Written by Dr Meghan van Drimmelen
I believe that supporting women throughout mid-life starts with education and empowerment. Helping my patients understand how hormones effect their health and wellbeing, as well as taking the time to go over all hormone testing and treatment options is a HUGE part of my practice.
Here are some common questions that come up in my practice around menopause:
What's the difference between peri-menopause, menopause and post-menopause?
Peri-menopause is a period in a women’s life where ovarian function and sex hormone production slowly starts to decline. This natural transition can start as early as your late 30's or early 40's, and can be associated with changes in length and flow of your menstrual cycle, mood swings, hot flashes, night sweats, anxiety, depression, low energy, foggy thinking, insomnia, loss of skin tone, vaginal dryness, and loss of sex drive.
Menopause occurs when a women has full cessation of her menstrual period for 12 consecutive months. The average age of menopause is 51.
Once a woman has gone through menopause, she is considered to be post-menopausal. During the post-menopausal period many of the bothersome symptoms listed above start to ease for many women. However, each individual differs, and for some, these symptoms can persist for a number of years significantly impacting quality of life.
What kind of therapies are used by Naturopaths to support women during peri- menopause and post- menopause?
When re-balancing hormones throughout mid-life, Naturopathic Doctors commonly use Bio-identical Hormone Therapy, Diet & Lifestyle recommendations, Herbal Medicines, Vitamin & Mineral Therapies, and/or Acupuncture. Treatment plans are tailored to the individual, and are based on current symptoms, medical history, and hormone lab results.
What's the difference between bioidentical hormones and synthetic hormones?
The molecular structures of bioidentical hormones are identical to the hormones that are made in the body, while synthetic hormones are not. Good examples of synthetic hormones are Premarin, Provera, and the birth control pill. Bioidentical hormones are typically derived from yam or soy, and can come in the form of pills, patches, creams and gels. Examples of bioidentical hormones are Prometrium (micronized progesterone), Estradot (estrodiol patch), Vagifem (vaginal estradiol suppository), compounded Bi-est cream (a combination of estradiol and estriol), and compounded progesterone cream.
Bioidentical hormones are recommended over their synthetic counterparts as numerous studies suggest that they have a safer side effect profile.
Links to studies here:
The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?
Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk.
Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: results from the E3N cohort study.
Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort.
Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study
Estriol Prevention of Mammary Carcinoma Induced by 7,12-Dimethylbenzanthracene and Procarbazine
Effects of progestogens on the postmenopausal breast.
Could transdermal estradiol + progesterone be a safer postmenopausal HRT? A review.
The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned?
Progesterone in Peri- and Postmenopause: A Review
What type of hormone testing do Naturopathic Doctors typically recommend?
Naturopaths recommend a variety of hormone tests - including blood, urine, and salivary hormone testing. The type of test recommended depends on the hormone being tested, the individual's symptoms, medical history, and whether they are peri-menopausal or post-menopausal. Here are some examples of when and why I order certain tests:
I recommend blood testing for thyroid hormones - this method of thyroid testing is the gold standard.
I often recommend salivary hormone testing for adrenal hormones (cortisol and DHEA), as well as sex hormones in the peri-menopausal period. Salivary hormone testing measures the amount of hormone that is available to target tissue (ie. the bioavailable hormones), which better relates to symptoms of excess or deficiency.
In more complex cases where there is a family or personal history of breast cancer, or symptoms of estrogen dominance (ie. endometriosis, uterine fibroids, fibrocystic breasts) I will recommend urine hormone testing for sex and adrenal hormones. Urine hormone testing provides a more complete picture of your overall hormone balance, including how you metabolize your hormones.
In post-menopausal women, I will often order sex hormones through the blood to get a basic idea of where your hormones are at. At this point hormones are lower, and we often do not need a more comprehensive panel.
The hormones that we typically test for include progesterone, estrogen, testosterone, thyroid hormone (TSH, fT3, fT4, TPO), cortisol, and DHEA.
If you would like to learn more about your hormones fill our my Hormone Questionnaire! This is a great tool to see whether or not your hormones are to blame for your bothersome symptoms.
To book an appointment with a Naturopath at Juniper Family Health please contact the clinic at 778-265-8340 or firstname.lastname@example.org or click here to book online.