Discovering Hormone Replacement for Women

By Dr. Greg Brannon

Let me put my OB/GYN hat on and talk first to women, specifically about changes in their levels of testosterone, estrogen, and progesterone.

Changes in Testosterone

Women need testosterone. It’s not just a man’s hormone! In the past, testosterone levels in an average twenty-year-old woman might have been between 70-90 ng/dL. What I am seeing in today’s women are ranges much lower: between 8-30 ng/dl. By the time those women reach the age of fifty, their levels will drop even more significantly—to between 2-10 ng/dL. On average, women are losing 3% of their testosterone each year. By menopause, women have lost 70-90% of their total testosterone.

At Optimal Bio, we restore a woman’s testosterone level to somewhere between 90-200 ng/dl. Female T-levels are not considered high unless they are over 200. I routinely find the most advantageous T-level for each one of my female patients. The higher a woman’s T-level, the greater her libido and energy level, however, we don’t want to go so high that she starts to see side effects, such as clitoromegaly, an enlargement of the clitoris. It is a careful balancing act with each female patient. In general, the optimal level for a woman’s testosterone is 10% of a man’s optimal level.

In 1996, a clinical study was conducted by treating Alzheimer’s patients with testosterone. Although there is no cure for Alzheimer’s, the researchers proved that the disease could be slowed. The patients who participated in the study experienced some regression and some incredibly positive outcomes. Other similar studies confirm the therapeutic effects of testosterone on the human brain.

Women benefit from healthy levels of testosterone!

The human body is like a finely tuned engine. It converts cholesterol into hormones necessary for optimal functioning. The diagram below illustrates the conversion of cholesterol to progesterone, testosterone, and estrogen.

Changes in Estrogen

Estrogen is produced by a maturing ovum during the menstrual cycle. When the estrogen in a woman’s body reaches 200pg/ml, that triggers her anterior pituitary to release luteinizing hormone, which causes ovulation. Menstruating women produce estrogen from the time their periods start as teenagers, until menopause. Levels can fluctuate from 50-400 pg/ml throughout their cycles.

At menopause, a woman’s body stops producing estrogen, and over time, her levels of estrogen drop to zero.

The lack of estrogen may lead to a variety of symptoms, including:

• PMS, irregular menstrual cycles, heavy bleeding
• weight gain
• decreased sex drive, mood swings, and depression
• thyroid dysfunction
• fibroids, endometriosis
• gallbladder problems
• breast tenderness and fibrocystic breasts

Changes in Progesterone

Progesterone, testosterone, and estradiol are all made in the ovaries. The corpus luteum in the ovaries is the primary site of progesterone production in women, although progesterone is also produced in smaller quantities by the adrenal glands. If a woman becomes pregnant, her progesterone levels will continue to rise. Progesterone prepares the lining of the uterus to accept a fertilized egg. During a woman’s monthly cycle, progesterone peaks after ovulation, a time when most women report feeling their best.

Levels of progesterone begin to decline, commonly by age thirty-five. At this time, women may notice changes in their periods, such as prolonged bleeding and shorter times between menstrual cycles. They may also experience mood swings and have more trouble sleeping. It is at this point that many women complain to their doctors about anxiety, sleeping problems, and depression. That is why progesterone can be thought of as the anti-stress hormone.

In addition to receiving estrogen and testosterone in the form of bioidentical pellets, women who still have an intact uterus would also be prescribed progesterone at our clinic. Studies have shown that estrogen therapy without progesterone therapy can increase the chances of endometrial cancer; therefore, the addition of natural progesterone eliminates this concern for women who still have an intact uterus. For women who have had a hysterectomy, the progesterone would be optional.

However, taking progesterone has many irrefutable benefits, even if a woman no longer has a uterus, including blood sugar regulation, the promotion of normal sleep patterns, and the stimulation of new bone cells. Accordingly, women who have undergone a hysterectomy may choose to take progesterone anyway.

Women have the option of taking natural progesterone using one of the following delivery methods:

• It can be absorbed through the skin using a cream rubbed on at night.
• It can be prescribed in the form of a troche, which is a small medicated lozenge designed to dissolve on the tongue.
• It can be taken orally in the evening as a pill called Prometrium®, a patented form of bioidentical progesterone that comes in 100 and 200 mg doses.

All three forms of progesterone are made from plant sources like yams, olive oil, and soy, and will protect the uterus from cancer. They are all useful as a treatment for the symptoms of perimenopause and menopause.

A Normal Menstrual Cycle

Remember this equation:

T = 10 x E

In other words, T is the testosterone level, and E is the estrogen level. Your testosterone level should, ideally, be ten times your estrogen level. Depending on the time during a woman’s menstrual cycle, a woman’s testosterone level can be up to 100x greater than her estrogen level. However, a normal woman’s menstrual cycle affects her hormone levels, and so her levels fluctuate up and down more than men’s throughout any given month.

Women, the crucial aspects to note here are:

• The menstrual cycle occurs in two phases. The beginning of the cycle is the follicular phase, and the final part of the cycle is the luteal stage. Midway through the cycle, between days twelve and sixteen, is when ovulation occurs.
• The levels of estrogen and progesterone fluctuate consistently throughout every menstrual cycle.
• When you know how a typical menstrual cycle works, you can understand the symptoms of premenstrual syndrome (PMS), perimenopause, and menopause. These symptoms are often the result of hormone imbalance.
• An irregular menstrual cycle is a good indicator of hormonal imbalance.

Symptoms of Menopause

When a woman’s hormone levels drop, she will begin to enter menopause, where common symptoms include:

• Menstrual periods that occur less frequently and eventually cease
• Heart pounding or racing
• Hot flashes (usually worst during the first one or two years)
• Night sweats
• Skin flushing
• Sleeping problems
• Sexual response changes or decreased sexual interest
• Forgetfulness
• Headaches
• Mood swings including irritability and anxiety
• Urine leakage
• Vaginal dryness and painful sexual intercourse
• Vaginal infections
• Joint aches and pains

Can you relate to some or all of these?

Lab tests can be performed to look for changes in hormone levels. Test results can help determine if you are close to or have already gone through menopause. Lab testing may include determining levels of estradiol, FSH, luteinizing hormone (LH), testosterone, free testosterone, thyroid panel with thyroid stimulating hormone, T3 uptake, total T4 , free T4 index, progesterone, complete blood count, and vitamin D.

BHRT is the Cure for Menopause

Women, the most important thing to remember is you don’t need to fear the change of life. If you are approaching perimenopause, are in the throes of menopause, or menopause has already come and gone, BHRT can alleviate any symptoms you may have. BHRT prevents you from going through dramatic symptoms associated with the change for as long as you are on it. If your ovaries are intact and functional, you will most likely continue to ovulate, which is healthy for your body and will preserve your health and your looks for a much longer time.

One patient asked me, “So, will I be able to get pregnant when I’m seventy-five?” The answer to that is no. At a certain point, your ovaries will stop releasing eggs. You will undoubtedly continue to ovulate for longer than you might have without the bioidenticals, but even on hormone replacement therapy, your ovaries will cease to be functional as you reach your mature years.

After starting bioidenticals, if a woman’s uterus is still intact but she has gone through menopause, she will be given both estrogen and progesterone to avoid resuming her menstrual cycle, which is undesirable to most women. Most of the time, women will not have a full-on period, but they may have some breakthrough bleeding. The relief of other post-menopausal symptoms is so great that usually the minimal amount of bleeding from time to time is simply a minor inconvenience.

If breakthrough bleeding occurs, we ask our female patients to see their regular gynecologists to have it evaluated. Sometimes bleeding can be an indication of another problem unrelated to hormone therapy, such as polyps, fibroids, or endometrial cancer. In most cases, our patients’ workups will prove benign. The spotting is usually merely the result of restoring the sex hormones to youthful levels. (Imagine your uterus is asleep, and I’m going to wake it up!) However, if spotting does occur, a thorough evaluation by a gynecologist is a precautionary measure to protect you from overlooking a more significant issue.

Ladies, I will be happy to talk with you about your situation during our one-on-one consultation and answer any questions you may have regarding BHRT and how it can prevent the symptoms of menopause forever.

Who Can Benefit from BHRT?

First, women suffering symptoms of perimenopause or menopause (listed above) will experience immediate and life-long relief. BHRT is also particularly restorative for women who have had a full or partial hysterectomy.

Additionally, bioidenticals can treat and improve a broad spectrum of other problems, including Chronic Fatigue Syndrome, Post Traumatic Stress Disorder, depression, autoimmune diseases, hypothyroidism, metabolic syndrome, weight gain, low energy, insomnia, osteoporosis, low libido, adrenal fatigue, PMS, memory loss, and migraines.