
Dr Langer points out the risk of extrapolation of data and findings for a certain patient group to a larger group when he says “initial results from women who were, on average 12 years past menopause to all post menopausal women has led to the needless suffering and lost opportunities for many.”
He also adds “Sadly, one of the lessons from the WHI is that starting HT [hormone therapy] 10 years or more after menopause may not be a good idea, so the women who were scared away by the WHI over this past decade may have lost the opportunity to obtain the potential benefits.”
Professor JoAnn Manson (Harvard Medical School and Brigham and Women’s Hospital, Boston, MA), who has been one of the WHI Principal Investigators since the study started, said: “An important contribution of the WHI was to clarify that, for older women at high risk of cardiovascular disease, the risks of HT far outweighed the benefits.
This halted the increasingly common clinical practice of prescribing HT to women who were far from the onset of menopause. Unfortunately, these findings were extrapolated to newly menopausal and healthy women who actually had a favourable benefit: risk ratio with HT.
The WHI results point the way towards treating each woman as an individual. There is no doubt that HT is not appropriate for every woman, but it may be appropriate for many women, and each individual woman needs to talk this over with her clinician.”
Breast cancer incidence among women taking HRT was the major issue in the original WHI study. The experts accept that there was increase in breast cancer incidence (when synthetic hormones were used), but say that the increase was small and should not obscure the benefits that HRT can bring to patients with significant menopausal symptoms and low cancer risks.
As per researcher Professor Mathew Allison, the WHI trial results showing the risk of breast cancer from HRT is surpassed by the risk of the disease one has by being obese, not exercising and excess alcohol consumption.
Eluned Hughes, Public Health and Information Manager at Breakthrough Breast Cancer says that there is confusion and differing opinion on the extent of increased risk of breast cancer due to HRT and that women should have access to accurate and adequate information allowing them to make an informed decision on taking the treatment.
But she adds that women taking the HRT “should be closely monitored and reviewed at least once a year.”
Using bioidentical hormones does not increase the risk of breast cancer. Thus, women do not have to worry about this; the risk is the same as if no hormones were used.Â Since the benefits are very high, why not embrace the beneficial potentials of hormone therapy. To learn more, go to Hormone Vitality Plus.
[Source: This write up is sourced from the article “HRT and Breast Cancer Risk Re-assessed”Â by Nicky BroydÂ datedÂ May 22, 2012 WebMD UK Health News]