As a woman and a physician it became clear early on in my studies that there was very little information out there on treating conditions specific to women. Most research lumped men and women into the same category and, subsequently, the same method of treatment. I knew many women that had been going to the same doctor their entire life and, although their health was adequately cared for, there was always a feeling that their issues were unique and misunderstood. This became even more apparent as I began training specifically dedicated to Women’s Health. I felt that there was a silent population that was misunderstood, misinformed and misguided. Having the same issues myself I wanted to dedicate my career to helping women make important health care decisions about menopause, osteoporosis, heart disease and general health as it applied specifically to women.

One example is Hormone Replacement Therapy (HRT).  During my studies, I was introduced to bio-identical hormones.  Using a hormonal preparation identical to the hormones a women’s body naturally produces made sense to me.  A short time later, the Post-menopausal Estrogen-Progestin Intervention (PEPI) demonstrated a clear advantage in using natural Progesterone over the synthetic Provera. The Progesterone was better tolerated and had benefits with respect to cholesterol.  It was clearly the hormone preparation of choice.

A fad in the nineties put forth by Dr. John R. Lee was the use of progesterone cream for symptoms related to menses or menopause.  Although I agree with the use of natural progesterone, I  did not see the benefits Dr. Lee claimed that progesterone cream offered over other combinations.  After all, haven’t we all noticed the increase in bloating, moodiness, fatigue and cravings  the week before menstruation?  That’s when progesterone is at its peak. Estradiol (our primary estrogen) and testosterone also play a key role in how we feel as well.

Further challenges came in 2002  when the Women’s Health Initiative trial was halted. The first arm of the study  to hit the news associated Prempro (daily dose of a Premarin/Provera combination) with an increase in  heart attacks and stroke early usage and an increase in breast cancer after five years.  Many women panicked and discontinued HRT  but soon found themselves experiencing hot flashes. Unfortunately, the media often emphasizes negative hype and fails to completely inform the public. Many women  still  didn’t know the second arm of the study demonstrated lower risk of breast cancer. In addition, both arms consisted primarily of older women who had not been on  HRT for the past 10-15 years. That simply never happens in clinical practice.  Women either decide at the time of menopause to take hormones as a way to improve quality of life, or decide hormones are not for them.

Also in vogue in the late nineties was saliva testing as a way to individualize hormone therapy. We completely advocate taking a customized approach and saliva testing can be helpful in testing adrenal function.  Recent studies, however, have shown saliva testing is still not as reliable as serum. Knowing  that,  we use serum levels to determine the right direction in achieving  balance. We then work  to improve energy, sexual interest, and mood while trying to decrease unwanted symptoms such as hot flashes, weight gain, irritability, acne, bloating and breast tenderness.  This often involves a properly dosed amount of natural testosterone. We also need to protect the woman who still has her uterus from uterine cancer, typically caused from excess estrogen exposure. Only oral progesterone has been proven effective for balancing oral estrogen.

So, there is much to understand regarding Hormonal Replacement Therapy  and it is important to decide together what is right for each woman.  Now, thanks to the Women’s Health movement, we have more information than ever before to make the right decision for her.