Seasons Wellness Clinic » Menopause

The Top 3 Answers to the Question “Why Should I Take Hormones?”

Dr. Nathan Goodyear — Fri, 06 Apr 2012 16:59:21 +0000

Dr. Nathan Goodyear, Overseeing Physician at Seasons Wellness Clinic

Recently during a patient’s visit, we were reviewing her most recent OB/GYN appointment. Her physician asked why she was taking hormones. Unable to offer a technical explanation, she simply stated that she felt much better than she did before she began her treatment program.

While the basic question of WHY is a good question by her physician, we actually need to answer three questions.

What are my individual hormone levels?
Are my hormones in appropriate balance?
Is my body metabolizing those hormones in the right way?

The answers to these three questions will answer the one question: “Why should a patient take hormones?”

What are my individual hormone levels?

Contrary to what most think, hormones are not just about individual numbers. Instead, hormones work collectively as a means of communication within the body. I am amazed at the answers I get when I ask postmenopausal women, “Does your body still have or need hormones?”

The answer is a resounding YES, but most people seem to think otherwise. The body must have hormones to survive. For example, those who suffer from Addison’s Disease have a life-threatening deficiency of cortisol (one of the body’s many hormones).

Far too often I hear the comment, “I’ve had a hysterectomy, so I don’t need progesterone.” The truth is having a hysterectomy does not eliminate your body’s use or need for hormones. It just means you are missing your uterus. Hysterectomy or not, millions of cells throughout the body have progesterone receptors and those cells could care less if you’ve had a hysterectomy or what your OB/GYN thinks about progesterone. [Insert laugh here!] These organ systems throughout the body have receptors for progesterone because they need progesterone.

The aforementioned patient’s hormone therapy included progesterone cream and DHEA capsules. Testing results showed her to be deficient in both progesterone and DHEA (read about how we test hormones at Seasons), and thus replacement was needed. In addition to test results, the patient’s clinical symptom history warranted the replacement of these hormones.

So why was DHEA included in her treatment program? Two reasons. The first is that her DHEA levels were low in her testing results. The second reason? This patient had Type II Diabetes and, after some additional testing, was found to have chronic inflammation throughout her body. DHEA has been shown to reduce inflammation, improve insulin function, and reduce obesity, all of which are associated with diabetes. DHEA does this through a complex interaction with the hormones adiponectin and insulin. As insulin levels rise with insulin resistance, adiponectin falls. This hormone imbalance will result in Diabetes for many people.

Additionally, Type II Diabetes has been shown to be the result of chronic inflammation. What does that mean, you ask? Chronic, dysregulated inflammation causes insulin resistance. What is the source of this inflammation, you ask? Fat cells! The obesity epidemic is the root cause of our current healthcare crisis.

Let’s go back to the patient’s hormone therapy. Her test results showed her deficient in progesterone. Because progesterone is a natural anti-inflammatory, it is currently being used in traumatic brain injuries (TBI) to reduce inflammation and improve outcomes. In addition, women with low progesterone tend to have significantly more menstrual cramps, the result of inflammatory signals called prostaglandins. Progesterone therapy has been shown to reduce those prostaglandins and thus reduce menstrual cramps.

Are my hormones in appropriate balance?

Hormones don’t exist in a vacuum, as many seem to think. Hormones exist in a delicate balance. The most well publicized imbalance is that of the estrogens and progesterone. Imbalance of estrogen and progesterone have been linked to many health problems: fatigue, weight gain, headaches, and increased risk of breast cancer to name a few.

I often tell patients that with every cause there is an effect. You can’t give one hormone without affecting many others. The addition of progesterone to the body when it has been chronically low will not only restore progesterone to an appropriate physiologic level, but will also allow estrogen signals to work better. The balance of hormones allows each hormone to work as it was intended. Mind you, we are NOT talking about using synthetic hormones which are simply not what the body is looking for and contain harmful additives. We only treat with bioidentical hormones (bioidentical hormone replacement therapy, also known as BHRT).

Is my body metabolizing my hormones in the right way?

The final key point is looking at how the body processes hormones (metabolism). Hormone metabolism is just as important as the individual hormone levels and the hormone balance.

Let’s use estrogen metabolism, for example. Estrogens (there are actually three different types of estrogen) can be metabolized three ways: 2-hydroxy estrone, 4-hyroxy estrone, and 16-alpha-hydroxy estrone. Some of the risks associated with estrogen come from the body metabolizing estrogen utilizing the 4-hydoxy estrone pathway. This pathway results in many dangerous metabolites (break down products). Think of it as turning down the wrong road as you’re driving somewhere, and you end up in a briar patch!

Think about it. Many women with breast cancer and men with prostate cancer don’t take bioidentical estrogen nor do they take synthetic estrogen. Their problem, as it relates to hormones, comes from endogenous hormone production (the body’s own hormone overproduction or underproduction), hormone metabolization, and the often undiscussed environmental xenoestrogens (from environmental toxin exposure). In lay terms, the body is metabolizing estrogen using the 4-hydoxy estrone pathway resulting in higher risk of cancer.

It has only been in the last 50 to 60 years that major hormonal imbalances in industrialized countries seem to have come to our attention. Before that, people and their hormones seemed to do just fine for thousands of years. We can attribute much of that to diminishing nutritional value in our foods and continually increasing exposure to toxins. Nutrition and toxins both have profound effects on the body, hormones included.

In conclusion, why should a patient take hormones (BHRT)?

The answer is a summary of the three points we’ve looked at here. By determining current hormone levels, restoring balance, and evaluating the body’s metabolic processes, the body can once again function as God intended it. Should a patient be on hormones? Well, only if you need them. But the truth is few of us have perfectly balanced hormones due to nutrition, toxin exposure, and prescription medication side effects.

At Seasons Wellness Clinic, we use state-of-the-art testing that reveals your body’s biochemistry. With our years of advanced training, we can carefully customize a treatment plan to restore your body, offsetting the damage of poor nutrition, toxins, and prescription drugs. Our goal is to eliminate any need for prescription medication! We want you to be HEALTHY!

WELLNESS IS POSSIBLE! You don’t have to settle for a body that is not working as it should. You can make a conscientious choice towards good health and a longer, happier life.

All Estrogens Are Not Created Equal

Dr. Nathan Goodyear — Wed, 13 May 2009 16:20:17 +0000

There is a lot of confusion in the medical and non-medical communities regarding estrogens. Many today think there is only one estrogen. Many today think bioidentical estrogens and synthetic estrogens are identical in structure and function. Many today think estrogen production stops after menopause or after a total hysterectomy. However, this couldn’t be further from the truth.

Dr. Nathan Goodyear

The body never stops producing estrogens. The body, in fact, produces 3 types of estrogens: estradiol, estrone, and estriol. These are the natural estrogens native to the body and the foundation of bioidentical hormone replacement of estrogen.

A woman’s body produces estrogens in various places. Most people knows that ovaries produce estrogens. But did you know that the adrenal glands and fat cells produce estrogens, too? Think about that for a minute. This explains why women of all ages continue produce estrogen. Our adrenal glands don’t disappear at menopause. And fat cells certainly don’t. So how do we know if a woman needs estrogen?

Let’s look more closely at the 3 main estrogens produced in the body.

estradiol
estrone
estriol

Estriol is a good place to start. Estriol is the weakest of all Estrogens. A woman’s placenta produces very large amounts of estriol during pregnancy. However, estriol is not confined to pregnancy. The liver produces small amounts, too. Estriol primarily affects a woman’s hair, nails, skin, and her vaginal lining. Studies also suggest estriol has potential in breast cancer prevention because estriol binds to specific receptors (beta-receptors) in the breast that inhibit breast cell growth. All other estrogens would be expected to increase breast cell growth (which can lead to cancer) through activity with alpha-receptors.

Estrone is the second most potent estrogen. Estrone is predominately produced in fat cells after menopause. Overweight women have high circulating estrone levels. Unfortunately, 63% of American women are overweight or obese, so many women have high estrone levels. Estrone levels rise even more after menopause, and estrone has been implicated in breast tumors in animal studies. (Scientists say this because estrone has a 5:1 affinity for alpha breast receptors, but that’s pretty technical.) Just remember that alpha-receptors increase breast cell growth. You could say estrone encourages breast cell growth, and that can lead to uncontrolled breast cell growth. We call that breast cancer.

Estradiol is the most potent estrogen. Estradiol is produced predominately from the ovaries. This means a woman will have less estriadiol after menopause because her ovaries are producing less. Estradiol is the main stimulus for growth of the lining of the uterus in the first 2 weeks of the monthly cycle, and it helps in triggering ovulation. Like estrone, estradiol has been implicated in breast tumors. It has a 3:1 affinity for alpha-receptors in the breasts, which promote breast cell growth and can lead to cancer.

That’s a lot of information for one blog post, I know. But remember the overall point. Bioidentical hormone therapy is much more than the use of bioidentical estrogen. It is about which estrogens your body needs to maximize efficacy, reduce side effects, and prevent disease.

Bioidentical Hormones: A User’s Guide (health.usnews.com)
Bioidentical Hormones: Safer For Hot Flashes Than HRT? (health.usnews.com)
Marcia Stefanick: Continue Hormone Replacement Therapy? (health.usnews.com)
Should I take hormones or not? (cnn.com)

What Is Seasons?

Elizabeth — Mon, 13 Apr 2009 13:40:51 +0000

At Seasons, our focus is wellness, not just treatment of disease. In this video, Dr. Nathan Goodyear talks about his vision for Seasons and our revolutionary approach to women’s health care.

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Menopause is not a disease

Dr. Nathan Goodyear — Fri, 05 Dec 2008 14:41:03 +0000

“First do no harm.” This is from the Hippocratic Oath that every physician takes prior to graduating from medical school.

“First do no harm.” Here’s what that means for me: First, work with the body to prevent disease.

Often, we see patients after they already have a disease. At that point, we begin treatment and intervention—which typically involves introducing a drug not normally present in the body. This is why drug companies have to do so much testing to measure the effects/side effects of any new drug. When I prescribe treatment and intervention, I’m always weighing the benefits of a drug versus the risks associated with that drug. Medical training does a great job of helping doctors understand how to treat disease.

But PMS, perimenopause, and menopause and all the symptoms that go along with them aren’t the result of a disease. They are the result of hormone imbalances. Having imbalanced hormones is not the same as having a disease—and doctors should not treat a hormone imbalance as if they are treating disease.

Instead of medicating with synthetic drugs, doctors can seek to rebalance the patient’s hormones.

Bio-identical hormones represent the essence of this approach. (Dr. Dixie Mills has some good thoughts about Bio-identical hormones at Women to Women.) There is no rocket science or voodoo behind Bio-identical hormones as some may suggest. In fact, if you look at the scientific literature, the support is all for Bio-identical hormones. The rest of the world is way ahead of the US on this one.

Then why are so many physicians still focused on the disease model, instead of the health and prevention model? I can’t answer that question. But I can treat my patients differently—using methods supported by scientific literature as being more healthy and effective.

Bio-identical hormones merely represent understanding how the body works and working within the body’s framework. It makes a lot of sense. Patients receive hormones that are structurally and functionally identical to those produced in your body.

Hormone imbalance is not a disease. But doctors can treat the imbalance with Bio-identical hormones to give you better health and help prevent future disease.

From the Doctor’s Desk: What’s All The Fuss About Saliva Testing?

Dr. Nathan Goodyear — Thu, 06 Nov 2008 03:37:24 +0000

Dr. Nathan Goodyear

Confused about saliva testing? Don’t worry, your physician may be just as confused.

I don’t mean to suggest that the science of saliva testing is new. In fact, the clinical use of saliva testing of hormones has been validated over the past 25+ years, and it is well documented in journal publications such as Gynecology Endocrinology, Journal of Clinical Endocrinology, and Menopause. I know, you’re probably not going to run out and subscribe to those now, but these journals are important to doctors. They range from hard-core bench research to more clinical research.

So why use saliva testing for hormones? The short answer is accuracy.

This is going to get technical, so stick with me. See, hormones in the blood stream are mostly bound to carrier proteins (95-99%) for transportation to target tissues. In this transportation form, hormones are inactivated and not available for use. Only when the hormone is released inside the cells of the target tissue does it begin to have an effect. Saliva testing allows us to see your hormone levels inside the cells at the tissue level. That is where these free hormones can cause symptoms like hot flashes, irritability, breast tenderness, and dry skin.

You’re probably wondering, “Then why isn’t every doctor checking my hormones with a saliva test?” Or even worse, you may have been told that saliva testing is dangerous or inaccurate. Unfortunately, physicians are slow to apply new evidence into practice. History has shown this before. The medical community knew vitamin C replacement prevented scurvy on long sea journeys for 193 years before action was taken.

Hopefully, we will not wait that long this go around.

Why you should be concerned about estrogen dominance

Dr. Nathan Goodyear — Mon, 27 Oct 2008 12:04:02 +0000

October is breast cancer awareness month!

Last week, in a post about three ways to help prevent breast cancer, I talked a little bit about estrogen dominance. You’re probably wondering what it is and why it matters. I’ll do my best to explain this as thoroughly as I can without getting too technical.

What is it?

Estrogen dominance occurs when you stop ovulating. During the first half of a woman’s cycle, estrogen stimulates growth of her uterine lining. Half way through the cycle, ovulation occurs. At this point progesterone production dominates-which limits further estrogen growth. Without ovulation, progesterone does not balance the estrogen produced in the first half of the cycle. Instead, a woman’s body continues to produce estrogen resulting in estrogen dominance.

When does this occur?

Estrogen dominance can occurs for several reasons. First is when young teenagers start their periods. They often have irregular periods for the first two to three years because of lack of ovulation. Second is during perimenopause (the transition to menopause). During perimenopause, a woman again stops ovulating and stops producing progesterone to balance estrogen. Finally, estrogen dominance occurs in women who have polycystic ovarian syndrome. This syndrome is a collection of hormonal symptoms that have at their root cause, lack of ovulation and thus estrogen dominance.

Why is this important?

Estrogen dominance during the perimenopause puts women at a greater risk for weight gain and breast cancer. High levels of estrogen can lead to constant stimulation for growth. This means all estrogen is encouraging all cells to grow-normal cells and abnormal cancerous cells in the breast.

What can we do about estrogen dominance?

During perimenopause, the simple addition of bio-identical progesterone can balance the estrogen. This corrects estrogen dominance, helps women lose weight, and reduces the incidence of breast cancer.

(Special thanks to MesserWoland for providing copyright permission of the pink ribbon through Wikipedia.)

Who needs Hormones?

Dr. Nathan Goodyear — Mon, 23 Jun 2008 12:00:19 +0000

Who needs hormones? The answer is: not everyone. Some need hormones, and some don’t. Additionally, a need for hormone therapy is not unique to women. Men can benefit from hormone therapy as well.

If you have symptoms of hormone imbalances, then hormone replacement therapy may be right for you. However, a “one size fits all approach” is never appropriate. Each individual’s hormone needs are as unique as his or her thumb print.

Hormone testing will help determine the specific hormone imbalances and direct treatment.

Menopause and Hormones 101

Dr. Nathan Goodyear — Mon, 26 May 2008 12:00:59 +0000

If you’re experiencing symptoms of menopause, you are probably wondering about hormones. Everyone is talking about hormones these days. So here’s a quick crash course in the ones that affect your body.

Let’s start with the three estrogens.

Estradiol: Estradiol is produced primarily in the ovaries and is the most potent of the 3 estrogens. This estrogen will decrease significantly during menopause or after removal of ovaries. This estrogen is responsible for the symptoms that most associate with menopause.
Estrone: Estrone is produced primarily from fat tissue and muscles. This estrogen is the second most potent. It will be elevated in women who are overweight and has been linked to the accelerated growth of breast cancer among other things. In fact, this hormone is best left out of hormone replacement regimens.
Estriol: Estriol is the weakest of the 3 estrogens. It is dominate during pregnancy and has been linked to breast cancer protection.

There are several other hormones that you’ll hear about.

Progesterone: Progesterone is the counterpart to estrogen. Where estrogen promotes growth, progesterone promotes maturation or stabilization. Progesterone is dominant in the latter half of the menstrual cycle. Progesterone has been shown to have PMS, anti-depressant and anti-anxiety benefits. Simply put, progesterone balances estrogen.
Testosterone: Yes! Women have testosterone too. It is produced primarily from the ovaries before menopause. After menopause, it is primarily produced by the adrenal glands. Testosterone has well known libido benefits.
T4: This thyroid hormone is produced in the thyroid gland and released for circulation. It can be replaced with such medicines as synthroid and levothryoxine. Low T4 can be a result of iodine deficient diets.
T3: This is the most potent of the two thyroid hormones and is produced from the conversion of T4 in the liver and kidneys. T3 is present in the medicines armour thyroid and cytomel.
Cortisol: Produced in the adrenal glands, cortisol is released in large response to stress. High cortisol levels promote slow metabolism and fat storage. Prolonged stress and high cortisol levels, can result in adrenal exhaustion and low cortisol levels. Low cortisol levels cause fatigue and other symptoms that can mimic depression.

ZRT Laboratory has an interactive graphic that is very helpful in giving you an overview of most hormones your body produces.

What symptoms indicate hormone imbalance?

Dr. Nathan Goodyear — Thu, 15 May 2008 12:00:26 +0000

The symptoms of low estrogen include…

hot flashes
night sweats
vaginal dryness
urinary frequency
depressed feeling
sleeping difficulty
no interest in sex
no periods

The symptoms of low testosterone include…

fatigue
lack of drive
lack of initiative
less assertive
decline in sense of well being
general depressed moods
irritable
lack of self-confidence
difficulty in setting goals
decline in mental sharpness
no stamina/endurance
loss of muscle mass, strength, or tone
increased body fat around waist
elevated cholesterol
decreased libido
decreased sexual ability
sleep apnea

The symptoms of low thyroid include…

general fatigue or afternoon fatigue
elevated cholesterol
difficulty losing weight
cold hands and feet
sensitivity to cold
difficulty thinking clearly
difficulty concentrating
poor short term memory
depressed moods
hair loss
constipation
dry, itchy skin
fluid retention
recurrent headaches
restless sleep
tingling or numbness in hands and feet
decreased sweating
infertility or recurrent miscarriages
recurrent infections
muscles aches
joint pain
thinning of eyebrows and eyelashes
enlargement of tongue and teeth indentations
decreased body hair
hoarse voice
slow heart rate
low blood pressure
low body temperature
sleep apnea

The symptoms of high estrogen/low progesterone include…

premenstrual breast tenderness
premenstrual mood swings
premenstrual fluid retention and/or weight gain
migraine headaches
severe menstrual cramps
heavy periods with clotting
irregular menstrual cycles
uterine fibroids
fibrocystic breasts
endometriosis
history of infertility
history of miscarriages
joint pain
muscle pain
decreased libido
anxiety and/or panic attacks

Did you say saliva testing?

Dr. Nathan Goodyear — Tue, 13 May 2008 12:00:46 +0000

We use saliva testing to measure hormone levels at our Seasons offices. Naturally, the phrase “saliva testing” raises a few questions.

How do we collect your saliva? We don’t. You do it at home with saliva collecting kits. It isn’t a difficult process, but you do need to follow the directions carefully:

30 minutes before collection, please do no eat or drink anything except water.
Rinse mouth thouroughly with cold water 3-4 minutes prior to saliva collection.
Following the collection schedule below, collect saliva in each of the 4 blue cap tubes to fill three quarters or more, excluding any foam. Take your time. Recap tubes and place into the zip lock bag.

Morning/Fasting 7 – 8 AM
Noon 11 – 1 PM
Afternoon 4 – 5 PM
Midnight 11 – 12 PM

Each saliva collection kit includes some “pour off tubes.” Here’s how they work.

Pour off enough saliva from the noon and/or afternoon tubes to fill 1/4 of the tubes labeled FL and FT3. Cap tubes tightly. Follow the mailing instructions. If you pour more, do not pour saliva back into the blue cap tubes.

Finally, on the day you are collecting saliva, there are a few things you want to avoid.

Do Not Eat chocolate, onions, garlic, cabbage, cauliflower/broccoli.
Do Not Drink coffee, tea, or caffeinated drinks (like coke, guarana, etc.)
Do Not Use sublingual hormones or troches as of the night before collection.
Avoid antacids, bismuth medications or mouth washes.
Stop your current hormone therapy 72 hours prior to the saliva collection.